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Objective:To compare the efficacy of ultrasound combined with endoscopy and ultrasound combined with X-ray guided percutaneous nephrolithotomy(PCNL) in the treatment of complex renal calculi.Methods:The clinical data of 119 patients with complex kidney stones treated by ultrasound combined with endoscopy or ultrasound combined with X-ray guided PCNL in the Second Affiliated Hospital of Anhui Medical University from March 2019 to February 2022 were analyzed retrospectively. According to different guidance methods, they were divided into ultrasound combined with endoscopic guidance group and ultrasound combined with X-ray guidance group.There was no significant difference in age [(53.9±14.2) years vs. (55.6±13.5) years], gender (male/female: 38/21 vs. 30/30), body mass index [(25.0±3.7) kg/m 2 vs. (24.8±3.8)kg/m 2], stone location (left/right: 34/25 vs. 31/29), maximum diameter of renal stones [(31.9±8.3)mm vs. (33.9±13.5)mm], kidney stones maximum cross-sectional area [(601.5±242.5)mm 2 vs. (632.6±278.9)mm 2], number of renal calices involved (3.5±0.9 vs. 3.6±1.3), S. T.O.N.E. scores (9.4±1.0 vs. 9.7±1.4), Guy's grade(Ⅲ/Ⅳ: 45/14 vs. 41/19), preoperative hemoglobin [(125.2±21.5)g/L vs. (125.6±18.4)g/L], serum creatinine[(89.1±33.8) μmol/L vs. (81.9±27.1) μmol/L], urinary tract infection (43/59 vs. 47/60)and positive urinary bacterial culture (12/59 vs.11/60) between the two groups(all P>0.05). The patients in the ultrasound combined with endoscopic guidance group were placed in the modified prone split-leg position. Flexible ureteroscope retrograde into the renal pelvis, combined with ultrasound to determine the best puncture calices. The channels were established and stones were removed under the guidance of ultrasound and endoscopy. In the ultrasound combined with X-ray guidance group, the F5 ureteral catheter was placed retrogradely into the operative side ureter under the lithotomy position. Then the patient changed to prone position and the target calices were punctured under the guidance of ultrasound and X-ray. Through anterograde or retrograde injection of contrast medium, the puncture position was determined to enter in the center of the calicean dome, and the channel establishment process and stone removal are monitored. The operative results and postoperative data were recorded. Results:The average operation time in the ultrasound combined with endoscopic guidance group was significantly shorter than that in the ultrasound combined with X-ray guidance group [(90.2 ± 34.5) min vs. (129.4 ± 43.0) min, P < 0.001]. There was no significant difference in the success rates of initial channel establishment [94.0% (63/67) vs. 87.7% (107/122), P = 0.167], the time of single channel establishment [(7.7 ± 1.9) min vs. (7.7 ± 1.4) min, P =0.765], serum creatinine on the first day after operation[ (89.3±33.6) μmol/L vs. (82.9±27.0) μmol/L, P=0.257] and postoperative hospital stay[(5.3±1.6) d vs.(5.4±1.7) d, P=0.883]. In contrast, patients in ultrasound combined with X-ray guidance group had higher stone free rate [93.3% (56/60) vs. 81.4% (48/59), P=0.049] and lower reoperation rate [3.3% (2/60) vs. 15.3% (9/59), P=0.025]. The mean hemoglobin decrease value of ultrasound combined with endoscopic guidance group was significantly lower than ultrasound combined with X-ray guidance group on the first day after operation [(8.7±6.3) g/L vs. (16.8±6.9) g/L, P<0.001]. The complication rate of ultrasound combined with endoscopic guidance group was significantly lower than that of ultrasound combined with X-ray guidance group [5.1% (3/59) vs. 16.7% (10/60), P = 0.043]. Conclusions:Ultrasound combined with endoscopic guidance PCNL does not need to change body position during operation and has fewer puncture channels, thus saving operation time and reducing complications. It is more suitable for patients with isolated kidney or easy bleeding. Ultrasound combined with X-ray guidance is conducive to the establishment of multi-channel, the stone clearance rate is high and the reoperation rate is low, which is suitable for patients with good health and more renal calices involved with stones.
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Objective:To investigate the value of enhanced MRI in evaluating the tissue permeability of pancreatic ductal adenocarcinoma (PDAC) animal model.Methods:The experimental animals were 27 female C57BL/6 mice. The mice were divided into 3 groups with 9 mice in each group by random number method. Murine pancreatic adenocarcinoma (Panc02) and embryonic fibroblasts (NIH/3T3) were implanted subcutaneously at the ratio of 2∶1 and 1∶1 to establish PDAC models with different tissue permeability, which were low fibroblast group and high fibroblast group, respectively, and simple Panc02 implantation model was control group. The positive expression rate of α-smooth muscle actin (α-SMA), the positive expression rate of fibroblast activating protein (FAP), the coverage rate of collagen fibers, number of blood vessels and the long/short diameter of tissue vessels were quantitatively evaluated by tissue staining, and the tissue permeation efficiency was quantified by the average optical density (AOD) of tissue sections stained by Evans blue (EB). Enhanced MRI was performed on mice, and the enhancement degree and the enhancement rate of 20 min were obtained. One-way ANOVA was used to compare the overall differences of tumor histological indexes and MRI enhancement parameters in each group, and the correlation between the indexes was analyzed by Pearson correlation analysis. Multiple linear stepwise regression analysis was conducted with 20 min enhancement rate as dependent variable, while α-SMA positive expression rate, collagen fiber coverage rate and vascular long/short diameter as independent variables.Results:There were significant differences in AOD value, α-SMA positive expression rate, FAP positive expression rate, collagen fiber coverage rate, vascular long/short diameter, 20 min enhancement degree and 20 min enhancement rate among the three groups ( P<0.001), but there was no significant difference in the number of blood vessels ( P=0.650). The AOD value was negatively correlated with the positive expression rate of α-SMA, the coverage rate of collagen fibers and the long/short diameter of blood vessels in PDAC model, respectively ( r=-0.888, P=0.001; r=-0.813, P=0.008; r=-0.915, P<0.001). The 20 min enhancement degree was positively correlated with AOD value ( r=0.954, P<0.001). The positive expression rate of α-SMA, collagen fiber coverage and vascular long/short diameter were negatively correlated with 20 min enhancement rate ( r=-0.901, P<0.001; r=-0.837, P=0.005; r=-0.880, P=0.002). The results of multiple linear stepwise regression analysis showed that the positive expression rate of α-SMA was an important influencing factor for the 20 min enhancement rate (R 2=0.813, P=0.001). Conclusions:The increase of fibroblast implantation ratio significantly decreased the permeation efficiency of tumor tissue. The positive expression rate of α-SMA, the coverage rate of collagen fibers and the long/short diameter of blood vessels were negatively correlated with the permeation efficiency of tumor tissue. The 20 min enhancement degree was positively correlated with tissue permeation efficiency.
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Zinner syndrome is a congenital genitourinary embryo malformation, which is clinically rare, difficult to diagnose, and usually found in the sexually active stage. MRI is the preferred method for diagnosis. Conservative treatment was usually conducted for most asymptomatic patients. Symptomatic patients can be treated by laparoscopic or robotic surgery. For patients with infertility complicated with ejaculatory duct obstruction, transurethral resection of the ejaculatory duct is feasible, which contributes to improving sperm vitality and quantity and increasing semen volume. However, some patients still have azoospermia after surgery. The etiology is needed further studied. A case of infertility with Zinner syndrome and ectopic ureteral opening in seminal vesicle cyst is reported.
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Objective:To explore the clinical feasibility of extra-peritoneal laparoscopic radical cystectomy based on the concept of 3D membrane anatomy.Methods:The clinical data of 10 male patients with bladder cancer who underwent 3D extra-peritoneal laparoscopic radical cystectomy + ileal-orthotopic-neobladder surgery from October 2020 to June 2021 were retrospectively analyzed. The median age was 67 years. The ASA score was 1-2 in 8 cases and 3 in 2 cases. There were 4 cases of hypertension, 2 cases of diabetes, 1 case of heart disease, no case of abdominal surgery history. During the operation, the concept of 3D membrane anatomy was used to identify the important fascia in the pelvic cavity and to find the key layers and structures in the pelvic cavity.It was separated from the prevesical fascia to the laterovesical space, and confluenced with Retzius space and Bogros space. It was dissected in the layer surrounded by the prevesical fascia, the vesicohypogastric fascia, and the urogenital fascia to complete the process of cystectomy.Results:The operations of 10 patients were completed successfully and there was no conversion to open operation. The median operation time was 276(237-325) minutes, and the median blood loss was 160(50-280)ml. The postoperative bowel recovery median time was 1.8(1-3)days, and the patients were out of bed about 1.3(1-2) days. The median postoperative hospital stay was 9(5-12) days. The number of median lymph node dissection in all patients was 10(6-20). Positive lymph nodes was found in 3 cases. Positive margin was found in no case. Postoperative tumor pathological stages were T 2 stage in 7 cases, T 3 stage in 3 cases. During the follow-up, all patients had no obvious complications. Conclusions:It is feasible to apply the concept of 3D membrane anatomy to identify and locate the key fascia structures and levels in extra-peritoneal laparoscopic radical cystectomy. The operative complications were less and the postoperative recovery was faster. The anatomy is clear during the operation, which has good safety and reduces the difficulty of the operation.
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Objective:To discuss the feasibility and clinical efficacy of laparoscopic ureteroplasty with buccal mucosa graft for ureteral stricture.Methods:The clinical data of 10 patients with ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2018 to November 2019 were retrospectively analyzed, including 7 males, 3 females, 5 cases on each side, with an average age of (47.9±7.8)years. All patients had a history of operation related to ureteral calculi. The median value of preoperative serum creatinine was 71(68~610)μmol/L. The status of hydronephrosis and ureteral stricture was evaluated by ultrasonography, CTU and ureteral retrograde angiography.The separation of the renal pelvis on the affected side was (3.1±0.7)cm.There were 7 cases of upper segment stenosis, 2 cases of middle segment stenosis, and 1 case of multiple stenosis. The length of ureteral stenosis was (3.2±0.7)cm. Laparoscopic buccal mucosa ureteroplasty was performed in all 10 cases under general anesthesia. After the stricture ureter segment was separated during the operation, the ureteral stenosis segment was longitudinally cut. According to the stenosis, the buccal mucosa with a length of 3.0-4.5 cm and a width of 1.0-1.5 cm was cut. Buccal mucosa grafts were harvested and placed in the ureter as an anterior onlay with omental wrapping.Results:Ureteral repair was performed laparoscopically in all cases, with no conversion to open and no serious complications. The operative time was (199.2±27.4)min, the blood loss was (101.5±54.7)ml, the median postoperative indwelling time of the drainage tube was 4.5(3.0-7.0)d, and the postoperative hospital stay was (7.9±1.9)days. The patients had clear pronunciation and barrier-free eating one week after the operation.The double J tube was removed one to two months after surgery. The patients were followed up for (11.3±4.2)months after the operation. Follow-up patients underwent imaging and other examinations, which showed significant improvement in hydronephrosis on the affected side, and the median value of renal pelvis separation on the affected side was 1.8(0-2.2)cm. The median value of serum creatinine was 82(66~235)μmol/L. The serum creatinine in 2 patients with renal insufficiency decreased significantly after operation.Conclusions:Laparoscopic buccal mucosa graft ureteroplasty could be a safe and feasible option for the treatment of ureteral stricture with less trauma and rapid recovery. The results of the initial experience are encouraging.
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Exosomes are nanometer-sized vesicles that contain various types of biologically active components, including proteins, nucleic acids, carbohydrates, and lipids, which vary with the type and physiological state of the cell. In recent years, several studies have showed that exosomes can provide new non-invasive diagnostic and prognostic biomarkers in patients affected by cancers, including bladder cancer (BC), and the lipid bilayer membrane structure makes exosomes as promising delivery vehicles for therapeutic applications. Exosomes have the characteristics of high abundance, high stability, tissue specificity, and wide distribution in body fluids, and are secreted as various types by cells in different states, thereby possessing great potential as biomarkers for BC. Herein, we briefly summarize the functions and roles of exosomes in the occurrence and development of BC and the current progress of research on exosomes in BC, while focusing on potential clinical applications of the diagnosis, treatment, and prognosis of BC.
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Objective:To explore the application of panoramic teaching in clinical practice.Methods:From October 2017 to October 2018, 40 clinical undergraduate interns were collected into the experimental group (panoramic teaching group, n=20) and the control group (traditional teaching group, n=20). The experimental group received panoramic teaching including case teaching, scenario design, and situational simulation, while the control group adopted traditional teaching mode. After the internship, theoretical and operational examinations, and questionnaire survey were conducted to evaluate the teaching effects of the two teaching modes. The data were collected and analyzed by t test using SPSS 16.0 software. Results:The results showed that theoretical examination [(85.4±3.3) vs. (82.5±2.5)] and clinical operational examination [(31.5±3.5) vs. (27.6±2.2)] scores in the panoramic teaching group were significantly higher than that in the traditional teaching group. The questionnaire survey on the satisfactions with teaching mode showed that the panoramic teaching group was significantly better than the traditional teaching group in theory learning [(7.7±0.9) vs. (6.8±0.7)], clinical practice[(7.8±0.9) vs. (6.7±0.7)], learning interest [(8.1±0.7) vs. (6.9±0.7)], self-learning ability [(7.7±0.7) vs. (7.1±0.6)], teacher-student communication ability [(7.6±0.8) vs. (6.8±0.7)], doctor-patient communication ability [(7.5±0.6) vs. (7.0±0.8)], medical humanistic spirit [(7.9±0.7) vs. (6.8±0.7)], group working [(8.2±0.6) vs. (6.5±0.5)], humanistic concern [(8.4±0.5) vs. (7.4±0.7)], and total satisfactions [(8.4±0.5) vs. (7.4±0.7)].Conclusion:Panoramic teaching can significantly improve the theoretical and operational performance of family practice interns, enhance the effect of clinical teaching of family practice, and increase students’ interest and satisfaction in clinical teaching.
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Objective@#To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.@*Methods@#The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed. A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019. According to different surgical methods, 56 cases were divided into the modified prone split-leg position group (observation group) and the traditional pre-lithotomy position followed by prone position group (control group). In observation group, the average age of 11 males and 17 females was (54.1±10.2)years. The mean body mass index was (23.8±2.9) kg/m2. The location of stones were left in 14 cases and right in 14 cases. The average kidney involvement calyces number was 2.4±0.7.The mean kidney stones maximum cross-sectional area was (870.9±157.7)m2. According to the Guy′s classification system, there were 3 cases of grade Ⅰ, 11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group. The kidney stones S. T.O.N.E scores was 8.7±1.3 and ureteral calculi S. T.O.N.E scores were 13.1± 1.6.In the control group, the average age was (57.0±8.3)years old. The mean body mass index was (24.4±2.9)kg/m2. The average kidney involvement calyces number was 2.1±0.7 and the mean kidney stones maximum cross-sectional area was (808.8±189.6)mm2. To the kidney stones Guy′s classification, there were 5 cases of grade Ⅰ, 15 case of grade Ⅱ, 7 case of grade Ⅲ and 1case of grade Ⅳ in the control group. The kidney stones S. T.O.N.E scores were 8.5±0.6 and the ureteral calculi S. T.O.N.E scores were 12.4±1.7. The operation time, calculus clearance rate, postoperative hospitalization days, reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.@*Results@#The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8±27.3)min vs.(94.4±22.8)min](P<0.05). In the observation group, 23 patients had complete removal of renal and ureteral calculi, and 3 patients need reoperation. While in the control group, 16 patients had complete removal and 10 patients had reoperation. There were significant differences between the two groups (P<0.05). According to the complication severity of Clavien-Dindo, there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group, 4 cases of grade Ⅰ, 2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group. There were no serious complications of grade Ⅳ and Ⅴ in both groups (P>0.05). In observation group, one case accepted the DSA embolization therapy due to the severe bleeding. One case accepted the puncture drainage due to the perinephric effusion. There was no difference in average postoperative hospital stay between the two groups [(6.5±1.2)d vs.(7.0±2.1)d, P>0.05].@*Conclusions@#It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position. One position can solve many problems simultaneously, which can significantly reduce the operation time, increase the stone free rates, reduce the reoperation rate and improve the effectiveness of the operation.
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Objective To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.Methods The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed.A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019.According to different surgical methods,56 cases were divided into the modified prone split-leg position group (observation group)and the traditional pre-lithotomy position followed by prone position group (control group).In observation group,the average age of 11 males and 17 females was (54.1 ± 10.2) years.The mean body mass index was (23.8 ± 2.9) kg/m2.The location of stones were left in 14 cases and right in 14 cases.The average kidney involvement calyces number was 2.4 ± 0.7.The mean kidney stones maximum cross-sectional area was (870.9 ± 157.7) m2.According to the Guy's classification system,there were 3 cases of grade Ⅰ,11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group.The kidney stones S.T.O.N.E scores was 8.7 ± 1.3 and ureteral calculi S.T.O.N.E scores were 13.1 ± 1.6.In the control group,the average age was (57.0 ± 8.3) years old.The mean body mass index was (24.4 ± 2.9) kg/m2.The average kidney involvement calyces number was 2.1 ± 0.7 and the mean kidney stones maximum cross-sectional area was (808.8 ± 189.6)mm2.To the kidney stones Guy's classification,there were 5 cases of grade Ⅰ,15 case of grade Ⅱ,7 case of grade Ⅲ and 1 case of grade Ⅳ in the control group.The kidney stones S.T.O.N.E scores were 8.5 ±0.6 and the ureteral calculi S.T.O.N.E scores were 12.4 ± 1.7.The operation time,calculus clearance rate,postoperative hospitalization days,reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.Results The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8 ± 27.3) min vs.(94.4 ± 22.8) min] (P ＜ 0.05).In the observation group,23 patients had complete removal of renal and ureteral calculi,and 3 patients need reoperation.While in the control group,16 patients had complete removal and 10 patients had reoperation.There were significant differences between the two groups (P ＜ 0.05).According to the complication severity of Clavien-Dindo,there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group,4 cases of grade Ⅰ,2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group.There were no serious complications of grade Ⅳ and Ⅴ in both groups (P ＞0.05).In observation group,one case accepted the DSA embolization therapy due to the severe bleeding.One case accepted the puncture drainage due to the perinephric effusion.There was no difference in average postoperative hospital stay between the two groups [(6.5 ± 1.2) d vs.(7.0 ± 2.1) d,P ＞ 0.05].Conclusions It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position.One position can solve many problems simultaneously,which can significantly reduce the operation time,increase the stone free rates,reduce the reoperation rate and improve the effectiveness of the operation.
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Objective The aim of this study was to investigate the expressions of and clinical significance of F-box/WD-40 domain protein 10(FBXW10) as well as the expression of cell cycle protein cyclin E( cyclin E) in renal clear cell carcinoma. Methods Immunohistochemistry SP method was used to detect the expressions of FBXW10 and cyclin E protein in 60 cases of renal clear cell carcinoma and 20 cases of adjacent normal tissues. The relationship between the expressions of FBXW10 and cyclin E,and the clinical pathological characteristics was analyzed. Results The expression rates of FBXW10 and cyclin E protein in renal clear cell carcinoma were 40. 0% ,70. 0% ,respectively and adjacent normal tissues were 55. 0% and 25. 0% ( P<0. 05). The expression of FBXW10 was correlated with the histologic grade of renal clear cell carcinoma(P=0. 041),histologic grade( P=0. 030);the ex-pression of cyclin E was correlated with the pathological tumor stage of clear cell renal cell carcinoma(P=0. 005),degree of differen-tiation(P=0. 035),and distant metastasis(P=0. 011). There was a significant correlation between the expressions of FBXW10 and cyclin E in renal clear cell carcinoma(r=0. 533,P<0. 001). Conclusion FBXW10 and cyclin E may play important roles in the development of renal clear cell carcinoma.
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Objective To investigate the application value of pH sensitive manganese-loaded caramelized carbonaceous nanospheres (Mn-CNS) in the synchronous MRI and photothermal therapy for breast cancer. Methods Anhydrous glucose was used as carbon source to prepare caramelized carbonaceous nanospheres(CNS).Mn2 +was absorbed and bonded to its surface to obtain the Mn-CNS.The MR signal values of aqueous solutions of Mn-CNS under different pH(pH=7.4,6.0,5.0)with different Mn2+concentrations(0,0.14,0.28,0.57,1.14 and 2.28 mmol/L)were measured to obtain the relaxation rate.The cell counting kit-8(CCK-8)assay was used to determine the effect of Mn-CNS on the viability of 4T1 cells. Pathological examination was used to evaluate the systemic toxicity. Inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze Mn uptake by different cell lines (human breast cancer cells MCF-7, human normal mammary epithelial cells MCF-10A and human macrophages cells). The 4T1 tumor-bearing BALB/c mice were divided randomly into four groups (6 mice per group): (1) normal saline (intratumoral injection)plus near infrared laser(NIR);(2)normal saline(intravenous injection)plus NIR;(3) Mn-CNS(intratumoral injection)plus NIR;(4)Mn-CNS(intravenous injection)plus NIR.After intratumoral injection for 30 min and intravenous injection for 12 h,the tumors were continuously irradiated with 808 nm laser for 10 min,the temperature changes and relative tumor volume were recorded.The MRI was obtained at different time point(pre-injection and post-injection at 15 min,30 min,1 h,4 h,8 h,12 h,24 h,48 h,4 d, respectively)with the dose of Mn-CNS(4 mg Mn/kg)by intravenous injection.The changes of Mn2+content before and after Mn-CNS incubation and the tumor volume differences among each group were compared by t test.Results The values of r1were 0.18 L·mmol-1·s-1(pH 5.0),3.48 L·mmol-1·s-1(pH 6.0)and 5.42 L· mmol- 1·s- 1(pH 7.4), respectively. The cells viability of 4T1 were all above 90 % when the cells were incubated with Mn-CNS at different concentrations (25, 50, 100 and 200 μg/ml). MCF-7 and human macrophages cells were ingested Mn2+.The Mn2+amount before and after uptake were significant difference(P<0.05).The MCF-10A had a slight uptake of Mn2+which was not statistically significant(P>0.05).After 10 minutes of the laser exposure (2 w/cm2), the change of temperature with tumor among different groups were shown as follow:Mn-CNS(intratumoral injection)>Mn-CNS(intravenous injection)>normal saline(intravenous injection)>normal saline (intratumoral injection). After photothermal therapy, the relative tumor volumes of Mn-CNS (intratumoral injection)and normal saline(intratumoral injection)were statistically different(t=-2.724,P<0.05). Meanwhile,the relative tumor volumes also showsd significant difference among Mn-CNS(intravenous injection) and normal saline (inject intravenous injection) groups (t=-5.193,P<0.05). After intravenous injection of Mn-CNS in 4T1 tumor-bearing mice, the signal intensity of T1gradually increased and reached the peak of enhancement at 4 h after which the signal intensity remained stable and decreased slightly at 12 h,then gradually decreased to normal. The T1signal intensity of kidney was consistent with that of the tumor and higher. Meanwhile, the degree of liver tissue enhancement was the lowest. Conclusions Mn-CNS is highly biocompatible and self-degradable,it can targeted MRI and achieve precise photothermal therapy simultaneously, which is of great value in the integrated diagnosis and treatment of breast cancer.
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Objective To investigate the X-ray,CT and MRI features of chondroblastoma (CB)and to improve diagnostic skills of this disease.Methods The X-ray,CT and MRI imaging of 27 cases with CB which were verified by histopathological examination and the misdiagnosed cases were analyzed retrospectively.Results Accurate diagnosis of preoperative images was made in 10 cases and all 10 cases were located in the epiphysis of long bone.X-ray and CT showed eccentric round and oval osteolytic bone destruction,with sclerotic rim and internal spotted calcification;MRI showed hypointensity on T1 WI and heterogeneous hypo-and hyperintensity on T2 WI,with peripheral regions of marrow edema and adjacent joint effusion.Seventeen cases were misdiagnosed preoperatively,including 8 cases in long bone epiphysis or apophysis,8 cases in short,flat and irregular bones and 1 case in metaphysis of long bone.Twelve cases showed expansive changes and 10 cases with associated aneurysmal bone cyst(ABC)showed fluid-fluid levels.Conclusion The CB shows sandy or stippled calcification,rim sclerosis,extensive surrounding bone marrow edema.CB in unusual sites usually shows expansive bone destruction,peripheral bone marrow edema,secondary aneurysmal bone cyst.Combined utilization of clinic,pathology and imaging features is helpful for the diagnosis.
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Objective To investigate the differences of CT features for different subtypes of pulmonary neuroendocrine tumors (PNETs).Methods CT imaging data of 41 patients with PNETs and 5 patients of lung cancer with neuroendocrine differentiation confirmed by pathology were analyzed retrospectively,and the differences in CT features among pathological subtypes were explored. Results Among the pathological subtypes of 41 PNETs,the statistical differences in the CT features including vascular invasion,the metastatic lymphadenopathy in the hilus and mediastinum were found(P<0.05).However,no differences were found in other imaging findings (lesion location,spiculation,bronchial invasion,atelectasis and obstructive pneumonia,and pleural effusion or thickening)among the subtypes (P>0.05).Among those subtypes PNETs and lung cancer with neuroendocrine differentiation,the differences in tumor size,vascular invasion,and metastatic lymphadenopathy in the hilus and mediastinum were also found (P<0.05).However,no differences were found in other imaging findings (P>0.05).In addition,there were differences in tumor size among different enhancement types and different metastastic presences in the lung or outside of the chest (P<0.05).Conclusion CT shows certain differences among the different subtypes of PNETs,which may be helpful for the differential diagnosis but not specific.
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Objective To investigate the imaging manifestations of os odontoideum and to improve the level of diagnosis and treatment of this disease.Methods Imaging data of 22 patients with os odontoideum were analyzed retrospectively.Results Os odontoideum was divided into round,oval,conical and irregular shapes,with intact cortex and hypertrophy of anterior arch of atlas.Two cases of orthotopic and 20 cases of dystopic os odontoideum were included.There was no displacement of the base of the odontoid process in 7 cases,with anterior displacement in 6 cases and posterior displacement in 9 cases.A widening of anterior atlanto-axial joint space with varying degrees was observed in 14 cases.Thickening of the soft tissue posterior to the odontoid process was showed in 18 cases,spinal canal stenosis in 21 cases,spinal cord degeneration in 11 cases and craniocervical junction malformation in 9 cases.Conclusion Os odontoideum is a well-corticated bone mass,with other related changes,such as hypertrophy of anterior arch of atlas,small posterior arch of atlas,atlantoaxial instablity, spinal stenosis and so on.The imaging features can provide important reference for clinical diagnosis and treatment.
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Objective To investigate the enhanced CT features of papillary renal cell carcinoma (PRCC)and its subtypes (PRCC-Ⅰ, PRCC-Ⅱ)and chromophobe renal cell carcinoma(CRCC).Methods The CT features of 30 tumors with pathologically proved PRCC and CRCC were analyzed retrospectively,including location,size,enhanced types,calcification and necrosis etc.The differences in the CT features among PRCC and its subtypes and CRCC were evaluated.Results 1 2 cases of PRCC with single lesion (7 in the right kidney and 5 in the left)were shown;1 case was multifocal PRCC with 1 lesion in the right kidney and 2 lesions in the left.1 5 cases of CRCC were single lesion(9 in the right kidney and 6 in the left).The medium tumor maximum size of CRCC was larger than that of PRCC,and the PRCC-Ⅰ tumors tended to be smaller than PRCC-Ⅱ ones.53% of the PRCC had heterogeneous enhancement,and all calcification and necrosis were found in PRCC-Ⅱ lesions.Of all the CRCC,27% had uniform enhancement,20% had calcification and 40% had necrosis or central scar.There was no significant difference between PRCC and its subtypes and CRCC in location, maximum size,heterogeneity,calcification,necrosis and central scar.The degree of enhancement of CRCC(89.53 HU)was significantly greater than that of PRCC(66.60 HU),PRCC-Ⅰ(71.75 HU)and PRCC-Ⅱ(64.73 HU)in the cortical phase(P<0.05).The enhancement peak in the nephrographic phase was CRCC,PRCC-Ⅰ,PRCC and PRCC-Ⅱ from high to low in turn,which were all higher than that in cortical phase.In the excretory phase,the enhancement of all lesions was declined.Conclusion Contrast-enhanced CT is of certain value in the differential diagnosis among PRCC and its subtypes and CRCC.The enhancement degree of CRCC in the cortical phase is significantly greater than that of PRCC and its subtypes.The enhancement peak of PRCC and its subtypes and CRCC appears in the nephrographic phase.
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As the highest academic institution, the academic committee is the core of the academic management system and organizational structure in medical colleges and universities. The regulations on the Academic Committees are the criteria for the academic operation of colleges and universities. Since the promulgation of the "Regulations on Academic Committees of Higher Education" by the Ministy of Educa-tion in 2014, medical colleges and universities have gradually improved the construction of the regulations. However, few studies have been conducted on the construction of academic committees in medical colleges and universities. The present paper analyzed the regulations on the academic committees of 20 medical colleges and universities, pointed out the inadequacies of the regulations on the academic committees of the medical colleges and universities in China from the aspects of the functions and construction, aiming to provide reference for the construction of the academic management system for modern medical colleges and universities.
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Objective To evaluate the effectiveness and security of Botulinum toxin type A (BTX-A) in treating interstitial cystitis /bladder pain syndrome,and also the effect of different site injection.Methods Sixty-nine consecutive BPS/IC patients from October 2011 to February 2016 were divided into three groups randomly,including control group (group A) and treatment group (group B and group C).There were 5 males and 64 females,with age from 23 to 66 years old (average 44.5 years old).Twentythree patients (1 male and 22 females,aged from 23 to 69 years old,with mean age of 44.6 years old) in control group (group A) underwent hydrodistention.Twenty-four patients (2 males and 22 females,aged from 27 to 65 years old,with mean age of 42.8 years old) in group B underwent BTX-A detrusor combined triangle injection plus hydrodistention.Twenty-two patients (2 males and 20 females,aged from 30 to 68 years old,with mean age of 44.3 years old) in group C underwent BTX-A triangle injection alone plus hydrodistention.The parameters such as daytime frequency,nocturia,visual analogue scale/score (VAS),functional cystemetric volume (FCV),post-void residual volume (PVR),QOL score,maximal bladder capacity (MBC),interstitial cystitis symtom index (ICSI),interstitial cystitisproblem index (ICPI),Qmax,and Hamilton anxiey scale (HAMA) score between pre-treatment and 1,3,6 and 9 months after therapy in the three groups were compared.Results There were no serious complications observed in the three groups.All parameters 1 month after therapy were obviously superior to that of pretreatment.The efficacy in control group decreased significantly 3 months after treatment except nocturia (3.0 vs.5.0),daytime frequency(7.0 vs.14.0)and Q (14.0 ml/s vs.13.0 ml/s).However,all parameters in research groups except PVR were still obviously superior to pretherapy.The parameters except Q and nocturia in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,the parameters except Q nocturia and somatic anxiety score in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).VAS (2.0 vs.3.0) and somatic anxiety score (6.0 vs.10.0) in group B were superior to group C (all P ＜ 0.05).When it came to 6 months after therapy,urinary frequence and urgency and pain symptoms were the same to pretherapy and all parameters had no statistically significant difference between pretherapy and after therapy in group A(all P ＞ 0.05).But all parameters except PVR in research group was still superior to pretherapy.the parameters except PVR,Q and QOL in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,The parameters except PVR,Q MBC,ICSI and QOL in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).Meanwhile,efficacy in group B was better than group C in term of ICPI (6.0 vs.8.0) and somatic anxiety score (7.0 vs.10.0) (all P ＜ 0.05).The efficacy decreased significantly 9 months after treatment in both group B and C,with no statistically significant difference compared with that of pretreatment.ICSI(10.0 vs.13.0),ICPI(9.0 vs.13.0),QOL(5.0 vs.6.0)in group B,and QOL(5.0 vs.6.0)in group C had statistically significant difference compared with the contemporary parameters in group A.ICSI(10.0 vs.12.0),MBC(285.0 ml vs.237.5 ml) in group B was better than that in group C (P ＜ 0.05).Conclusions Symptoms in IC/BPS patients can be alleviated significantly by detrusor BTX-A injection plus hydrodistention.Quality of life can be improved remarkably and HAMA scores can be reduced significantly after treatment.Thus,it's an effective therapeutic mnethod for IC/BPS,and detrusor combined triangle injection can provide a better effect than single triangle injection.
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Objective To explore the fibrotic stroma characteristics of orthotopic liver cancer in rat and the relationship with MR delayed contrast enhancement.Methods 4 Wistar rats with orthotopic liver cancer underwent conventional triphasal and longer-de-layed contrast-enhancement MR scanning.12 HCC specimens obtained from the four Wistar rats were sliced and stained with HE, picric-sirius red,Verhoeff Van-Gieson elastic fiber,Gordon-Sweets reticular fiber and anti-α-SMA immunohistochemical staining.The relationshp between intratumoral fibrotic stroma and MR delayed phases of the 1 2 tumors were analyzed.Results Collagen fiber was expressed mainly in tumor fibrous septum.Elastic fiber distributed in tumor fibrous septum and the artery wall.Reticular fiber dis-tributed in fibrous septum of the regenerative nodules,portal area and tumor psuedocapsule.Integrated optical density (IOD)value of collagen fiber,elastic fiber and reticular fiber analyzed by Image-pro Plus6.0 were 0.102±0.020,0.063±0.018 and 0.109±0.032, respectively.As a result,the amount of collagen and elastic fibers were statistically different (P<0.01),and so were reticular fibers and elastic fibers (P<0.01).And there was a positive correlation between collagen fiber and MR delayed contrast enhancement (P<0.05).Conclusion MR delayed contrast enhancement of hepatic cancer in rat is closely associated with the collagen fiber,thus this fiber in liver cancer can be evaluated noninvasively by MRI.
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Objective To elucidate the correlation between the enhancement degree of renal clearcell carcinoma (RCC) on dynamic contrast-enhanced CT and multiple vascular morphometric characteristics including microvessels and mature vessels.Methods A retrospective review was carried out on the records of 37 patients pathologically diagnosed with RCC who underwent plain and triphasic contrast-enhanced CT.The absolute (enhancement attenuation-pre-enhancement attenuation) and relative(absolute enhancement value÷cortex enhancement attenuation) enhancement values of RCC were measured in arterial,venous and delayed phases.And all lesions were divided into hypervascular and hypovascular groups.The number,mean area,perimeter and diameter,shape factor (4π*area/perimeter2) and the total area of microvessels and mature vessels were obtained by CD34 or a-SMA immunohistochemical staining.Then the correlation of radiographic parameters and various vascular morphometric parameters were analyzed.Results In arterial,venous and delayed phases,the absolute enhancement values were positively correlated with the number and the total area of microvessels and mature vessels (P0.05).In addition, the significant differences in the number of microvessels and mature vessels between hypervascular and hypovascular groups were found (P<0.05).Conclusion CT enhancement degrees of RCC are related to multiple vascular morphometric indicators,which gives us more insights in the mechanism of RCC enhancement on CT.
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Objective To investigate the MRI features of different fibrotic stroma of hepatocellular carcinomas (HCC) and the relationships between them and delayed contrast-enhanced MR findings. Methods Twenty eight patients were enrolled in the study who had undergone dynamic contrast-enhanced MRI scanning. MRI showed largely complete rim-like enhancement in delayed phase in all the lesions which were confirmed by surgery and pathology. Delayed-enhancement in peripheral and internal position of HCC were evaluated and the thicknesses of rim-like enhancement in delayed phase were measured by analyzing the 5 minute delayed images. Among the 28 lesions, 22 were sampled and pathologically analyzed both in peripheral and internal portion of HCC and the remaining 6 were in the internal portion only. The pathological features were observed including distributions of three fibers (elastic, collagen and reticular fibers) in the periphery and internal positions of HCC, degrees of inflammatory cells infiltration outside the capsule and in the internal portion of HCC, the blood vessels in the capsules and thicknesses of fibrous capsule. The pathological features of HCC with different degrees of delayed-enhancement were compared using χ2 test, and differences in the thicknesses of rim-like enhancement of HCC in delayed phase among different pathological features were analyzed using Chi-square test. Results (1) In the periphery:pathological features: the typical fibrous capsules showed in all 22 HCC. And three kinds of fibers were crisscrossed within the capsules without quantitative differences. MRI findings:statistical differences in the amounts of blood vessels in the capsule of HCC among different degrees of delayed-enhancement were found (P0.05). In addition, the statistical differences in the thicknesses of rim-like enhancement of HCC showed among different thicknesses of fibrous capsule, degrees of inflammatory cells infiltration and amounts of blood vessels (all P<0.05). (2) In the internal positions:pathological features: the amounts of three kinds of fibers in the internal positions were significantly lower than those in the periphery. MRI findings: the statistical differences in collagen fibers, elastic fibers, reticular fibers and the degrees of infiltration of inflammatory cells of HCC were all seen among different degrees of delayed enhancement inside tumors (all P<0.05). Conclusion The delayed MR enhancement of HCC in peripheral and internal positions showed correlation with the fibers and degrees of infiltration of inflammatory cells in the tumor.