Three dimensional nephrometry system for partial nephrectomy: Our initial exploration / 北京大学学报(医学版)

OBJECTIVE@#To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value.@*METHODS@#The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed.@*RESULTS@#A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss (r=0.502, P=0.020; r=0.403, P=0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm3 and (33.0±36.4) cm3, respectively (P=0.229). The tumor volume was significantly related to the intraoperative blood loss (r=0.660, P < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications (r=0.410, P=0.041; r=0.587, P=0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation.@*CONCLUSION@#Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.

A case report of individualized treatment of high risk and volume metastatic prostate cancer / 中华泌尿外科杂志

A 69-year old man presented with high-risk metastatic prostate cancer. After 7 months of androgen deprivation therapy (ADT), he progressed to metastatic castration resistant prostate cancer. We suggested him comprehensive therapy, including Abiraterone, chemo-therapy, radio-therapy, platinum chemo-therapy and Enzalutamide, which proved effective with his long term survival.

Evaluation and prediction of therapeutic response to neoadjuvant androgen deprivation therapy for prostate cancer by diffusion weighted imaging / 中华泌尿外科杂志

Objective To evaluate the effect of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer on diffusion weighted imaging base on the pathological results after radical prostatectomy.Methods Medical records of 33 patients diagnosed with prostate cancer and treated with neoadjuvant androgen deprivation therapy and radical prostatectomy between January 2016 and September 2019 at Peking University First Hospital were retrospectively reviewed.Average age of patients was 67.7 (49-81) years old.All of the patients underwent prostate MRI examination before and after neoadjuvant ADT.Results Mean prostate volume after neoadjuvant ADT is 28.5 (6.25-113.76) em3,which decreased significantly by therapy (Z =-4.458,P ＜ 0.05).Apparent diffusion coefficient (ADC) values increased significantly in tumor (1.070 ± 0.325) vs.(0.828 ± 0.291) × 10-3 mm2/s (P ＜ 0.001) and decreased in benign prostatic tissue (P ＜ 0.05).Relative changes in ADC differed significantly between low-median level ISUP group and high level ISUP group (0.315 ± 0.173) vs.(0.164 ± 0.224) × 10-3 mm2/s (P ＜ 0.05),as well as obvious reaction group and focal reaction group(0.278 ± 0.21) vs.(0.094 ± 0.119) × 10-3 mm2/s (P ＜ 0.05).Conclusions There were significant,quantitative measurable changes of ADC value in prostate cancer after neoadjuvant ADT.DWI can be used to assess the efficacy of neoadjuvant ADT for prostate cancer as well as predicting pathological features.

Evaluating inferior vena cava wall invasion in renal cell carcinoma tumor thrombus with MRI / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the diagnostic performance of MRI for the assessment of inferior vena cava (IVC) wall invasion by IVC thrombus in patients with renal cell carcinoma (RCC).@*METHODS@#We retrospectively collected patients who underwent radical nephrectomy and thrombectomy for RCC between 2010 and 2018 at Peking University First Hospital. All the patients underwent imaging on a 1.5 Tesla or 3.0 Tesla MRI scanner. Fifty-six patients met the inclusion criteria. Preoperative imaging was reviewed by two radiologists blinded to details of the patient's surgical procedure and histopathology. Two radiologists measured the maximum anterior-posterior diameter and coronal diameters of the IVC and renal vein, and the craniocaudal extent of tumor thrombus, and evaluated the MRI features of IVC thrombus, including occlusion of the IVC lumen, the margin of the tumor thrombus (smooth vs. irregular), contact of the IVC thrombus and IVC wall, and altered signal of the IVC wall. Univariable and multivariable associations of clinical and radiographic features with IVC wall invasion were evaluated by Logistic regression.@*RESULTS@#Of the 56 patients [male: 43, female: 13, mean age: (55.64±0.43) years], 17 (30.36%) were detected with IVC wall invasion, and most were clear cell carcinoma. Tumor thrombus with IVC wall invasion showed an increase in length of IVC thrombus [(7.91±3.59) cm vs. (5.94±3.57) cm, P=0.049], and more features of complete occlusion of the IVC lumen (P=0.002), irregular margin of the IVC thrombs (P=0.005), contact of the IVC thrombus and IVC wall (P=0.001), and altered signal of the low-intensity vessel wall (P<0.001), with a sensitivity of 94.12% and a specificity of 79.49%.@*CONCLUSION@#The present study indicates that MRI could be a means of evaluating RCC with IVC wall invasion, and the combination of tumor thrombus length and subjective impression of IVC wall invasion achieved a high sensitivity and specificity for diagnosis.

Analysis on influencing factor of the complications of percutaneous dilational tracheotomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To Analyze the influence factors on the complications of percutaneous dilational tracheotomy.</p><p><b>METHODS</b>Between August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation.</p><p><b>RESULTS</b>Among 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P < 0.05). Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05).</p><p><b>CONCLUSION</b>Although percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.</p>

The Characteristics of Vestibular Autorotation Test in Patients with the Posterior Circulation Transient Ischemic Attacks / 听力学及言语疾病杂志

Objective To study the characteristics of vestibular autorotation test (VAT) in patients with the posterior circulation transient ischemic attacks(PCTIA) ,further reveal the pathogenesis vestibular function damage because of PCTIA .Methods VAT was performed on 41 patients with posterior circulation transient ischemic at‐tacks(PCTIA group) and 30 healthy controls(control group) .Parameters analyzed included gains ,phases and a‐symmetry of VAT .The positive result of the test could be defined if any of the paramaeters was abnormal .Results In the PCTIA group and control group ,gains were enhanced without being reduced as showed in 25 (62 .5% ,25/40) cases and 5(16 .7% ) ,respectively (χ2 =7 .09 ,P<0 .01) ,gains were enhanced with reduced as showed in 10(25% ) cases and 0(0% ) ,respectively (χ2 =8 .78 ,P<0 .01) .Conclusion The results of VAT in patients with the PCTIA can show gains enhanced with reduced in different frequency .VAT can provide valuable reference on positioning as‐sessment of vestibular system damage in patients with PCTIA .

Aerodynamic Measure of the Phonation in Patients with Vocal Polyps and Vocal Nodules / 听力学及言语疾病杂志

Objective To investigate the aerodynamic characteristics of vocal polyps and vocal nodules.Methods Aerodynamic parameters of 58 patients with vocal polyps or vocal nodules and 30 normal adults were measured by Aerophone Ⅱ Voice Function Analyzer.The mean airflow rate,intraoral pressure,glottal resistance,glottal efficiency were compared among different group.Results The mean airflow rate,glottal resistance and glottal efficiency of vocal polyps,vocal nodules and normal adult were 254.50±36.02 ml/s,33.55±4.63 cmH_2O/(L·S),2.46±1.49,177.45±25.93 ml/s,38.83±8.88 cmH_2O/(L·S),7.75±3.71,118.44±29.98 ml/s,53.04±8.64 cmH_2O/(L·S),9.17±3.87,respectively.The difference between them was significant(P＜0.01).The difference of intraoral pressure between vocal polyps (8.97±1.36 cmH_2O) and normal adult (6.24±0.99 cmH_2O) was significant (P＜0.01).The mean airflow rate,glottal resistance,glottal efficiency were significantly different between vocal polyps and vocal nodules(P＜0.01).Conclusion The degree of vocal fold adduct and the effciency of voice production in vocal polyps is worse than that of vocal nodules.The aerodynamic parameters can make quantifiable,objective assessment in voice function of vocal polyps and vocal nodules.

The analysis of smooth pursuit test in unilateral vestibular peripheral vertigo / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the result of smooth pursuit test(SPT) in unilateral vestibular peripheral vertigo and investigate its influencing factors.Method:Smooth pursuit test (SPT) and spontaneous nystagmus (SN)were examined in one hundred and eighty-five patients with unilateral peripheral vertigo(case group) and 51 normal persons(control group) by Video-Nystagmography (Synapsys, France), and the gain of SPT and SN were selected as the observation parameters in order to analyze the waveform and gain of SPT and the relativity between SN and the gain of SPT.Result:Of the 185 patients, 105(56.8%),72(38.9%) and 8(4.3%) cases producedⅠ,Ⅱ and Ⅲ waveforms respectively. Of these patients, 58(31.4%) demonstrated SN and none had Ⅳ waveform. While of 51 normal persons, 38(74.5%), 13(25.5%) persons producedⅠand Ⅱwaveforms repectively and there were no Ⅲ, Ⅳ waveforms or SN. There was statistical significance between the stong and weak gain of SPT in these two groups. Weak gain was significantly different between two groups. The stong and weak gain of SPT in case group were 0.86±0.06,0.80±0.06; 0.78±0.09, 0.65±0.1; 0.68±0.13, 0.45±0.12. The relativity between SN and the gain of SPT was positive when they had same direction(r_s=-0.63,P＜0.05)and negative when opposite (r_s=0.34,P＜0.05).Conclusion:Ⅰ,Ⅱ,Ⅲ three waveforms of SPT could appear in unilateral vestibular peripheral vertigo and the corresponding gains are gradually decreasing.SN is the influencing factor of SPT.

Objective evaluation of nasal ventilation function in healthy adults in Tianjin area / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To establish reference values of acoustic rhinometry, rhinomanometry and rhinospirometer in healthy adults in Tianjin area, analyze the effects of age,sex and side on the value, investigate the correlation of the measure values, offer the diagnosis date for test nasal ventilation function in Tianjin area.@*METHOD@#Four hundred and sixty-six healthy adults in Tianjin area were tested. A1 acoustic rhinometry was used to measure the minimum cross-sectional area (MCA), distance of the minimal cross-sectional area to the nostril (DCAN) and the nasal volume from 0-5 cm, 2-5 cm (V5, V2-5); At 150 Pa, 75 Pa and broms, NR6 Rhinomanometry was used to measure unilateral nasal inspiratory resistance (IR)and expiratory resistance (ER), bilateral nasal inspiratory and expiratory resistance (TIR and TER), and differences of the bilateral nasal resistance can be calculated; NV1 Rhinospirometer was used to measure unilateral inspiratory capacity (IC) and expiration capacity (EC), and the nasal partitioning ratio (NPR) can be calculated. Practical measure the distance of nostril to ahead of the inferior turbinate and compare with DCAN. Make the correlational analysis on different index of three exam.@*RESULT@#Reference values of acoustic rhinometry: MCA was (0.45 +/- 0. 16) cm2 for male, (0.44 +/- 0.16) cm2 for female; V2-5 was (3.52 +/- 1.38) cm3 for male, (3.36 +/- 1.22) cm3 for female, V5 was (5.10 +/- 1.47) cm3 for male, (4.86 +/- 1.12) cm3 for female; DCAN have two distance, (2.22 +/- 0.398, 0.53 +/- 0.625) cm was for male, (2.10 +/- 0.37, 0.67 +/- 0.15) cm was for female. No significant gender, side and age differences were shown in MCA, V5, V2-5. Significant gender differences were shown in DCAN but no side and age differences. Reference values of rhinomanometry: Significant gender but no side and age differences were shown in IR, ER, TIR, TER. Reference values of rhinospirometer: IC was (2.06 +/- 1.10) L/20 s for male, (1.37 +/- 0.34) L/20 s for female, EC was (2.15 +/- 1.23) L/20 s for male (1.39 +/- 0.58) L/20 s for female. NPRi was 0.11 [0.05, 0.23],NPRe was 0.11 [0.05, 0.19]. Significant gender but no side and age differences were shown in IC and EC. No gender and age differences were shown in NPRi and NPRe. There was significant correlation found between MCA and IR/ER/IC/EC, IR and IC, ER and EC, Rlr and NPRi/ NPRe.@*CONCLUSION@#Acoustic rhinometry,rhinomanometry and rhinospirometer can be useful reference values to evaluate nasal ventilation function, more value will be found if use the three together.

The analysis of smooth pursuit test in unilateral vestibular peripheral vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the result of smooth pursuit test (SPT) in unilateral vestibular peripheral vertigo and investigate its influencing factors.@*METHOD@#Smooth pursuit test (SPT) and spontaneous nystagmus (SN) were examined in one hundred and eighty-five patients with unilateral peripheral vertigo (case group) and 51 normal persons (control group) by Video-Nystagmography (Synapsis, France), and the gain of SPT and SN were selected as the observation parameters in order to analyze the waveform and gain of SPT and the relativity between SN and the gain of SPT.@*RESULT@#Of the 185 patients, 105 (56.8%), 72 (38.9%) and 8 (4.3%) cases produced I , II and III waveforms respectively. Of these patients, 58 (31.4%) demonstrated SN and none had IV waveform. While of 51 normal persons, 38 (74.5%), 13 (25.5%) persons produced I and II waveforms respectively and there were no III, IV waveforms or SN. There was statistical significance between the strong and weak gain of SPT in these two groups. Weak gain was significantly different between two groups. The strong and weak gain of SPT in case group were 0.86 +/- 0.06, 0.80 +/- 0.06; 0.78 +/- 0.09, 0.65 +/- 0.1; 0.68 +/- 0.13, 0.45 +/- 0.12. The relativity between SN and the gain of SPT was positive when they had same direction (r(s) = -0.63, P<0.05) and negative when opposite (r(s) = 0.34, P<0.05).@*CONCLUSION@#I , II, III three waveforms of SPT could appear in unilateral vestibular peripheral vertigo and the corresponding gains are gradually decreasing. SN is the influencing factor of SPT.