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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 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 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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A method for rapid determination of semicarbazide in water by hydrophilic interaction chromatography-quadrupole / electrostatic field orbitrap high resolution mass spectrometry was developed. The sample was extracted with acetonitrile after 0. 1 mol/ L NaOH was added in the sample and then excessive amounts of Na2 SO4 was added to stratify acetonitrile from the mix solution. The acetonitrile extraction solution was dehydrated with anhydrous sodium sulfate. The preparation was separated by an amide column using as hydrophilic interaction column, and gradient elution program was employed by using water and acetonitrile containing 0. 1% formic acid as mobile phase, then it was detected in positive and selected ion monitoring mode by a quadrupole / electrostatic field orbitrap high resolution mass spectrometry. Internal standard method was used for quantitative analysis. The linear correlation coefficient of semicarbazide was 0. 997 in the concentration range of 0. 2 -20 μg / L under the optimal conditions. The limit of detection was 0. 09 μg / L, while the limit of quantitation was 0. 30 μg / L. The recoveries were 82. 3% to 92. 0% , and the relatively standard deviations were less than 7. 6% at the spiked levels of 0. 5, 1. 0 and 5. 0 μg / L using river water and sea water as blank samples. The developed method is suitable for the analysis of trace semicarbazide in environment water samples.
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A rapid and sensitive method for the determination of trace carbaryl in water by using diallyl phthalate-europium ( Eu3+) as fluorescent probes was developed. The interaction between Eu3+ and diallyl phthalate and carbaryl was studied by high resolution mass spectrum, and the fluorescence spectra change of complexes before/after binding with carbaryl was also investigated. The influence factors of fluorescence intensity including solution pH and interferent were studied. The results showed that two diallyl phthalate molecules were complexed with one Eu3+to form stable complexes. Carbaryl could also interact with the probe to form multiple complexes, which significantly increased the fluorescent efficiency of the probe. At pH 9. 0 of solution and by using 245/615 nm as excitation/emission wavelength, the fluorescence intensity showed good linear relationship with the carbaryl concentration ranged from 6. 25í10-8 mol/L to 2. 50í10-6 mol/L, and the linear correlation coefficient was 0. 9968. The detection limit of the method was 9. 6í10-9 mol/L. Water samples were extracted by acetonitrile, and then detected by europium ( Eu3+)-diallyl phthalate fluorescent probe. The recovery of the method was 91. 8%-94. 5%, while RSD was within 6. 1%. The method is suitable for the rapid determination of carbaryl in water samples.
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Objective To evaluate the effect of combination therapy of tolterodine and tamsulosin in improving symptoms in patients with indwelling double-J ureteral stents.Methods A total of 96 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease,which were prospectively randomized ( random numbers table) into two groups.The tamsulosin group ( n =48) was administered tamsulosin 0.2 mg once daily,the combination group (n =48) was administcred tamsulosin 0.2 mg once daily and tolterodine 2 mg twice daily.All the patients completed a validated Ureteral Stent Symptom Questionnaire (USSQ),the Overactive Bladder Symptom Score (OABSS),the International Prostate Symptom Score (IPSS) one day before he placement and 4 weeks after stent placement of stent.Results The mean urinary symptom index score (25.4 ± 4.0 vs 15.3 ± 2.9,P ＜ 0.0001 ),the mean pain index score (15.0 ±2.6 vs10.3 ±2.1,P ＜0.0001),the mean general health index score (15.4 ±2.2 vs 11.0±1.5,P＜0.0001),the work performance index score (13.0±2.2vs9.7±1.9,P＜0.0001),the sex index score (3.6 ± 1.1 vs 2.2 ± 0.9,P ＜0.0001 ) improved significantly in combination group than those in tamsulosin group.There was a statistically significant difference between tamsulosin group and combination group in the IPSS score ( 12.8 ± 2.0 vs 9.2 ± 1.7,P ＜ 0.0001 ) and OABSS score ( 6.7 ± 1.4 vs 4.2 ± 1.4,P ＜ 0.0001 ) at the 4 weekfollow-up.Conclusions Indwelling ureteral stents have a significant impact on health related quality of life.It is effective for improving symptoms in patients with indwelling double-J ureteral stents by combination therapy with tolterodine and tamsulosin.