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Objective@#To explore the value of modified Chinese Version of Test for Respiratory and Asthma Control in Kids(TRACK) in the management of asthmatic children aged 0-5 years old by comparing with Global Ini-tiative for Asthma(GINA) guideline.@*Methods@#A total of 157 children aged 0-5 years old were enrolled at the Pedia-tric Asthma Outpatient Department of the Affiliated Hospital of Qingdao University from March to August 2018.All children were treated with individualized anti-asthma treatment for 3 months.After treatment, asthma experts assessed the level of asthma symptom control based on the GINA guideline, while caregivers of all children completed TRACK questionnaire.The optimal threshold of the TRACK questionnaire for asthma control was determined by analyzing receiver operating characteristic curve(ROC curve), and consistency of the 2 evaluation methods was compared.@*Results@#All enrolled children were divided into 3 groups based on GINA guideline: 59 children for the well controlled group, 52 children for the partly controlled group and 46 children for the uncontrolled group.There was a significant difference statistically in TRACK scores among the well controlled group [90(85, 95) scores], the partly controlled group [80(70, 85) scores] and the uncontrolled group [60(55, 65) scores] after treatment (H=101.740, P<0.001). Area under the ROC curve was 0.909 for diagnosing asthma control by the modified Chinese version of TRACK, with 80 scores for optimal threshold, 87.3% for sensitivity and 73.5% for specificity.The Kappa value of the consistency test between the TRACK questionnaire and the GINA guideline was 0.553, and consistency rate of these 2 evaluation methods was 77.1%.@*Conclusions@#The modified Chinese version of TRACK can be used as an effective assessment tool to monitor and manage asthmatic children aged 0-5 years.
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Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.
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Objective To summarize our experience in robotic-assisted laparoscopic surgery for adrenal diseases Methods The clinical data of 243 patients with adrenal tumor treated by robotic-assisted laparoscopic surgery from March 2010 to February 2017 were retrospectively reviewed.There were 99 men and 144 women.The mean age was 51.6 years (range, 19-84).Tumors located at left adrenal in 140 cases, right in 97 cases,and both sides in 6 cases.The average diameter was 3.32 cm (range, 0.8-12 cm).However, there were 41 cases whose tumor diameter were greater than 5 cm.Results There were 2 cases of conversion during operation, 1 case converted to open surgery and the other to the traditional laparoscope surgery.The mean operative time was 35 min (range, 20-130 min).Estimated blood loss was 80 ml (range,20-1 200 ml).Blood transfusion was needed in 6 cases.The mean postoperative hospital stay was 5d (range, 3-20 d).The pathological diagnosis included 37 cases of pheochromocytoma, 149 cases of cortical adenoma, 3 cases of cortical carcinoma, 5 cases of metastatic tumor, 9 cases of adrenal myelolipoma, 3 cases of adrenal cyst, 2 cases of bronchogenic cyst, 25 cases of adrenal nodular hyperplasia,2 cases of angiomyolipomas, 1 case of mature teratoma, 1 case of diffuse large B-Cell lymphoma, 1 case of angioma, and 4 cases of neurofibromatosis.Conclusions Robotic-assisted laparoscopic adrenalectomy was safe and effective.Robotic-assisted laparoscopic surgery has the advantages over laparoscopic surgery in treatment of complicated adrenal tumor, such as large adrenal tumors, pheochromocytoma, bilateral adrenal diseases, overweight and obese patients with adrenal diseases.
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Objective To evaluate the feasibility and advantages of robot-assisted laparoscopic radical prostatectomy (RALRP) in treating high-risk prostate cancer.Methods From Mar.2010 to Dec.2014,69 men with high-risk prostate cancer (clinical stage ≥ T3a,serum PSA ≥ 20 μg/L or biopsy Gleason score ≥8) underwent surgical treatment at our center.RALRP was performed in 44 cases,with a mean age of (66.7 ± 8.6) yrs (range:50 ～ 82) and a mean baseline PSA of (23.1 ± 11.2) μg/L (range:3.6-48.8).Transperitoneal approach was adopted in all cases.Twenty-five patients were treated with ORP.The mean age was (64.3 ± 5.9) yrs (range:52-75) and baseline PSA was (21.7 ± 10.2) μg/L (range:5.7-41.3).Baseline clinical features,including age,initial PSA,biopsy Gleason score and clinical staging,were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups.Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly (158 ± 47)min for RALRP group and (152± 42)min for ORP group,respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were (328 ± 254) ml and (8.4 ± 3.1) days,both of which were significant lower than those in ORP group,(674 ± 302) ml and (14.4 ± 3.7) days.Two cases of urine leak and two of lymphatic leak occurred after RALRP,and a statistically insignificantly higher complication rate was observed for the ORP group,in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5％ and 24％,respectively.After the mean follow-up of 25 (RALRP) and 27 months (ORP),continence rate was significantly higher in the RARLP group (93.2％ vs.72.0％).PSA failure was observed in seven RALRP cases (15.9％) and four ORP cases (16.0％).Conclusion Compared with traditional ORP,RALRP shows significant advantages,including less blood loss,fewer complications,shorter length of stay,better postoperative continence and equivalent oncologic outcome when dealing with high-risk prostate cancer cases.Robot-assisted surgery is a safe and efficacious surgical modality in this setting.
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Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .
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Objective To establish a rat model of chronic nonbacterial prostatitis (CNP) and investigate the histopathological characteristics of CNP in rat. Methods The prostate tissues of 4 male SD rats were taken out under aseptic condition,and prostate tissue homogenate supernate (PTHS) was made.Another 20 male SD rats were randomly divided into control group and CNP group with 10 rats each.Each rat of group CNP was immunized with 1.0 ml PTHS (20 mg/ml) emulsified by isopyknic Freund's complete adjuvant (FCA) intradermally in the multiple points,and simultaneously immunized with 0.5 ml pertussisdiphtheria-tetanus (PDT) vaccine intraperitoneally on 0 and 30th day.Each rat of control group was injected with equivalent normal saline in the same way.Rats from each group were sacrificed 45 days after immunization,and the prostates were harvested under aseptic condition.Prostatic tissues were examined macropathologically and histologically for degree of inflammation.Another 80 CNP rats were established after confirming success of the modeling.They were divided into high-dose androgen group (H),medial-dose androgen group (M),low-dose androgen group (L) and control group (C) with 20 in each.Rats of group H,M and L were injected with different concentrations of testosterone propionate ( 1,2,4 mg/ml).Rats of group C were injected with sterilized peanut oil.O.5 ml was applied through subcutaneous injection every other day.Each group was equally divided into 4 subgroups,in which the durations of medication were 1,2,4 and 6 weeks,respectively.After the expiration of the injection,animals from each subgroup were sacrificed and the macropathological and histological features of the prostatic tissues were examined as above. Results Macroscopic features of prostate tissues of group CNP at the 45th day were serious congestion and edema,adhesion with surrounding tissues,aneretic prostate capsule and so on.Histologically,the prostatic tissues were characterized by lymphoid tissue proliferation and chronic inflammatory cell infiltration in the stromal connective tissue around the acini or ducts.The rats of control group showed no inflammatory manifestations as above.After injection of testosterone propionate,the inflammatory degree of the CNP rats was lessen in varying degrees.For example,the destructive glands and stroma appeared repair and regeneration,the lymphoid tissue proliferation was alleviated,and the locations,ranges and amount of chronic inflammatory cell infiltration were also decreased.Furthermore,the relief of inflammatory degree had a positive correlation with the concentration and duration of testosterone propionate.The degree of inflammation in group C scarcely changed. Finally,the histopathological characteristics of CNP in rat model were summarized according to the results of histopathology,including inflammation locations,ranges and grades.Inflammation locations:①inflammation in the glands referred to the inflammatory cell infiltration in the ductal epithelium,alveolar epithelial and (or)glandular cavity; ②inflammation in the periglandular tissues referred to the inflammatory cell infiltration in the stroma and around the glandulartube; ③inflammation in the stroma referred to the inflammatory cell infiltration in the stroma without the glandulartube.Inflammation-rangeg:①focal inflammation indicates that the area of inflammatory cell infiltration was less than 10％ ; ②multifocal inflammation indicates that the area of inflammatory cell infiltration ranged from 10％ to 50％ ; ③diffuse inflammation indicates that the area of inflammatory cell infiltration was more than 50％.Inflammation grades:①grade Ⅰ meant that scattered inflammatory cells were in the specific area,cell count 1 - 10/HP; ②grade Ⅱ meant that inflammatory cell assembled without glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count l1 -20/HP; ③grade Ⅲ meant that inflammatory cell assembled with part of glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count ＞ 20/HP; ④grade Ⅳ meant that inflammatory cell assembled with a mass of glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count full field of vision/HP. Conclusions The CNP rat model can be established by immunized with syngeneic PTHS plus FCA and PDT.The histopathological characteristics of CNP in rat can be evaluated according to the locations,ranges and grades of inflammation,which serve for further research of pathogenesis and treatment of this disease.
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ObjectiveTo investigate the diagnosis and treatment of adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH). MethodsThe clinical data of 14 cases of AIMAH from August 1972 to July 2010 were retrospectively analyzed.The cases included 5 males and 9 females with a mean age of 45 (range 26 to 58 ) years.Ten patients demonstrated typical Cushing's syndrome (CS) and 4 patients presented with weight gain,hypertension or diabetes mellitus without any signs of CS.The circadian rhythm of serum cortisol was abnormal.Low and high dose dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.All patients underwent open surgery,including 5 cases of unilateral adrenalectomy,6 cases of adrenalectomy combined with contralateral subtotal adrenalectomy and 3 cases of bilateral adrenalectomy.ResultsIt was established by pathological examination that all patients had bilateral adrenal macronodular or adenomatoid hyperplasia.During the mean follow-up of 69 months (range 12 to 120 months),the clinical symptoms of CS disappeared after surgery in all cases.The 5 patients who received unilateral adrenalectomy had urinary free cortisol and serum cortisol within normal ranges and no further enlargement of the contralateral gland was noticed.Among the 3 patients who received bilateral adrenalectomy,1 case died of adrenal crisis on day seven post-operation.The remaining 2 cases presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy.Nelson's syndrome was not observed in the other patients.ConclusionsAIMAH has unique endocrinological and pathological features,presenting as an independent etiology of CS.Unilateral adrenalectomy appears to be an effective and safe alternative treatment for AIMAH and long-term remission can be achieved.Bilateral adrenalectomy or unilateral adrenalectomy combined with contralateral subtotal adrenalectomy may be performed if the symptoms have not improved or recurred after unilateral adrenalectomy.
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Objective To investigate the diagnosis and treatment of extra-adrenal pheochromocytoma(EAP). Methods The clinicsl data of 37 cases of EAP from April 2003 to April 2010 were retrospectively analyzed.Hypertension was observed in 31 cases.The typical triad of headache,palpitation and sweating was observed in 12 cases.The positive rate of plasma-free MNs and 24-hour urinary CA in diagnosing EAP was 96.8%(30/31) and 86.5% (32/37) respectively.The main localization diagnosis included ultrasonography,CT,MRI and 131I-MIBG,with positive rates of 91.7% (33/36),97.0%(32/33),90%(9/10) and 82.6%(19/23) respectively.Two patients underwent radiotherapy, and the remaining 35 cases underwent surgical treatment. Results Among the total of 37 cases,32 cases were single tumor,and five were multiple tumors.The anatomic locations of the single tumors were as follows: 14 wre adjacent to the abdominal aorta,seven in the bladder,four adjacent to the inferior vena cava,four adjacent to the renal hilum,two adjacent to the lilac blood vessel and one in the upper pole of the right kidney.Thirty cases underwent complete tumor resection,three cases underwent tumor resection plus right nephrectomy and two cases underwent partial cystectomy.Twenty-four cases were diagnosed benign and 11 cases were diagnosed malignant by pathological examination.Among 31 cases with preoperative hypertension,postoperative blood pressure returned to normal in 23 patients,blood pressure descended mildly in six cases and blood pressure was still hypertensive in two cases.Thirty-four patients were followed up for five months to seven years,during which five cases had tumor recurrence or metastases and five cases died postoperatively. Conclusions EAP is a rare neuroendocrine tumor and its accurate diagnosis is rather difficult.Plasma-free MNs and 24-hour urinary CA are important qualitative examinations.Ultrasonography,CT,MRI and 131I-MIBG scintigraphy are important methods for the localization of the tumor.Transperitoneal resection of the tumor is the preferred choice of management and adequate perioperative preparation is the key to a successful operation,including bringing down blood pressure,expanding blood volume and correcting arrhythmia.Patients with malignant EAP may be treated with 131I-MIBG after surgical therapy.