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OBJECTIVE@#To investigate the molecular mechanism underlying inherent fosfomycin resistance of Klebsiella pneumoniae (K. pneumoniae).@*METHODS@#The draft genomic sequences of 14 clinical hypervirulent/hypermucoviscous K. pneumoniae (HvKP/ HmKP) isolates were obtained using the next-generation sequencing technology. The genomic sequences were analyzed using the Resistance Gene Identifier (RGI) software for predicting the resistome based on homology and SNP models in the Comprehensive Antibiotic Resistance Database (CARD) and for identification of the presence of phosphomycin resistancerelated genes uhpt and fosA and their mutations in the bacterial genomes. The results were verified by analyzing a total of 521 full-length genomic sequences of K. pneumonia strains obtained from GenBank.@*RESULTS@#All the 14 clinical isolates of HvKP/ HmKP carried hexose phosphate transporter (UhpT) gene mutation, in which the glutamic acid was mutated to glutamine at 350aa (UhpTE350Q mutation); the presence of fosA6 gene was detected in 12 (85.71%) of the isolates and fosA5 gene was detected in the other 2 (14.29%) isolates. Analysis of the genomic sequences of 521 K. pneumonia strains from GenBank showed that 508 (97.50%) strains carried UhpTE350Q mutation, 439 (84.26%) strains harbored fosA6, and 80 (15.36%) strains harbored fosA5; 507 (97.31%) strains were found to have both UhpTE350Q mutation and fosA6/5 genes in the genome. Only 12 (2.30%) strains carried fosA6/5 genes without UhpTE350Q mutation; 1 (0.19%) strain had only UhpTE350Q mutation without fosA6/5 genes, and another strain contained neither UhpTE350Q mutation nor fosA6/5 genes.@*CONCLUSION@#UhpTE350Q mutation with the presence of fosA6/5 genes are ubiquitous in K. pneumonia genomes, indicating a possible intrinsic mechanism of fosfomycin resistance in the bacterium to limit the use of fosfomycin against infections caused by K. pneumoniae, especially the multi-resistant HvKP/HmKP strains.
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Fosfomycin , Klebsiella pneumoniae , Mutation , Databases, Factual , High-Throughput Nucleotide SequencingABSTRACT
The most toxic DNA damage is DNA double strand breaks (DSBs), which are mainly repaired by non-homologous end joining (NHEJ). DNA-dependent protein kinase (DNA-PK) belongs to phosphatidylinositol-3-kinase-related protein kinase family (PIKK) and plays a key role in NHEJ. DNA-PK is overexpressed in a variety of cancer cells and is related to the occurrence, development and drug resistance of malignant tumors. In this article, the representative DNA-PK inhibitors with anticancer effects are reviewed, in order to provide a reference to discovery novel DNA-PK inhibitors.
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Objective:To explore the correlation between self-efficacy and discharge readiness in patients with enterostomy.Methods:It was a cross-sectional study. Using the self-efficacy Scale and the Readiness for Discharge Scale as research tools, the patients who underwent enterostomy in the Department of General Surgery of Peking Union Medical College Hospital from December 2018 to December 2019 were conveniently selected for questionnaire survey. Statistical descriptive variables such as mean values, median values and frequency were used to investigate the current situation of self-efficacy and discharge readiness of patients with enterostomy. Pearson correlation analysis (or Spearman correlation analysis) was used to explore the correlation between self-efficacy and discharge readiness in these patients.Results:The total self-efficacy score of the 121 patients with enterostomy was (75.81±21.16) points, and the total discharge readiness score was (138.11±34.60) points. The total score of self-efficacy in the patients with enterostomy was positively correlated with the total score of readiness for hospital discharge ( r=0.379, P<0.01). No correlation was found between the self-condition dimension and the confidence and efficacy of sexual life ( r=0.125, P>0.05) and the confidence and efficacy of sexual life satisfaction ( r=0.062, P>0.05). The disease knowledge dimension was positively correlated with the following variables, self-efficacy score ( r=0.311, P<0.01), stoma care efficacy ( r=0.358, P<0.01), self-social efficacy ( r=0.227, P<0.05), diet choice efficacy ( r=0.221, P<0.05) and stoma self-care confidence efficacy ( r=0.249, P<0.01). The post-discharge coping ability dimension was positively correlated with the total score of self-efficacy ( r=0.428, P<0.01). Anticipatory social support dimension was positively correlated with self-efficacy ( r=0.218, P<0.05), self-social efficacy ( r=0.226, P<0.01), vitality confidence ( r=0.202, P<0.05) and stoma self-care confidence ( r=0.198, P<0.05). Conclusion:The self-efficacy level of patients with enterostomy can positively predict the level of readiness for discharge.
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Objective:To investigate the value of machine learning-based computed tomography (CT) images radiomics analysis in preoperative evaluation of surgical portal vein-superior mesenteric vein (PV-SMV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).Methods:The retrospective study was conducted with 156 consecutive PDAC patients who were underwent surgery at the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University between January 2010 and July 2021. There were 95 males and 61 females, with the age of (65.7±8.2) years. Patients were randomly split into training set and validation set by a ratio of 3∶2. Minimum redundancy maximum relevance was used to select radiomic features, which were extracted from contrast-enhanced CT images. Five machine learning classifiers were developed, and those models' area under the curve (AUC) values were compared with the conventional radiologic-feature-based evaluation.Results:Ninety-four and 52 patients were included into the training set and validation set, respectively. Their PV-SMV invasion rates were confirmed by intraoperative exploration with 31.9%(30/94) and 40.3%(25/61), respectively. Five models: LASSO regression, random forest, support vector machine, k-nearest neighbor and Naive Bayesian, were established based on ten features from CT images radiomics, and LASSO regression model achieved the highest AUC value compared with the other four models (all P<0.05). Compared with the conventional radiologic evaluation, the LASSO regression model had higher AUC (0.920 vs. 0.752) and sensitivity (92.0% vs. 86.5%)(both P<0.05). Conclusion:Machine learning-based CT images radiomics analysis can be used to evaluate PV-SMV invasion status preoperatively in PDAC. The LASSO regression model showed better performance than the conventional radiologic evaluation.
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Objective: To analyze the dynamic changes and influencing factors of HIV-1 DNA load in HIV-1 infected individuals under antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture, Yunnan province, and provide information support for the clinical use of HIV-1 DNA quantitative detection. Methods: The HIV infection cases in recent infection cohort from Dehong Center for Disease Control and Prevention during 2009-2018 were selected as study subjects. The dynamic curve of HIV-1 DNA load varrying with time was generated and logistic regression analysis was conducted to identify the risk factors for HIV-1 load in the recent follow up after ART and statistical analysis was performed by using SPSS 17.0. Results: Among the 113 HIV infection cases detected from the recent infection cohort, the recent HIV infection rate were 49.6%(56/113) males, sexual transmission cases and drug injection transmission cases accounted for 53.1% (60/113), 80.5% (91/113) and 19.5% (22/113), respectively. The dynamic changes curve showed that HIV-1 DNA load was relatively high (>800 copies /106 PBMCs) before ART, and droped rapidly (<400 copies /106 PBMCs) after ART for 1 year. However, HIV-1 DNA load decreased insignificantly from the second year of ART, and remained to be 269 copies/106 PBMCs after ART for 6 years. Univariable logistic regression analysis indicated that OR (95%CI) of CD8, CD4/CD8 and HIV-1 DNA load were 1.00 (1.00-1.00), 0.30 (0.09-1.05) and 1.01 (1.00-1.01), respectively. Multivariable logistic regression analysis showed that OR value of HIV-1 DNA load base was 1.00 (1.00-1.01). Conclusions: HIV-1 DNA load decreased significantly in the first year of ART, then remained stable for years. HIV-1 DNA load base was the key factor associated with the decrease of HIV-1 DNA load, the lower the HIV-1 DNA load base, the lower HIV-1 DNA load. Therefore, earlier ART can contribute to the decrease of HIV-1 DNA load.
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Humans , Male , China/epidemiology , DNA/therapeutic use , HIV Infections/drug therapy , HIV Seropositivity , HIV-1/genetics , Viral LoadABSTRACT
OBJECTIVE@#To investigate the clinical characteristics, diagnosis and treatment of renal cell carcinoma with urinary tract tumor thrombus.@*METHODS@#From January 1, 2015 to December 31, 2019, patients with renal cell carcinoma complicated with urinary tract tumor thrombus who were hospitalized in the Peking University Third Hospital and Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. Meanwhile, we reviewed the literature, and the reported patients of renal cell carcinoma with urinary tract tumor thrombus were also included in our study. The basic information, clinical manifestations, treatment, pathological characteristics and follow-ups of all the patients were analyzed.@*RESULTS@#In our study, 6 patients from the two hospitals and 16 patients from previous literature reports were included. There were 13 males and 9 females with an average age of 54.7 years (22-79 years). Fifteen patients had renal cell carcinoma on the left side, 6 on the right side, and 1 on the unknown side. Gross hematuria was the most common chief complaint, including 18 patients. One patient complained of weight loss, 1 patient complained of microscopic hematuria, and 1 patient was found by ultrasound examination. Tumor thrombus was classified as grade Ⅰ in 9 cases (the tumor embolus protruded into the renal pelvis, but did not reach the ureteropelvic junction), grade Ⅱ in 10 cases (the tumor embolus protruded into the ureter, but not into the bladder), and grade Ⅲ in 3 cases (the tumor embolus passed through the ureter and protruded into the bladder). Only 11 patients were diagnosed with renal cell carcinoma before operation. Radical nephrectomy was performed in 9 cases and nephroureterectomy in 12 cases. In pathological diagnosis, there were 15 cases of clear cell renal cell carcinoma, 1 case of papillary renal cell carcinoma, 1 case of chromophobe cell carcinoma, 1 case of mixed cell renal cell carcinoma, 4 cases of renal cell carcinoma with undetermined classification. Eleven patients were followed up for 3-31 months, and 3 patients had lung metastasis within 6 months.@*CONCLUSION@#Renal cell carcinoma with urinary tract tumor thrombus is rare in clinic. It needs to be differentiated from renal pelvis carcinoma in diagnosis. The treatment principle can refer to general renal carcinoma. For locally advanced cases, complete resection is the best treatment, and its oncological prognosis needs more long-term and large-scale follow-up observation.
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy , Retrospective Studies , Thrombosis/surgery , Urologic NeoplasmsABSTRACT
Renal clear cell carcinoma metastasis to the gallbladder is rare. This paper reported a case of gallbladder metastasis of renal clear cell carcinoma detected after two years of left radical nephrectomy. The patient underwent laparoscopic cholecystectomy and followed by postoperative targeted therapy of sunitinib. No new metastasis was found after 5 months of follow-up.
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At present, the mechanism of scar formation in filtering area after glaucoma filtering surgery has not been fully understood.It is believed that stimulation of cytokines and growth factors during postoperative wound healing causes excessive activation of fibroblasts in the Tenon capsule, resulting in the deposition of extracellular matrix and scar formation.Long non-coding RNA (lncRNA) is a kind of RNA sequence that does not encode proteins.It can regulate cell proliferation, apoptosis and become a precursor of microRNA, and its specific expression has been proved and plays an important regulatory role in various fibrotic tissue.With the deepening of research, lncRNA has also been found to be involved in the formation and development of filtering bleb scarring after glaucoma filtering surgery.Previous studies have shown that lncRNA is specifically expressed in Tenon capsule tissues after glaucoma filtering surgery, and different lncRNAs can affect the proliferation of fibroblasts in Tenon capsule or the synthesis of extracellular matrix through different ways, which can affect the formation of fibroblasts scarring.In this article, the role of different lncRNAs in the proliferation of Tenon fibroblasts and its potential in treating bleb scarring were summarized so as to provide a new direction for the treatment of postsurgical scarring.
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Recently, acupuncture is the main treatment for peripheral nerve injury in animal experiments. The main diseases involved sciatic nerve injury, denervated skeletal muscle atrophy and diabetic peripheral neuropathy. Acupuncture can promote the regeneration and repair of peripheral nerve injury by regulating apoptosis, so as to improve the function of peripheral nerve. The mechanism is to regulate the apoptosis, Bcl-2 family, Caspase-3, Caspase-8, apoptotic factor-1 and the ligand expression, and regulate MAPK signal pathway and PI3K-Akt signaling pathway and endoplasmic reticulum stress pathway forinhibiting apoptosis.
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ObjectiveTo understand the infection of AIDS， syphilis， and gonorrhea in men who have sex with men （MSM）， and the factors influencing the acceptance of gonorrhea testing in Dehong Dai Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province. MethodsAcross-sectional survey was conducted to describe and analyze the acceptance of AIDS， syphilis， and gonorrhea testing among MSM tracked in Dehong Prefecture in 2018. ResultsA total of 385 MSM were included in the analysis， with a 100.0% HIV and syphilis testing rate. The HIV antibody positivity rate was 10.6% （41/385） and the positivity rate of syphilis antibody was 14.8%（57/385）. Only 30.4% of the subjects were willing to test for gonorrhea， and 13.7%（16/117）of them were test positive. Further multifactorial analysis revealed that local MSM and syphilis co-infected individuals were more likely to be tested for gonorrhea （aOR=2.48， 95%CI=1.33-4.65， P=0.004； aOR=2.59， 95%CI=1.43-4.71， P=0.002）. ConclusionThe positive rates of AIDS， syphilis and gonorrhea in MSM population in Dehong Prefecture are relatively high. Integrated interventions of STD/AIDS and gonorrhoea detection should be strengthened.
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ObjectiveTo understand the infection of AIDS， syphilis， and gonorrhea in men who have sex with men （MSM）， and the factors influencing the acceptance of gonorrhea testing in Dehong Dai Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province. MethodsAcross-sectional survey was conducted to describe and analyze the acceptance of AIDS， syphilis， and gonorrhea testing among MSM tracked in Dehong Prefecture in 2018. ResultsA total of 385 MSM were included in the analysis， with a 100.0% HIV and syphilis testing rate. The HIV antibody positivity rate was 10.6% （41/385） and the positivity rate of syphilis antibody was 14.8%（57/385）. Only 30.4% of the subjects were willing to test for gonorrhea， and 13.7%（16/117）of them were test positive. Further multifactorial analysis revealed that local MSM and syphilis co-infected individuals were more likely to be tested for gonorrhea （aOR=2.48， 95%CI=1.33-4.65， P=0.004； aOR=2.59， 95%CI=1.43-4.71， P=0.002）. ConclusionThe positive rates of AIDS， syphilis and gonorrhea in MSM population in Dehong Prefecture are relatively high. Integrated interventions of STD/AIDS and gonorrhoea detection should be strengthened.
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Objective:To investigate the correlation between the location and volume of cerebral microbleeds (CMBs) and lacunar infarction (LI) in patients with cerebral small vessel disease (CSVD).Methods:Participants from the CSVD cohort in the Department of Neurology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School of Nanjing University from February 2017 to March 2019 were enrolled retrospectively. All participants underwent magnetic resonance imaging scans, standardized clinical assessment and diagnosis. AccuBrain, an automatic brain segmentation and quantification software developed by the Chinese University of Hong Kong, was used to quantitatively analyze the volume of CMBs and white matter hyperintensities (WMHs). Ordered multi-class logistic regression analysis was used to determine the independent influencing factors of LI, and then multiple linear regression analysis was used to investigate the correlation between the volume of deep or infratentorial CMBs (DI-CMBs) and the number of LI. Results:A total of 317 patients with CSVD were included in the analysis, including 214 (67.5%) in the non-LI group, 43 (13.6%) in the single LI group, and 60 (18.9%) in the multiple LI group. The comparison of the three groups showed that older age, male, smoking, drinking, history of previous stroke or transient ischemic attack (TIA), lower levels of high-density lipoprotein cholesterol, larger CMBs and WMHs volume, higher enlarged perivascular spaces (EPVS) grade might be the risk factors for LI. Ordinal multivariable logistic regression analysis showed that male (odds ratio [ OR] 2.058, 95% confidence interval [ CI] 1.084-3.909; P=0.027), previous stroke or TIA history ( OR 1.962, 95% CI 1.089-3.535; P=0.025), larger WMH volume ( OR 8.716, 95% CI 4.034-18.832; P<0.001), higher EPVS grade ( OR 1.915, 95% CI 1.292-2.839; P=0.001), larger DI-CMB volume ( OR 1.022, 95% CI 1.006-1.038; P=0.008) or more DI-CMB number ( OR 1.187, 95% CI 1.005-1.403; P=0.044) were the independent related factors of LI. Multiple linear regression analysis showed that there was a significant correlation between the volume of DI-CMB and the number of LI ( r=0.330, P<0.001). Conclusion:In patients with CSVD, there is a significant correlation between DI-CMBs and LI.
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Objective@#The role of preoperative overt hepatic encephalopathy (OHE) in the neurophysiological mechanism of cognitive improvement after liver transplantation (LT) remains elusive. This study aimed to explore changes in sub-regional thalamic functional connectivity (FC) after LT and their relationship with neuropsychological improvement using resting-state functional MRI (rs-fMRI) data in cirrhotic patients with and without a history of OHE. @*Materials and Methods@#A total of 51 cirrhotic patients, divided into the OHE group (n = 21) and no-OHE group (n = 30), and 30 healthy controls were enrolled in this prospective study. Each patient underwent rs-fMRI before and 1 month after LT. Using 16 bilateral thalamic subregions as seeds, we conducted a seed-to-voxel FC analysis to compare the thalamic FC alterations before and after LT between the OHE and no-OHE groups, as well as differences in FC between the two groups of cirrhotic patients and the control group. Correction for multiple comparisons was conducted using the false discovery rate (p < 0.05). @*Results@#We found abnormally increased FC between the thalamic sub-region and prefrontal cortex, as well as an abnormally decreased FC between the bilateral thalamus in both OHE and no-OHE cirrhotic patients before LT, which returned to normal levels after LT. Compared with the no-OHE group, the OHE group exhibited more extensive abnormalities prior to LT, and the increased FC between the right thalamic subregions and right inferior parietal lobe was markedly reduced to normal levels after LT. @*Conclusion@#The renormalization of FC in the cortico-thalamic loop might be a neuro-substrate for the recovery of cognitive function after LT in cirrhotic patients. In addition, hyperconnectivity between thalamic subregions and the inferior parietal lobe might be an important feature of OHE. Changes in FC in the thalamus might be used as potential biomarkers for recovery of cognitive function after LT in cirrhotic patients.
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Objective:To analyze the research hotspot of advance care planning (ACP) at home and abroad, understand the research status and development trend of this field, and provide reference for the development of ACP in China.Methods:The recently literature of ACP through PubMed and Wan Fang database was searched, then bibliographic information data mining system and graph clustering tool kit cluster analysis were used.Results:A total of 2 717 articles were retrieved, extracted high frequency keywords that account for more than 50% of the total, including 35 domestic subject words and 89 foreign "main subject words+ sub-subject words" . Domestic research hotspots included: culture and value of ACP and advance directives, implementation and implementation status of ACP, research progress of ACP, research of ACP acceptance, attitudes and status of medical staff about ACP and advance directives. Foreign research hotspots included: the role of advance directives in ACP and its evaluation and application, influencing factors of ACP selection preference in terminal patients, status and methods of agency decision making, ACP and hospice care, the impact of end-of-life choices on care and quality of life, auxiliary decision-making mode of ACP.Conclusions:Although relevant research on ACP in China has been in the exploratory stage, there is still a gap in the breadth and depth of research at home and abroad. Research forms, objects and contents of ACP need to be deepened. In the future, the research should actively explore the new mode of ACP development in combination with China′s policy and cultural background.
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This paper analyzes the problems existing in the current theory of divergent meridian (""), such as the unclear route of divergent meridian, the controversy in the "---" and the lack of in-depth research on the theory of "", clarifies the source and privides insights. The author analyzed the word "" by means of the four proofreading methods combined with philology method to explore the origin of " ". The divergent meridians is the remnant of the original meridians system in the bamboo and silk documents, which was put into the meridians system after being sorted out by doctors. The twelve meridians are combined in two, forming the "" point, which is located in the neck, and has a great influence on the blood circulation of the head and neck. "" point and theory can guide the differentiation of acupuncture and moxibustion, and has an important guiding significance for the treatment of empirical, emergency and head and face diseases.
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Flexible ureteroscopic incision and drainage is an innovative surgical option for renal parapelvic cysts these years.Finding the thinnest part of the renal parapelvic cyst is the key point of the surgery.This paper reports two patients with renal parapelvic cysts treated with flexible ureteroscopic incision and drainage combined with All-Seeing needle.The operations were successful and had good outcomes with the two-year follow-up.
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Objective • To explore the relationship among depressive symptoms, attributional style and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder. Methods • Seventy patients with obsessive-compulsive disorder who met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM- ) were selected. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to evaluate the severity of obsessive-compulsive symptoms, the Beck Depression Inventor- Ⅱ (BDI- Ⅱ ) was used to measure the depressive symptoms, and the Attributional Style Questionnaire (ASQ) was used to measure the attributional style. The correlations among obsessive-compulsive symptoms, depressive symptoms and attributional style as well as the mediating role of obsessive-compulsive symptoms between attributional style and depressive symptoms were analyzed. Results • The globality dimension of negative events in attributional style was positively correlated with obsessive-compulsive symptoms and depressive symptoms (both P<0.05), and obsessive-compulsive symptoms were also positively correlated with depressive symptoms (P=0.000). The mediating effect analysis showed that the mediating role of obsessive-compulsive symptoms between the globality dimension of negative events and depressive symptoms was 0.105 (95%CI 0.031-0.218), with an mediating effect ratio of 44.20%. Conclusion • Obsessive-compulsive symptoms in patients with obsessive-compulsive disorder may play a completely mediating effect between the globality dimension of negative events in attribution style and depressive symptoms.
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Objective@#To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure.@*Methods@#A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded.@*Results@#All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax.@*Conclusions@#The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone).
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Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure.Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years'experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018.Of all the 58 patients,there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years.The calculi ranged from 9 mm to 93 mm,with the average of 26.5 mm.The separation of renal collecting system ranged from 5 mm to 30 mm,with the average of 15.1 mm.All of the 58 patients underwent one-stage PCNL and the numbers of punctures,the numbers of percutaneous tubes and the reasons for failure were recorded.Results All percutaneous tubes and surgeries were established and done successfully.Of all the 118 punctures,74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation).The total puncture success rate was 62.7％ (74/118).Of the total 74 successful punctures,56.8％ (42/74) succeeded at the first puncture,28.4％ (21/74)succeeded at the second puncture and 14.9％ (11/74)succeeded at least after three punctures.The success puncture rate of the 4 urologists were 59.2％ (29/49),64.1％ (25/39),66.7％ (16/24),66.7％ (4/6)respectively,and there were no statistical differences between the puncture success rates of the urologists (P =0.679).Each channel needed 1.7 punctures on average.Fouty-four punctures failed without detecting the urine,including 20 failed punctures because of the puncture tract deviation,17 punctures without seeing the urine after the core needle being removed,7 punctures no display on the ultrasound imagine.There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes.Five nephrostomy tubes'position were different with the preoperationally predicted position which means the discrepancy rate was 14.3％ (5/35).One patient had complications and classified as Grade Ⅱ or above on the modified Clavien Grading System of aerothorax.Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied.The main reasons of puncture failure are the deviation of puncture tract,unclear imaging of puncture tract and other unclear reasons (puncture needle went too deep or superficially or tip of the needle embedded into the stone).
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Objective To evaluate the diagnostic value of cardiac magnetic resonance (MR) for acute heart failure (AHF) with unknown cause. Methods A retrospective study was conducted, eleven patients with AHF with unknown cause admitted to Tianjin First Center Hospital from September 2017 to August 2018 were enrolled, and all the patients underwent complete cardiac MR imaging (plain MR and delayed enhancement imaging) with satisfactory image quality fulfilled the diagnostic requirement. Additionally, all of them had no history of heart disease and lack of diagnostic laboratory tests (routine blood test, blood biochemistry and myocardial enzyme), electrocardiogram (ECG) changes and echocardiography abnormality. Besides, 10 patients had completed invasive coronary angiography or coronary CT angiography (CCTA); the results of laboratory tests, ECG abnormality, echocardiography and cardiac MR were recorded, and the values of echocardiography and cardiac MR examination in the diagnosis and exploring the cause of patients with AHF with unknown cause were analyzed. Results Nine of 11 patients with AHF with unknown cause had positive finding on cardiac MR examination; there were 3 patients with chronic myocardial infarction, 3 with dilated cardiomyopathy, 2 with cardiac involvement of amyloidosis and 1 with myocarditis. The left ventricular end systolic volume (LVESV) measured on cardial MR was significantly higher than that on echocardiography (mL: 120.68±57.47 vs. 108.84±50.49, P < 0.05), the left ventricular ejection fraction (LVEF) and myocardial valvular regurgitation measured on MR were less than those on echocardiography (LVEF: 0.36±0.09 vs. 0.43±0.10; regurgitation: 11 vs. 22, both P < 0.05); while, the differences of the end diastolic volume (LVEDV) and the number of patients with pericardial effusions between MR and echocardiography had no statistical significant differences [LVEDV (mL): 183.37±65.26 vs. 182.26±70.44; pericardial effusion: 6 cases vs. 6 cases, all P > 0.05]. Conclusion Cardiac MR could synthetically evaluate the heart by its morphology, function as well as accompanied sign (pericardial effusion) and cardiac tissue characteristics; eventually, it may provide valuable information concerning the selection of proper clinical therapeutic strategies and improvement of AHF patients' prognose.