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Objective:To analyze the predictive factors of postpartum SUI, and establish and validate nomogram model.Methods:A total of 272 patient from Affiliated Jinhua Hospital, Zhejiang University School of Medicine were reviewed, and the general clinical data and ultrasound parameters were analyzed. The median age (range) was 32 (28-38) years. Vaginal delivery was recorded in 191(70.0%), while cesarean section was performed in 81(30.0%) cases. The average body mass index (BMI) was (23.0±2.9) kg/m 2. The median bladder neck mobility was 2.5cm and rate of bladder neck funnel was 25%. Patients were divided into two groups: Group SUI(n=98) and Group NSUI (without SUI, n=174). The independent predicting SUI were analyzed by univariate and multivariate logistic regression analysis. Two predictive models were constructed with the important general clinical data and ultrasound parameters, then receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive power of two models. At last, the nomogram was established for the better model. Results:The results of multivariate analysis showed that age( OR=1.08, P=0.011), delivery method( OR=9.26, P<0.01), body mass index( OR=1.15, P=0.023), bladder neck distance ( OR=1.73, P=0.047) and bladder neck funneling( OR=18.44, P<0.01) were independent predictors for SUI. Two predictive models were used with independent predictors of SUI. The area under the receiver operating characteristic(ROC)curve of validation group was 0.88. The area under the ROC curve of general clinic factors was 0.77. The difference between the two model and other indicators was statistically significant( P<0.001). The nomogram model was well calibrated, with the mean absolute error of 1.9%. Conclusions:Age, delivery method, BMI, bladder neck mobility and bladder neck funneling were independent predictors for SUI. The nomogram model for predicting SUI has a good statistical significance.
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Objective To investigate the diagnostic value of ultrasound ADNEX model in ovarian tumors.Methods 226 patients with pathological-confirmed ovarian tumor from Jun.2014 to Jun.2018 were selected,and the preoperative ultrasound imaging,clinical and pathological data were analyzed.The ultrasound imaging was recorded,and ovarian tumor was diagnosed through ADNEX model.The diagnostic efficiency of ADNEX model for ovarian benign and malignant tumors was analyzed with pathological findings as the gold standard.Results The differences of onset age,CA125 level,tumor solid components maximum diameter and ratio,＞10 locules and ascites were all statistically significant between each ovarian tumor group (P＜0.05).The overall accuracy rate of ADNEX model in diagnosing different ovarian tumors was 83.2％,which has a good consistency with histopathological findings (Kappa=0.782,P＜0.05).The sensitivity and specificity of the prediction model in predicting benign,borderline,stage Ⅰ,stage Ⅱ-ⅣV and metastatic ovarian tumor were respectively 85.5％ and 95.7％,69.2％ and 96.0％,81.6％ and 93.8％,89.1％ and 94.4％,80.0％ and 98.5％.Conclusion Ultrasound ADNEX model is helpful in differential diagnosis of benign and malignant ovarian tumor,and it has important significance for clinical treatment and prognosis evaluation.
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Objective@#To investigate the preoperative clinical criteria for nerve-sparing radical prostatectomy.@*Methods@#A retrospective analysis of 79 patients undergoing radical prostatectomy with complete clinical and pathological data in Jinhua Hospital of Zhejiang University from January 2012 to December 2016 was performed. The distance between the edge of the prostate tumor and the neurovascular bundle (NVB) was measured. When the distance between the edge of the tumor and the ipsilateral NVB was >2 mm, NVB retention surgery can be performed; when it was ≤2 mm, NVB retention surgery cannot be performed. The influencing factors of the distance between the tumor edge and NVB were analyzed by χ 2 test and logistic regression analysis.@*Results@#Univariate analysis showed that side-specific positive biopsy core ≥1/3, side-specific maximum tumor length in biopsy core ≥5 mm, side-specific tumor involvement rate in biopsy core ≥1/2 and extraprostatic cancer extension by preoperative magnetic resonance imaging (MRI) examination were associated with the distance between the tumor edge and NVB (all P < 0.01). Multivariate analysis showed that extraprostatic cancer extension by preoperative MRI examination (OR = 3.66, P = 0.006) and side-specific positive biopsy core ≥1/3 (OR = 3.39, P = 0.008) were the independent influence factors.@*Conclusion@#The clinical criteria for a nerve-sparing radical prostatectomy are side-specific positive biopsy core <1/3 and no extraprostatic extension by preoperative MRI examination.
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Objective To explore the application and early efficacy of modified Veil nerve-sparing technique during laparoscopic radical prostatectomy(LRP).Methods Fifty-seven modified Veil nerve-sparing during LRP procedures were performed in patients with clinically localized prostate cancer between 2012 and 2016 by the same surgeon.Preoperative PSA level was 10.9 μg/ml,and Gleason score was 6.06(5-8).TNM clinical stage showed cT1 in 39 cases and cT2in 18 cases.All patients underwent transrectal ultrasonography before operation. Prostate volume was 40.2 (26- 99) ml. ECT bone scan excluded bone metastasis.MRI or CT examination showed no obvious prostate invasion and lymph node metastasis. The key technology was anatomical separation of detrusor apron, dorsal vascular complex (DVC) and the level between the prostate capsule, and a complete reservation was accomplished. Measurements: the rates and location of positive surgical margins (PSM) and tumor biochemical recurrence rate as well as functional outcomes were presented.Questionnaires were used to assess urine function and IIEF-5 score was used to estimate sexual function.Results Fifty-seven cases were followed up,and the average follow-up of 27.3(6-65)months.Five cases showed biochemical recurrence after 23 months.Five patients had a PSM(2 patients in apical margins,1 patient in left side,1 patient in right side and 1 patient in the bottom).At catheter removal,49 of 57 patients(86%)were dry(0 pads),and 8 of 57 patients(14%)needed one security pad.After 3 months and 6 months,42%(24 of 57 patients)and 60%(34 of 57 patients)presented an International Index of Erectile Function score>15(with or without phospho-diesterasetype-5inhibitors). Conclusions The modified Veil nerve-sparing technique during LRP can retain the fascia around the prostate more completely and restore postoperative urine and erectile function early.For selective cases, it will not increase the positive rate of surgical margins and biochemical recurrence rate.
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Objective To investigate the correlation between the blood flow characteristics of contrastenhanced ultrasound (CEUS) and malignancy of patients with ovarian tumor.Methods 60 cases with ovarian tumors treated by surgery and confirmed by pathology were selected,including 28 cases of ovarian cancer and 32 cases of benign ovarian tumor.The time of arrival (AT),peak time (TTP) and intensity of enhancement (EI) were determined by CEUS,and microvessel density (MVD) of tumor tissue was detected by immunohistochemistry.The correlation of the above parameters with MVD and tumor staging was analyzed.Results AT,TTP of the malignant tumor group (10.8±2.1,25.3±10.5) was significantly lower than those of the benign tumor group (15.4±2.7,59.4±11.2).EI of the malignant tumor group (28.6±2.9) was significantly higher than that of the benign tumor group (14.9±2.6),with statistical significance (P＜0.05).MVD of the malignant tumor group (62.8± 13.6) was significantly higher than that of the benign tumor group (21.5±11.4),with significant difference (P＜0.05).AT and TTP were negatively correlated with MVD and FIGO staging (r=-0.562,r=-0.504,r=-0.636,r=-0.623),while EI was positively correlated with MVD and FIGO staging (r=0.839 and r=0.785),with statistical difference (P＜0.05).Conclusions Blood flow characteristics of CEUS are closely related to the malignancy of ovarian tumors.CEUS can accurately evaluate angiogenesis,blood perfusion and malignancy of ovarian tumors.
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Objective To study the value of virtual touch tissue imaging quantification (VTIQ) and real-time elastography technology in the differential diagnosis of benign and malignant Thyroid Imaging Reporting and Data System (TI-RADS) 4 thyroid nodules. Methods The real-time elastography imaging and touch tissue imaging quantitative (VTIQ) image features of 110 patients (117 nodules) with TI-RADS 4 thyroid nodules were retrospectively analyzed. The real-time elastic technology was used to measure strain ratio (SR) of nodules. VTIQ technique was used to measure the shear wave velocity (SWV) of nodules. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the two methods alone and in combination were calculated using postoperative pathology as the gold standard. Then, the ROC curve was drawn, and the area under the curve (AUC) and the optimal cut-off value were obtained. Results There were 43 benign nodules and 74 malignant nodules in 117 thyroid nodules. The specificity, accuracy, positive predictive value, negative predictive value, the area under the ROC curve of the two technologies alone and in combination were 80.3% vs 86.7% vs 83.7%,72.5% vs 82.3% vs 84.2%,76.1% vs 84.6% vs 87.5%,73.3% vs 83.4% vs 84.5%,79.7% vs 85.5% vs 88.7%,0.786 vs 0.869 vs 0.881.According to the ROC curve, the optimal cut-off value of SR was 3.3 and the optimal cut-off value of VTIQ was 3.03 m/s. The Z values and P values of the two methods alone and in combination were (Z=1.95, 1.83, 1.03, all P>0.05), respectively. There was no difference statistically among the three methods. Conclusion The two techniques alone or in combination are valuable in the differential diagnosis of TI-RADS 4 thyroid nodules with similar diagnostic value in the three methods.
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Objective To describe a novel pubovesical complex preserving technique for laparoscopic radical prostatectomy and to evaluate its postoperative outcomes.Methods From January 2011 to May 2017,168 patients who underwent laparoscopic radical prostatectomy were enrolled and analyzed retrospectively.Their mean age were 62.8 (46-74) years,preoperative PSA 11.3ng/ml,Gleason score 6.7,preoperative prostate volume 46.5 ml.They all got preoperative potency (IIEF-5 score ≥ 15 score).TNM clinical stage:cT1 123 cases,45 cases cT2.There were 59 patients with pubovesical complex preserving technique for laparoscopic radical prostatectomy (group A):without pelvic fascia cut and deep vein complex suture.The preservation of the periprostatic anatomy was kept by preserving the pubovesical complex,including detrusor apron with pubovesical ligaments,DVC and NVB.There were 46 patients with conventional intrafascial laparoscopic radical prostatectomy (group B) and 63 patients with interfascial laparoscopic radical prostatectomy(group C).No differences were found between the three groups in terms of preoperative age,clinical staging,prostate-specific antigen (PSA) values,Gleason score at biopsy and preoperative good potency (IIEF-5 score)(P ＞0.05).Continence was defined as zero to one security pad per day.The three groups were compared for perioperative variables,PSM (positive surgical margin,PSM)rate,postoperative urinary continence functional and potency (IIEF-5 score).Biochemical recurrence-free survival was by Kaplan-Meier and log-rank.Results No differences were found in the three groups in terms of operative times,blood loss,catheterization time and postoperative stay and histologic status (PSM was similar to that of the groups (8.5％ in group A,13.0％ in group B vs.11.1％ in group C).Urinary incontinence:group A,the continence rate was 71％,82％,92％ and 100％ at 1,3 and 6 months after catheter removal,respectively;group B,the continence rate was 63％,80％,89％ and 96％ respectively;group C,it was 24％,54％,79％ and 86％ respectively.The group A showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month after catheter remove (x2 =27.47,P ＜ 0.001;x2 =15.20,P ＜ 0.01).The group B showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month,(x2 =17.00,P ＜ 0.01;x2 =8.20,P ＜ 0.05).No differences were found between the A and B groups at immediately after catheter removal and 1 month,(P ＞ 0.05).Regarding sexual function,at the postoperative 1,3,6 months,median IIEF-score was 10,11,16 in the group A,respectively,8,9,13 in the group B respectively,and 7,8,12 in the group C respectively.No differences were found in the three groups in potency (IIEF-5 score).Baseline IIEF-score was reached by 53％,35％ and 21％ at postoperative 6 months.There were significant differences between the A and the C groups.(x2 =13.45,P ＜0.01).There were no significant differences between the A and the B groups.(x2 =3.30,P ＞ 0.05).Follow-up was 31.6 (6-69) months.Biochemical recurrence-free survival at 3 years was 79.3％,76.3％ and 76.4％ by A,B and C group,respectively.Conclusions The pubovesical complex preserving technique for laparoscopic radical prostatectomy provides early recovery from incontinence,faster recovery of sexual function preoperative levels.
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Objective Malrotation of intestine with midgut volvulus is a special disease in newbo-rns.It is important of early diagnosis to avoid the risk of intestinal infarct and necrosis.We intended to ex-plore the value of early ultrasonographic diagnosis in malrotation of intestine with midgut volvulus,comparing with upper gastrointestinal imaging.Methods Ultrasonographic features and upper gastrointestinal imaging of 48surgically confirmed malrotation of intestine with midgut volvulus between January 2011and December 2014were retrospectively analyzed.Results All patients were comfirmed by operaion.The rotational degree of midgut volvulus were 90to 720°.In 43of 48patients (89.58%)of malrotation of intestine with midgut volvulus were diagnosed by ultrasonography.The typical ultrasonographic features were called “whirlpool sign”,which was the superior mesenteric vein and the mesentery around the superior mesenteric artery.In 35 of 48(72.92%)patients with malrotation were confirmed by the upper gastrointestinal imaging.The typical sign of the upper gastrointestinal imaging was the helical form of the distal duodenum and proximal jejunum located at middle abdomen.Compared with upper gastrointestinal radiographic examination,ultrasonographic examination had more sensitivity in diagnosis of malrotation of intestine with midgut volvulus (P﹤0.05). Conclusion Ultrasonographic examination have more sensitivity in diagnosis.Noninvasiveness,absence of X-rays,and low costs could make ultrasonographic examination a useful screening test in patients with sus-pected malrotation of intestine with midgut volvulus.“Whirlpool sign”could be considered a specific ultra-sonographic sign in diagnosis of midgut volvulus,which could provide reference for the clinical treatment of malrotation of intestine with midgut volvulus.
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Objective To explore the value of transperineal prostate biopsy guided by contrast-enhanced ultrasound(CEUS)and MR diffusion weighted imaging (DWI).Methods 128 patients with suspected prostate cancer were analyzed.Both MR diffusion weighted imaging(MRDWI)and contrast-enhanced ultrasound(CEUS) were applied before prostate tissue was biopsied .The suspected lesion was confirmed by specialists of MRI , Ul-trasound and Urological together .The regular six normal sites addition to suspected lesion were biopsied .Biopsy specimens were sent to pathological examination separately with defined puncture site .The sensitivity, specificity and accuracy of MRDWI , CEUS alone and the combination of two methods were analyzed .Results Of the 858 prostatic specimens from 128 patients , 278 specimens were positive , with 172 specimens found by MRDWI and 114 specimens found by CEUS .As for 278 positive specimens , 137 specimens were diagnosed by MRDWI cor-rectly rather than CEUS , and 79 specimens were diagnosed by CEUS correctly rather than MRDWI , 35 specimens were diagnosed by either MRDWI or CEUS and 27 specimens were diagnosed by neither MRDWI nor CEUS .The sensitivity,specificity,accuracy of biopsy guided by MRDWI , CEUS and both of them in diagnosis of prostate cancer were 61.87%,85.00%,77.51%;41.01%,93.97%,76.81% and 90.29%,80.52%,83.68%,respec-tively.The sensitivity and accuracy of biopsy guided by both MRDWI and CEUS were higher than MRDWI or CEUS alone, with statistically significant difference(P<0.05).Conclusions Suspicious lesions may be found more frequently by MRDWI than CEUS , however two methods can complement each other .Sensitivity and accura-cy of biopsy can be improved by the combination of MRDWI and CEUS , which should be recommended in future clinical practice , without increasing the number of needle .
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<p><b>OBJECTIVE</b>To evaluate the prognostic impact of tumor size, ultrasonography, central neck lymph node involvement, and age of patients in papillary thyroid microcarcinoma (PTMC).</p><p><b>METHODS</b>Two hundred and fifty-four patients who underwent total thyroidectomy and central neck dissection for PTMC between 2012 and 2014 were included in this retrospective study. Statistical correlation between tumor size and various clinicopathological parameters was assessed by univariate and multivariate analyses. The ultrasound findings were also evaluated.</p><p><b>RESULTS</b>A total of 254 patients (199 females and 55 males) were included in this study. PTMC showed a predilection for female patients, 41-50 years of age (43.3% of all cases, 110/254), and ultrasound showed hypoechoic nodules. Statistically significant correlation was demonstrated between central neck lymph node involvement and the following factors: age and tumor size. A tumor diameter greater than 0.5 mm (67.3% of all cases) most commonly occurred in patients older than 41 years, and was associated with a higher risk of metastatic central neck lymph node involvement (P<0.05). Hashimoto's thyroiditis was noted in the background in 39.4%(100/254) of cases.</p><p><b>CONCLUSIONS</b>Tumor size appears to have a prognostic impact in PTMC, and larger size is more likely to be associated with a higher risk of central neck lymph node involvement. It is controversial whether the etiology of papillary thyroid carcinoma is related to Hashimoto's thyroiditis.</p>