High power lateral green laser assisted non-blocking laparoscopic partial nephrectomy for T 1a renal tumors / 中华泌尿外科杂志

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

Initial application experience of six-step method high power side-emitting greenlight laser transurethral anatomical vapor incision technique for the treatment of benign prostate hyperplasia / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of transurethral anatomical vapor incision technique of prostate (VIT) with six-step method high power side-emitting greenlight laser in the treatment of benign prostatic hyperplasia (BPH).Methods:A retrospective analysis of 82 patients with BPH who used high power side-out green laser in the treatment from October 2018 to June 2020 in Gongli Hospital of Naval Medical University was performed. Among them, 40 patients were treated with six-step method VIT, and 42 patients were treated with photoselective vaporization of prostate (PVP). The two groups of patients were compared in age [(71.1±8.7)years vs.(72.1±7.0)years], prostate volume [75 (68.25, 89.00) ml vs. 73 (63.25, 85.00) ml], and peak urinary flow rate (Q max) [6.20 (5.20, 8.20) ) ml/s vs. 5.9 (4.75, 7.50) ml/s], post-void residual volume (PVR) [74.00 (42.50, 103.75) ml vs. 67.00 (58.00, 84.50) ml], international prostate symptom score (IPSS) [(21.2±5.2) vs. ( 21.0±3.9)], quality of life score (QOL) [5 (4, 6) vs. 5 (4, 6) ], prostate specific antigen (PSA) [6.20 (4.12, 8.43) ng/ml vs. 5.40 (3.88, 7.13) ng/ml ]. In general, there was no statistical difference ( P>0.05). The VIT group adopts the six-step method of marking, removing film, grooving, excision, trimming and crushing. In the PVP group, the prostate tissue was uniformly vaporized layer by layer from the inside to the outside. Perioperative indexes and complications were compared between the two groups. The Q max, IPSS, QOL, PVR and PSA between the two groups before and 3 months after surgery were compared. Results:All patients in the VIT group and PVP group successfully completed the surgery, and there was no case of transfer to TURP or open surgery. The average operation time was [60.00(50.00, 73.75)min vs. 70.00(50.00, 73.75)min] ( P<0.05). There was no significant difference in the amount of postoperative hemoglobin decline[15.00(10.00, 17.75)g/L vs. 16.00(14.00, 19.25)g/L], average bladder irrigation time[1(1, 1)d vs. 1(1, 1)d], indwelling catheterization time[3(3, 3)]d vs. 3(3, 3)d] and hospitalization time in patients after operation[4(3, 4)d vs. 4(4, 4)d] ( P>0.05). All patients had no blood transfusion, second bleeding, readmission, TURS, urethral stricture and urinary incontinence.There were 2 cases (5.0%) of postoperative urinary tract infection in the VIT group and 9 cases (21.4%) of postoperative urinary tract infection in the PVP group ( P<0.05), and they were cured after anti-inflammatory treatment. Three months after operation, Q max, IPSS, QOL, PVR and PSA in the two groups were significantly improved compared with preoperatively. Among them, the differences of IPSS [(5.7±2.5) points vs. (7.5±2.8) points] and PSA [2.65(2.10, 3.90)ng/ml vs. 4.00(2.45, 4.45)ng/ml] in the VIT group and PVP group after operation were statistically significant ( P<0.05). Conclusions:Applying the six-step method high power side-emitting greenlight laser transurethral anatomical VIT to treat BPH, there is less intraoperative and postoperative bleeding, short operation time, significant decrease in PSA, and fewer complications. It is a safe and effective minimally invasive technology for the treatment of BPH.

Preliminary experience in guiding individualized targeted therapy of advanced metastatic renal cell carcinoma with gene detection technology / 中华泌尿外科杂志

Objective To explore the efficacy and tolerance of adverse reactions of gene detection technique in guiding individualized targeted therapy for advanced metastatic renal cell carcinoma.Methods Retrospective analysis was performed on the clinical data of 62 patients with advanced metastatic renal cell carcinoma before and after receiving targeted drug treatment in our department from October 2015 to October 2017.Among the 62 patients,there were 36 males and 26 females,with an average age of (54 ± 13) years old.16 patients were treated with sunitinib,20 patients were treated with sorafenib and 26 patients were treated with pazopanib.A total of 28 patients (individualized group) were selected to receive targeted drug according to the results of gene detection,and 34 patients were treated with targeted drug empirically (empirical group).In individualized group,there were 17 males and 11 females with the average age of (51.3 ± 15.6) years old.20 patients accepted the operation.The distant metastasis included bone metastasis in 21 cases,lung metastasis in 7 cases,liver metastasis in 16 cases,epidermal metastasis in 4 cases and lymphatic metastasis in 14 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 15,7,6,respectively.7 patients were treated with sunitinib,8 patients were treated with sorafenib and 13 patients were treated with pazopanib.In empirical group,there were 19 males and 15 females with the average age of (56.3 ± 10.1) years old.22 patients accepted the operation.The distant metastasis included bone metastasis in 20 cases,lung metastasis in 5 cases,liver metastasis in 13 cases,epidermal metastasis in 3 cases and lymphatic metastasis in 15 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 20,g,6,respectively.9 patients were treated with sunitinib,12 patients were treated with sorafenib and 13 patients were treated with pazopanib.The baseline characteristics of the two groups of patients,including gender,age,whether operation was performed,site of metastasis,and risk of MSKCC,didn't show significant difference.Patients in both groups received the standard treatment regimen and the follow-up duration was 4-26 months to observe the efficacy,progression-free survival and tolerance to adverse reactions of the targeted therapy.Results After 12 months of treatment,15 patients in the individualized group was recorded objective remission.7 patients in the empirical group was recorded objective remission,as well.The tumor control efficacy of the individualized group was significantly better than that of the empirical group (46.4％ vs.20.6％,P =0.03).Meanwhile,the median progression-free survival time (15.2 months,3.7-24.2 months) in the individualized group was significantly longer than that in the empirical group (12.1 months,2.8-22.1 months) (P =0.009).Compared with the empirical group,the higher incidence of targeted treatment-related adverse reactions occurred in the individualized group,including thrombocytopenia (46.4％ vs.17.6％ P =0.014),leukopenia (46.4％ vs.17.6％ P =0.005),hypertension (71.4％ vs.44.1％,P =0.031) and hypothyroidism(60.7％ vs.29.4％,P=0.013).Conclusions Compared with the patients with empirical drugs,the application of gene detection technique to select individualized targeted drugs for the treatment of advanced metastatic renal cancer is obvious curatively effective,and to a certain extent extends the progression-free survival time of patients.

The planning, simulating and executing for the surgery of bilateral renal masses used the three-dimensional intelligent qualitative and quantitative analysis system(IQQA) / 中华泌尿外科杂志

Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning,simulation and implementation of precise surgery for bilateral renal tumors.Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed.There were 5 males and 2 females,with an average age of (54.6 ± 6.0) years,ranging 47.0-63.0 years.The average BMI index was (23.4 ± 2.4) kg/m2,ranging 21.2-28.0 kg/m2.The average diameter of 14 renal tumors in 7 patients was (3.8 ± 1.1) cm,ranging 1.9-5.3 cm.The average R.E.N.A.L score was 6.6 ± 1.2,ranging 5.0-9.0.The tumor stage was T1N0M0.The mean preoperative hemoglobin,albumin,creatinine and GFR were (138.6 ± 17.0)g/L and (47.3 ± 2.5 g/L),(51.6 ± 19.1) μmol/Land (56.9 ± 6.7) ml/min,respectively.Before operation,the original data of CT were input into IQQA system.Then we reconstructed kidney,blood vessel,collecting system and tumors using system.And the structure of kidney,tumors and vessels was visualized directly.The systematic analysis of the operation is carried out at terminals vary from various angles,and the surgical resection simulation.The position,angle and curvature of the cut surface are adjusted according to the effect.The plan of partial nephrectomy is designed.The resection area,remaining area of kidney is calculated.In this way,we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation.Last,we carried out the operation according to the designed plan.The laparoscopic standard partial nephrectomy was performed in 11 cases.The laparoscopic selective partial nephrectomy was performed in 2 cases.One underwent laparoscopic partial nephrectomy without obstruction.We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture.We collected of the surgical success rate,conversion to opening rate,operation time,warm ischemia time,intraoperative bleeding volume,complications and hospitalization after operation.The related laboratory indicators such as eGFR and creatinine were followed up for 3 months,and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed.Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients.The operations were completed successfully without conversion to open surgery or radical nephrectomy.The average operative duration was (68.9 ± 9.2) minutes,ranging 50.0-80.0 minutes.The average renal artery occlusion duration was (20.7 ± 4.1) minutes,ranging 15.0-29.0 minutes.The average intraoperative bleeding volume was (70.7 ± 29.7) ml,ranging 30.0-120.0 ml.The average indwelling time of drainage tube was (5.5 s0.7) days,ranging 5.0-7.0 days.The average hospitalization time was (6.3 ± 0.5) days,ranging 6.0-7.0 days.There were no perioperative complications such as bleeding,urinary leakage,infection,incision dehiscence and pulmonary infection.Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma.No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up.The creatinine and GFR in 3 months after operation were (52.0 ± 15.2) μmol/L(36.0-72.0 μmol/L) and (56.7 ± 5.3) ml/min(46.7-66.3 ml/min).There was no significant difference of creatinine and GFR with the preoperative (P ＞ 0.05).The mean Hb and albumin levels in 3 months after operation were (120.9 ± 17.0) g/L(90.0-147.0 g/L) and (41.4 ± 2.6) g/L (38.0-46.0 g/L),which were significantly lower than those before operation (P ＜ 0.05).Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney,tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction.The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney,and protect the renal function to the greatest extent.To accurately predict the retention of renal function after operation,so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy.

Clinical application of 3D printing combined with 3D laparoscopy in partial nephron-sparing surgery for partial endogenous renal cell carcinoma / 中华泌尿外科杂志

Objective To investigate the clinical feasibility and effectiveness of 3-D printing (3DP) combined with 3-D laparoscopic nephron-sparing surgery (LNSS) for partial endogenous renal cell carcinoma.Methods A retrospective analysis was made of the clinical data of 79 patients with partial endogenous renal cell carcinoma who were admitted to our department from July 2015 to October 2018.There were 46 males and 33 females.Their average age was (50.9 ± 7.9) years old,ranged from 33 to 68 years old.Tumor stages were T1aN0M0 in 53 cases and T1bN0M0 in 26 cases.The preoperative serum creatinine ranged from 40 to 107 μmol/L,with an average of (72.4 ± 14.2) μmol/L.The preoperative GFR ranged from 19 to 54 ml/min,with an average of (40.2 ± 6.2) ml/min.Thirty-four patients underwent 2-D laparoscopic nephron-sparing surgery (2DLNSS) based on preoperative enhanced CT scans.Forty-five patients underwent 3-D printing (3DP) based on three-dimensional reconstruction of renal CT scans.Seventeen patients underwent 2-D laparoscopic nephron-sparing surgery guided by 3-D printing model(3DP-2DLNSS),and 28 patients underwent 3-D laparoscopic nephron-sparing surgery guided by 3-D printing (3DP-3DLNSS).Serum creatinine levels ranged from 42 to 122 μmol/L with an average of (86.3 ± 14.8) μmol/L,and creatinine levels ranged from 8 to 66 μmol/L with an average of (19.1 ± 14.1) μmol/L.Six months after operation,the GFR of the kidney was 9-36 ml/min with an average of (21.4 ± 6.4)ml/min,and the fluctuation range was 6-40 ml/min with an average of (19.2 ± 8.8) ml/min.There was no statistical difference in the incidence of complications and pathological types after operation.Results There was no statistical difference in general data of preoperative patients.In intraoperative and post-operative statistics,the time of exploring renal artery was shorter than that of 2DLNSS (33.7 ± 7.5) min in 3DP-2DLNSS (28.3 ± 8.2,P =0.015) min and 3DP-3DLNSS (27.8 ± 6.5,P =0.002) min.In tumor detection time,3 DP-2DLNSS was shorter than 2DLNSS group (41.2 ± 6.6 vs.46.5 ± 6.9 min,P =0.012),and 3 DP-3DLNSS was shorter than 3DP-2DLNSS (35.4 ± 7.3 vs.41.2 ± 6.6 min,P =0.009).In warm ischemia time,3DP-2DLNSS min was shorter than 2DLNSS (23.5 ±9.7 vs.33.9 ±7.5 min P ＜0.001),and 3DP-3DLNSS was shorter than 3DP-2DLNSS (18.3 ± 4.6 vs.23.5 ± 9.7,P =0.023).In surgical time,3DP-2DLNSS (115.7 ± 23.0) min and 3DP-3DLNSS (103.3 ± 22.8) min were shorter than 2DLNSS (132.4 ± 28.9) min (P =0.031,P ＜ 0.001).In intraoperative bleeding volume,3 DP-3 DLNSS was less than 2DLNSS (117.9 ± 17.9 vs.130.6 ± 16.8,P =0.009) ml.Fasting for 1 to 4 days after operation,with an average of (1.7 ± 0.8) days.The indwelling catheterization ranged from 1 to 8 days after operation,with an average of (3.9 ± 1.3) days.Negative pressure drainage was removed 2-9 days after operation,with an average of (4.9 ± 1.4) days.And the hospitalization 5-11 days after operation,with an average of (7.3 ± 1.5) days.Conclusions Preoperative 3D printing combined with intraoperative 3D laparoscopic nephron sparing surgery for partial endogenous renal tumors is safe and effective,which is superior to the previous CT scan alone and intraoperative 2D laparoscopic treatment.

Application of early sequential unclamping method in laparoscopic partial nephrectomy for patients with T1b renal tumor / 中华泌尿外科杂志

Objective To analyze the value of early sequential unclamping method in laparoscopic partial nephrectomy.Methods From April 2017 to October 2017,a total of 8 cases of renal tumor patients by early sequential unclamping method of laparoscopic partial nephrectomy (LPN) were reviewed,with 5 males and 3 females and average age of 56.4 years (43-70 years).Three cases of renal tumor were located on the left side,5 cases on the right side.The mean tumor diameter was 5.6 (4.6-6.4) cm.The preoperativeR.E.N.A.L.score was 8.8 (7-10),and the mean ASA score was 1.4 (1-2).Preoperative serum creatinine level was 89.5 (72.1-104.2) μmol/L,and the GFR level of the kidney with tumor before operation was 55.5 (40.4-62.3) ml/min.The early sequential unclamping method was used for retroperitoneal laparoscopic partial nephrectomy:according to the preoperative CTA results,the main branches and branches of the renal artery were routinely separated.Before the tumor resection,the branches of renal artery and the main renal artery were sequentially blocked.After removal of the tumor,the first layer of bare kidney wound blood vessels and collection system were sutured and repaired.Then released the main renal artery occlusion clamp,restored most of the blood supply to the kidney,but kept the tumor-specific segmental renal artery blocked.Continuous suture of the kidney created a rough combination of the renal wound.After second layers of suture completed,unclamped the segmental renal artery and sutured the renal wound again,made the third layers of suture intersecting with the second seam suture to strengthen the hemostatic effect.Results All the 8 patients were performed LPN with early sequential unclamping method successfully.The average operative time was 132.5 (90-180) min,the intraoperative blood loss was 142.5 (100-200) ml,the completely warm ischemia time was 15.5 (12.0-20.0) min,and no blood transfusion was performed intraoperatively and postoperatively.The operative margin was negative.The postoperative pathology showed that 7 cases were clear cell carcinoma and 1 cases of papillary cell carcinoma.Postoperative complications such as urinary leakage,incision infection and fever were not found.Drainage tube removal time was 3.5 (3-5) days and the time of postoperative hospitalization was 4.8 (4-6) days.At 1 months after operation,the serum creatinine level was 94.0 (83.6-101.2) μmol/L and the GFR level of one side kidney with tumor was 52.3 (43.2-59.6) ml/min.After 2-9 months of follow-up,there was no recurrence of the tumor.Conclusions Early sequential unclamping method could shorten the warm ischemia time and reduce the risk of bleeding during the operation.It also maintains a clear operative field,which could reduce the difficulty of laparoscopic partial nephrectomy and make a more accurate tumor resection in the complex renal tumor patients.

Application of 3D printing technique combined with intra-operative ultrasound for completely endophytic renal tumor in laparoscopic surgery / 第二军医大学学报

Objective To explore the feasibility of 3D printing technique combined with intra-operative ultrasound for locating completely endophytic renal tumor in lapamscopic nephron-sparing surgery.Methods Fifteen patients with completely endophytic renal tumor,who undervwent 3D printing technique combined with intra-operative ultrasound assisted localization of laparoscopic partial nephrectomy from Mar.2014 to Mar.2016,received CT image 3D reconstruction and 3D printing kidney model using Fommlab Form1 + 3D printer before operation.Among 15 patients aging (55.7±10.5) years,11 patients were male and 4 were female;the tumor diameter was (2.8±1.0) cm;and 3 cases were ventral and 12 were dorsal,all had solitary tumors.The clinical data,including intra-operative blood loss,warm ischemia time,post-operative pathology and surgical margins,and post-operative renal function,were statistically analyzed in this study.Resuits Laparoscopic partial nephrectomy was successfully carried out in all cases:the average operation time was (105.0± 20.6) min,the average warm ischemia time was (22.8 ± 3.5) min,and the mean intra-operative blood loss was (87.3±15.8) mL.No case received blood transfusion during or after operation,and the average post-operative hospital stay was (6.7 ± 1.0) days.No obvious complication occurred after operation.The surgical margins were all negative.Post-operative pathology confirmed that 13 patients were with clear cell renal cell carcinoma,and 2 with papillary renal cell carcinoma.Patients were followed up for (23.7± 11.8) months,and nocontinuous deterioration of renal function or tumor recurrence was found.Conclusion Pre-operative 3D printing technique for patients with completely endophytic renal tumor can help to determine the tumor location and adjacent relationship,reducing the risk of surgery by guiding operation scheme.Meanwhile,propaganda and education using 3Dprinting kidney model can improve patients ' cognition to surgery and simplify pre-operative conversation process.Furthermore,utilizing intra-operative ultrasound to optimize tumor resection scheme can reduce the damage to the renalvessels and collection system,maximizing the clinical benefit by ensuring negative margin and renal function reservation.

Surgical strategy in treating synchronous sporadic bilateral renal cell carcinoma / 中华泌尿外科杂志

Objective To evaluate the impact of different surgical approach on postoperative renal function in patients with synchronous sporadic bilateral renal cell carcinoma ( SSBRCC) .Methods The medical records of 28 patients with SSBRCC were reviewed.Of all these cases, 21 patients were male and 7 were female, and the mean age was 51 ( 25-63 ) years.None of these cases had family history of renal carcinoma.The treatment and other clinical data were analyzed retrospectively.Results All of the 28 patients underwent bilateral surgeries.Single procedures were performed on 16 patients, of which, one underwent bilateral radical nephrectomy ( RN) , 8 bilateral nephron-sparing surgery ( NSS) and 7 unilateral NSS combined with contralateral RN.Staged procedures were performed on 12 patients, of which bilateral NSS was on 5 patients (NSS-NSS group), NSS followed by RN (NSS-RN group) on 3 patients and RN followed by NSS ( RN-NSS group) on 4 patients.In term of postoperative renal function preservation for SSBRCC patients, the standard NSS was better than RN.Between different staged procedures, NSS-NSS was the preferred choice, and the NSS-RN was superior to the RN-NSS.Conclusions In term of preservation of postoperative renal function, the staged procedures were recommended, and NSS was preferred in the first stage.In deciding the second stage surgical approaches, the surgeons should take the renal function preservation and the tumor size into consideration.

The trend of change and clinical significance of early-phase inflammatory indices after cervical fixation / 中国组织工程研究

BACKGROUND:The infection after spinal internal fixation was its serious complications. A number of studies have shown that erythrocyte sedimentation rate and C-reactive protein are of great importance in judging infections. OBJECTIVE:To analyze the trend of change of erythrocyte sedimentation rate and C-reactive protein for patients without infection after the cervical fixation. METHODS:Total y 56 patients, who underwent cervical fixation from October 2013 to July 2014, were retrospectively analyzed, and then divided into anterior cervical group (n=29) and posterior cervical group (n=27). Patients in the anterior cervical group underwent anterior cervical decompression bone graft internal fixation. Patients in the posterior cervical group underwent posterior cervical unilateral open door decompression internal fixation. The peripheral blood was col ected before fixation and at the early morning of the 1, 3, 6, 9 days after fixation. Erythrocyte sedimentation rate and C-reactive protein values were determined. The fol ow-up of patients was more than one year. Signs of infection did not appear. RESULTS AND CONCLUSION:(1) General rule:After the cervical fixation, the erythrocyte sedimentation rate was increased significantly and reached a peak on postoperative day 6. The peak level gradual y decreased but has not returned to normal at the 9 postoperative days. The C-reactive protein increased significantly on the first postoperative day and reached a peak on postoperative day 3. The peak level rapidly decreased but has not returned to normal at the 9 postoperative days. The level of erythrocyte sedimentation rate of patients in the posterior cervical group was significantly higher than that in the anterior cervical group at 3, 6 and 9 days after internal fixation (P0.05). (2) These results demonstrate that C-reactive protein is an important indicator of monitoring the inflammatory response of patients after cervical internal fixation, which was conductive to the judgment of early infection after internal fixation. The abnormal inflammatory indices of erythrocyte sedimentation rate and C-reactive protein do not suggest a presence of blade infection after internal fixation. C-reactive protein can reach the peak at 3 days after fixation. It is recommended to check blood at 2 and 3 days. If there is no apparent rebound, then the possibility of infection is smal . It may indicate the presence of infection if the inflammatory indices increased again or decreased slowly after the decrease.

Prognostic value of clinical and pathological factors for surgically treated localized clear cell renal cell carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical resection is the most effective treatment for renal cell carcinoma (RCC). Currently several prognostic factors and models are used for outcome prediction. However, whether intratumoral changes are independent prognostic factors for RCC or not remains unclear. The aim of the study was to investigate the prognostic roles of intratumoral changes in surgical treated localized clear cell renal cell carcinoma (ccRCC).</p><p><b>METHODS</b>Patients who received partial or radical nephrectomy between 2004 and 2009 in our center were retrospectively reviewed. Univariate and multivariate analyses were used to assess gender, age, body mass index (BMI), intratumoral hemorrhage, tumor necrosis, cystic degeneration, sarcomatoid change, Ki-67 expression, Fuhrman grade, and T stage on recurrence-free survival (RFS) and cancer-specific survival (CSS).</p><p><b>RESULTS</b>A total of 378 patients were included in our study. In univariate analysis, age, BMI, intratumoral hemorrhage, tumor necrosis, sarcomatoid change, Ki-67 expression level, Fuhrman grade, and T stage were prognostic factors for RFS. Age, BMI, tumor necrosis, sarcomatoid change, Ki-67 expression level, Fuhrman grade, and T stage were prognostic factors effecting CSS. In multivariate analysis, age, BMI, tumor necrosis, sarcomatoid change, Ki-67, Fuhrman grade, and T stage were independent prognostic factors for both RFS and CSS.</p><p><b>CONCLUSION</b>Intratumoral changes such as tumor necrosis and sarcomatoid change are independent prognostic factors for ccRCC.</p>

Preparation and in vitro Dissolution of Pioglitazone Hydrochloride Sustained-release Pellet Capsules / 中国药师

Objective:To prepare pioglitazone hydrochloride ( PGH) sustained-release pellet capsules and study the in vitro disso-lution. Methods:The preparation was prepared with a bottom spray fluidized bed, and the formula and technology were optimized by orthogonal test. Results:The method was simple and easy to operate, the reproducibility of the formula and technology was good, and the pellets had obvious sustained-release property. Conclusion:The formula and technology are easy and controllable, and the stability of sustained release pellets is good.

The anatomic relationship between the thoracic transverse process and adjacent bony structures / 中华创伤骨科杂志

Objective To study the anatomic relationship between the thoracic transverse process and adjacent bony structures and its clinical significance for thoracic screw fixation.Methods The present anatomic measurement used 45 dry cadaveric specimens of the normal adult thoracic vertebrae.We measured the distances from the horizontal midline of the transverse process to the superior,middle and inferior margius of the pedicle,the height of the anterolateral transverse process sheltered by ribs,and the position at the horizontal midline of the transverse process corresponding to the vertebral body.Results The horizontal midlines margius of the transverse processes of T1 to T10 are localized in the plane ranging from the superior to the inferior margins of the pedicle.The midlines of the transverse process are closer at T6 and T7 while more apart at T9 and T10.From T1 to T8,the anterolateral transverse process is totally or mostly sheltered by ribs,but the shelter is much less at T9 and T10.The horizontal midline of the transverse process corresponds to the upper 1/3 or middle 1/3 of the vertebral body.Conclusion Thoracic screw fixation across the transverse process to the vertebral body is safe,reliable and feasible in clinic.

Spinal sagittal imbalance in patients with osteoporotic vertebral compression fractures / 中国组织工程研究

BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. Al patients were subjected to percutaneous bal oon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing ful-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing ful-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P<0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P<0.05). In standing ful-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P<0.05). Al patients were fol owed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous bal oon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous bal oon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.

MRI and pathological discrimination of early pyogenic spondylitis from brucella spondylitis / 中国组织工程研究

BACKGROUND:Pathological examination and MRI have been widely used in clinic, but their combination is rarely reported in discrimination of early spine infections. OBJECTIVE:To determine the accuracy of pathology and MRI for discrimination between early pyogenic spondylitis and brucella spondylitis. METHODS:Twenty-two patients with pyogenic spondylitis and 20 patients with brucella spondylitis who had CT-guided percutaneous biopsy and MRI of the spine were retrospectively reviewed. Pathological observations included structure and activity of bone lesions, tissue cells and their main components;MRI observations included signal and sign changes at lesion sites. Statistical analysis was performed with the chi-square test. RESULTS AND CONCLUSION:The patients with pyogenic spondylitis had a significantly higher incidence of pathological and MRI findings as fol ows (P<0.05):neutrophil infiltration;intervertebral disc abnormal signal, location of vertebral body lesions anterior+posterior, obviously shape change in the vertebral body, paraspinal abnormal signal, presence of intraosseous or paraspinal abscess. Pathological and MRI examination was accurate for early differentiation of pyogenic spondylitis from brucella spondylitis.

Cultivating clinical medical interns' thinking ability in the clinical teaching of urology / 中华医学教育探索杂志

Cultivating Clinical thinking ability is an important tache of clinical medical education. Teachers'guidance, the charateristics that suit teaching, the organic combination of the active methods which can mobilize clinical medical interns' learning enthusiasm, such as problem-based learning, and humanity education are effective approaches to enhancing interns' clinical thinking ability.

The survival and prognosis of three common treatments for prostate carcinoma and the factors impacting on them / 中国癌症杂志

Background and purpose: The prognostic factors on survival for the patients with prostate carcinoma are still underdeterrnined. This study was to analyze the survival of three common treatment methods for prostate carcinoma and the prognostic factors on survival. Methods: 494 male patients who were diagnosed as prostate cancer were enrolled into the retrospective study. All of the data like age, stage, grade, PSA level, ALP, Hb and treatments were collected. Overall survival and disease specific survival rates for patients were analyzed by Kaplan-Meier method. Prognostic factors on disease specific survival were also analyzed by Log-rank test and Cox proportional hazards model. Results: Disease specific survival rates at 1, 3 and 5 year were 96.0%, 89.0% and 80.0% for all 494 patients, respectively. Disease specific survival rate at 3-year was 92.4% for brachytherapy, 100.0% for radical prostatectomy and 80.6% for hormonal therapy (P=0.008). Multivariate analysis by Cox model showed that stage, PSA level and age significantly impacted on disease specific survival. Conclusion: Brachytherapy and radical prostatectomy provides longer survival time than hormonal therapy for patients with prostate cancer. Clinical stage and PSA level and age of prostate cancer are independent factors impacting on survival significantly.

Primary signet ring cell carcinoma of the bladder (report of 3 cases and review of the literature) / 中国癌症杂志

Background and purpose: Primary signet ring cell carcinoma(SRCC) of the bladder is rarely diagnosed in the clinic. Few cases have been reported in the literature, so there was lack of understanding of the primary bladder SRCC in terms of diagnosis and treatment. Our study was to investigate the clinical features and treatment strategy for primary SRCC of the bladder and review the status of the disease along with the literature. Methods: 3 cases of primary bladder SRCC were studied, including clinical features, treatment, follow-up and their prognosis.The literature was reviewed. Results: All cases received ultrasound, computerized tomography, cystoscopy, biopsy and other related lab tests for diagnosis and differential diagnosis. Laparoscopic radical cystectomy and orthotopic ileal neobladders were performed in 2 cases, while the other case received laparoscopic radical cystectomy and ileal conduit diversion, Chemotherapy (cisplatin and 5-fluorouracil) was delivered in one case after surgery. One patient died at 6 months postoperatively because of multiple metastasis. The other 2 cases have been followed-up only for 8 and 12 months postoperatively, and no recurrence or metastasis have been observed. Conclusion: Primary SRCC of the bladder lacks distinctive clinical and imaging manifestations. The tumor grows very invasively. Radical cystcctomy is one of the optimal approaches for treatment of SRCC of bladder.

Clinical study of laporoscopic nephron sparing surgery for T1 renal cell carcinoma / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of laparoscopic nephron sparing surgery in the treatment of T1 renal cell carcinoma. Methods Thirty-two patients (24 males and 8 females) were diagnosed with T1 N0 M0 renal cell carcinoma by ultrasound, CT or MRI and un derwent laparoscopic nephron sparing surgery. The mean age was (49±2)years old (from 31 to 72 years old). The mean tumor diameter was (2.8±0.8)cm. There were 21 tumors in left kidney, 11 in right kidney. Of them, 10 tumors were in upper pole, 13 in lower pole, 5 in kidney center, 4 close to renal hilum, 18 in dorsal side and 14 in ventral side of the kidney. Tumor masses were resected with the surgical margin of 0. 5 cm. Twenty-five cases were done through retroperitoneal approach and 7 cases was done through transperitoneal approach. The pathological results showed that there were clear cell renal carcinoma in 28 cases, granule cell renal carcinoma in 3 cases and oncocytoma in 1 case. Renal function was examined by ECT before and after the surgery. Results Thirty-one cases under went laparoscopic nephron sparing surgery successfully and only one case converted to open surgery due to excessive intra-operative bleeding. The mean renal pedicle blocking time was (24±4)min (from 19 to 52 min). There were 3 cases having blocking time longer than 30 min (38 min, 45 min and 52 min) and accepted secondary blockage during the procedure. The mean operative time was (105 ± 15) rain. The mean estimated blood loss was (120±22)ml. Only 6 cases accepted 400 ml blood transfusion. D-J stents were placed in 5 eases with the tumor in kidney center before operation. In 3 cases with intra-operative exposure of renal calyx, D-J stems were placed after operation. Urine leakage in 2 eases were noted at 2 and 3 days and recovered at 15 and 21 days after operation. The mean hospital stay was (9±2)days. There was no recurrence in a mean follow-up time of (23±5)months. There were 3 cases with local hematoma (1 case of 4 cm × 3 cm, 2 cases of 2 cm×3 cm) in the surgical site confirmed by ultrasound or CT scan 1 month after surgery and they disappeared 3 months after the operation. Serum creatinine and urea nitrogen were all in normal range after operation. Compared with renal blood flow of the operated kidney before operation, there were 9 cases decreased by 10 %- 15 and 3 cases decreased by 20% at 15 days, 7 cases decreased by 10%-15% at 1 month and 3 cases decreased by 10%- 15% at (23 ± 5) months after operation. Conclusion Laparoscopic nephron sparing surgery is one of feasible and safe options for the treatment of T1 renal cell carcinoma.

Application of Problem-based Learning Teaching Mode in Urology Practice / 中华医学教育探索杂志

Problem-based learning(PBL) teaching mode was applied in Urology practice of the medical students.The externs were organized to analyze and discuss a real case,having grasped enough knowledge of relative diseases,and to provide their advice about the diagnosis and treatment,changing question mark into a full stop.And then their conclusions were verified by post-operational follow-up.PBL teaching mode can increase the students'study motivations and interests and the ability to resolve practical problems,master medical knowledge,train their clinical thinking and enhance the quality of teaching and thus it is an effective teaching mode.

Retroperitoneoscopic Radical Nephrectomy:Report of 108 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of retroperitoneoscopic radical nephrectomy.Methods From October 2001 to September 2006,a total of 108 patients underwent retroperitoneoscopic radical nephrectomy in our department.The tumors sized 1.0-8.0 cm in diameter with a mean of(4.3?2.9)cm.Before the operation,42 patients were in stage T1N0M0,54 in stage T2M0N0,and 12 in stage T3aN0M0.Results The operation time was 35-180 min with a mean of(63.5?30.3)min,and the blood loss was 20-1500 ml [mean,(75?23)ml].Totally 3 patients were converted to open surgery.The intra-and postoperative complications included hemorrhage caused by the injury of the inferior vena cava or renal artery(4 cases),wound infection(3 cases),and hypercapnia(8 cases).The patients were followed up for 6-36 months(over 12 months in 61 cases),during which 2 patients died of pulmonary metastasis one year after the surgery,1 patent died of liver metastasis 7 months after postoperation,the other 105 patients survived without tumor.The 1-year survival rate was 98.4%(60/61);and 3-year survival rate was 85.7%(18/21).Conclusions Retroperitoneoscopic radical nephrectomy is mini-invasive and effective for renal carcinoma.The patients recover quickly after the surgery.The procedure is worth being wildly used.