Pixel-based approach to delay multiply and sum beamforming in combination with Wiener filter for improving ultrasound image quality.

Unified pixel-based (PB) beamforming has been implemented for ultrasound imaging, offering significant enhancements in lateral resolution compared to the conventional dynamic focusing. However, it still suffers from clutter and off-axis artifacts, limiting the contrast resolution. This paper proposes an efficient method to improve image quality by integrating filtered delay multiply and sum (F-DMAS) into the framework. This hybrid strategy incorporates the spatial coherence of the received data into the beamforming process to improve contrast resolution and clutter rejection in the generated image. We also integrate a Wiener filter to suppress the spatiotemporal spreading using signals echoed from a single scatterer at the transmit focus as a kernel for the deconvolution. The Wiener filter is applied to the received waveforms before performing the hybrid strategy. The Wiener filter is shown to reduce interference due to the interaction between the excitation pulse and the transfer functions of the transducer elements, thus benefiting the axial resolution of the generated images. We validate the proposed method and compare it with other beamforming strategies through a series of experiments, including simulation, phantom, and in vivo studies. The results show that our approach can substantially improve both spatial resolution and contrast over the unified PB algorithm, while still maintaining the good features of this beamformer. The simplicity and good performance of our method show its potential for use in clinical applications.

Development and validation of Adaptability to Return-to-Work Scale (ARTWS) for cancer patients.

Introduction: The research on cancer patients returning to work in China is still in its infancy, and there is no research and discussion on the adaptability to return-to-work for cancer patients. It is critical to develop the Adaptability to Return-to-Work Scale (ARTWS) for cancer patients and evaluate its psychometric properties. Methods: The items of the initial scale were compiled based on the theoretical model and literature review results. Through two rounds of Delphi expert consultation (N = 15) and a pilot survey (N = 40), the initial scale was further checked and revised. Conduct a large sample survey (N = 376) and the construct validity and reliability of the ARTWS were assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results: The final ARTWS consisted of 24 items. "Focusing on rehabilitation," "Rebuilding Self-efficiency," and "Adjusting plans" as common factors in determining adaptability to return to work for cancer patients, and the cumulative variance contribution rate for these three factors was 66.6%. The S-CVI of the total scale was 0.979. The Cronbach's α coefficient was 0.937 and the 2-week test-retest reliability was 0.814. Discussion: ARTWS has good correlation validity and can be used as a tool to measure the adaptability of cancer patients' return to work. The presentation of the manuscript in Research Square (https://doi.org/10.21203/rs.3.rs-2323264/v1).

Improved ultrasound image quality with pixel-based beamforming using a Wiener-filter and a SNR-dependent coherence factor.

Pixel-based beamforming generates focused data by assuming that the waveforms received on a linear transducer array are composed of spherical pulses. It does not take into account the spatiotemporal spread in the data from the length of the excitation pulse or from the transfer functions of the transducer elements. As a result, these beamformers primarily have impacts on lateral, rather than axial, resolution. This paper proposes an efficient method to improve the axial resolution for pixel-based beamforming. We extend our field pattern analysis and show that the received waveforms should be passed through a Wiener filter before being used in the coherent pixel-based beamformer. This filter is designed based on signals echoed from a single scatterer at the transmit focus. The beamformer output is then combined with a coherence factor, that is adaptive to the signal-to-noise ratio, to improve the image contrast and suppress artifacts that have arisen during the filtering process. We validate the proposed method and compare it with other beamforming strategies using a series of experiments, including simulation, phantom and in vivo studies. It is shown to offer significant improvements in axial resolution and contrast over coherent pixel-based beamforming, as well as other spatial filters derived from synthetic aperture imaging. The method also demonstrates robustness to modeling errors in the experimental data. Overall, the imaging results show that the proposed approach has the potential to be of value in clinical applications.

Estimating the time of onset of testicular torsion using ultrasonography in an experimental rat model.

PURPOSE: We aimed to document the time of onset of ultrasonographic and histologic changes in the testes of a rat model following testicular torsion. METHODS: Twenty-five Sprague-Dawley rats were divided into four groups. All animals underwent preoperative Doppler ultrasonography. Groups 1, 2, and 3 underwent unilateral surgical torsion of the testis lasting for 72, 24, and 6 hours, respectively. Group 4 underwent a sham operation. The animals were followed with Doppler ultrasonography at 6, 24, 48, and 72 hours postoperatively. Histologic examinations were performed at the designated final time point for each group. RESULTS: After torsion, enlargement of the epididymal head and thickening of the spermatic cord over time were noted. Based on the ultrasonographic dimensions, the ratio of the epididymal volume increased with time following torsion (p=0.002). The torsed testes had an average weight gain of 0.27 g at 6 hours compared to the control testes, but an average weight loss of 0.22 g at 72 hours (P=0.006). Changes in testicular echotexture were noted as soon as 6 hours after torsion, but there was no consistent pattern of echotexture change thereafter. Histologically, viable tubules were seen 6 hours after torsion, while extensive hemorrhagic necrosis was found at 72 hours. CONCLUSION: In evaluating testicular torsion, the enlargement ratio of the epididymis and thickening of the spermatic cord on Doppler ultrasonography may be useful for determining the urgency of immediate surgery. Changes in testicular echotexture may not be a reliable indicator of the time of onset.

Robotic intracorporeal urinary diversion: technical details to improve time efficiency.

OBJECTIVES: To present time-efficiency data during our initial experience with intracorporeal urinary diversion and technical tips that may shorten operative time early in the learning curve. PATIENTS AND METHODS: Data were analyzed in the initial 37 consecutive patients undergoing robotic radical cystectomy and intracorporeal urinary diversion in whom detailed stepwise operative time data were available. Median age was 65 years and median body mass index was 27. Neoadjuvant chemotherapy was administered in 6 patients and 11 patients had clinical evidence of T3 or lymph node-positive disease. Each component of the operation was subdivided into specific steps and operative time for each step was prospectively recorded. Peri-operative and follow-up data up to 90 days and final pathological data were recorded. RESULTS: All procedures were completed intracorporeally and robotically without need for conversion to open surgery or extracorporeal diversion. Median total operative time was 387 vs 386 minutes (p=0.2) and median total console time was 361 vs 295 minutes (p<0.007) for orthotopic neobladder and ileal conduit, respectively. Median time for radical cystectomy was 77 minutes, extended pelvic lymph node dissection was 63 minutes, and diversion was 111 minutes (ileal conduit 92 minutes and orthotopic neobladder 124 minutes). Median estimated blood loss was 250 mL, and median hospital stay was 9 days. High grade (Clavien grade 3-5) complications at 30 and 90 days follow-up were recorded in 6 (16%) and 9 (24%) patients, respectively. Over a median follow-up of 16 months, 12 (32%) patients experienced disease recurrence and 9 (24%) died from bladder cancer. These correspond to 1-year recurrence-free and overall survival of 64% and 70%, respectively. CONCLUSIONS: Intracorporeal urinary diversion following robotic radical cystectomy can be safely performed and reproducible in a time-efficient manner even during the early learning curve.

Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles.

BACKGROUND: Robotic radical cystectomy (RC) for cancer is beginning to gain wider acceptance. Yet, the concomitant urinary diversion is typically performed extracorporeally at most centers, primarily because intracorporeal diversion is perceived as technically complex and arduous. Previous reports on robotic, intracorporeal, orthotopic neobladder may not have fully replicated established open principles of reservoir configuration, leading to concerns about long-term functional outcomes. OBJECTIVE: To illustrate step-by-step our technique for robotic, intracorporeal, orthotopic, ileal neobladder, urinary diversion with strict adherence to open surgical tenets. DESIGN, SETTING, AND PARTICIPANTS: From July 2010 to May 2012, 24 patients underwent robotic intracorporeal neobladder at a single tertiary cancer center. This report presents data on patients with a minimum of 3-mo follow-up (n=8). SURGICAL PROCEDURE: We performed robotic RC, extended lymphadenectomy to the inferior mesenteric artery, and complete intracorporeal diversion. Our surgical technique is demonstrated in the accompanying video. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Baseline demographics, pathology data, 90-d complications, and functional outcomes were assessed and compared with patients undergoing intracorporeal ileal conduit diversion (n=7). RESULTS AND LIMITATIONS: Robotic intracorporeal urinary diversion was successfully performed in 15 patients (neobladder: 8 patients, ileal conduit: 7 patients) with a minimum 90-d follow-up. Median age and body mass index were 68 yr and 27 kg/m2, respectively. In the neobladder cohort, median estimated blood loss was 225 ml (range: 100-700 ml), median time to regular diet was 5 d (range: 4-10 d), median hospital stay was 8 d (range: 5-27 d), and 30- and 90-d complications were Clavien grade 1-2 (n=5 and 0), Clavien grade 3-5 (n=2 and 1), respectively. This study is limited by small sample size and short follow-up period. CONCLUSIONS: An intracorporeal technique of robot-assisted orthotopic neobladder and ileal conduit is presented, wherein established open principles are diligently preserved. This step-wise approach is demonstrated to help shorten the learning curve of other surgeons contemplating robotic intracorporeal urinary diversion.

Large renal cavernous hemangioma with renal vein thrombosis: case report and review of literature.

Kidney cavernous hemangiomas are rare. Renal cavernous hemangioma complicated by secondary chronic thrombosis of the renal vein has not been previously reported. A 17-year-old boy was initially diagnosed with a renal mass with tumor thrombosis. Radical nephrectomy was performed, and the pathologic examination revealed a renal cavernous hemangioma with chronic renal vein thrombosis. We also reviewed the previous diagnostic and treatment methods described in previous reports.

Chinese urologists' practice patterns of diagnosing and treating chronic prostatitis: a questionnaire survey.

OBJECTIVES: To establish diagnostic and treatment practices for chronic prostatitis (CP) by surveying Chinese urologists. METHODS: A sample of 656 Chinese urologists from 29 provinces was surveyed using a questionnaire that explored attitudes and diagnostic and treatment patterns in the management of CP. RESULTS: A total of 627 (95.6%) urologists responded with valid questionnaires. More than one-third of the urologists were still not familiar with the National Institutes of Health's diagnostic categories. Only a minority of urologists perform specific lower urinary tract cultures. Although many Chinese urologists (64.6%) considered CP to be nonbacterial in nature, many (74.0%) still chose antibiotics as the first choice of therapy. Most urologists said they would prescribe antibiotics when bacterial culture was positive (64.4%), or when excessive leukocytes and/or pyocytes were present in expressed prostate secretions (65.9%). The second most commonly used pharmaceutical therapy was alpha-blockers (60.3%), which were prescribed by most urologists (70.3%) to relieve the obstructive voiding symptoms. The most commonly used nonpharmacologic therapies were psychotherapy (60.7%) and prostatic massage (54.2%). The beliefs regarding the cause affect the diagnostic and treatment strategies; meanwhile, the diagnostic practice has an influence on the selection of treatment methods. CONCLUSIONS: As seen in other countries, there is much confusion and frustration experienced by the Chinese urologists in the management of CP. This reflects the inability to identify the cause of voiding symptoms in many of the patients with CP and has likely led to the varied therapies that are used. It is necessary to improve their cognitive level about CP and standardize their practice pattern constantly.

Factors influencing the diagnosis and treatment of chronic prostatitis among urologists in China.

AIM: To identify the factors influencing diagnosis and treatment of chronic prostatitis (CP) among Chinese urologists. METHODS: A sample of 656 urologists from 29 provinces of China were asked to complete a questionnaire that explored attitudes towards CP as well as diagnosis and treatment patterns in the management of CP. Both univariate and multivariate logistic regression analysis schemes were used to determine the factors that influence the diagnosis and treatment of CP. RESULTS: A total of 656 questionnaires were given out. All were returned and 410 of those were included in the final univariate and multivariate analysis. Multivariate logistic regression analysis indicated that belief of bacterial infection in the etiology of CP (odds ratio [OR], 2.544; 95% confidence interval [CI], 1.650-3.923; P < 0.001) was the most significant factor influencing the routine performance of bacterial culture test. Using the same model, the type of hospital (OR, 2.799; 95% CI, 1.719-4.559; P < 0.001) and the routine use of the 4- or the 2-glass test (OR, 3.194; 95% CI, 2.069-4.931; P < 0.001) were determined to be significant factors influencing the use of the National Institutes of Health (NIH) new classification system. According to the same model, belief of bacterial infection in the etiology of CP (OR, 3.415; 95% CI, 2.024-5.762; P < 0.001) and the routine use of bacterial culture test (OR, 2.261; 95% CI, 1.364-3.749; P < 0.01) were important factors influencing the routine prescription of antibiotics. CONCLUSION: Our findings suggest that attitudes towards CP, and the characteristics of individual urologists' practices may influence the diagnosis and treatment of CP among Chinese urologists.

Giant prostatic utricle associated with proximal hypospadias: repair by mucosa divesting and muscular tunnel obliteration.

PURPOSE: The purpose of this study was to evaluate the effectiveness of a new approach to repair the giant prostatic utricle (pseudovagina) associated with proximal hypospadias. METHODS: Three patients with giant prostatic utricle associated with proximal hypospadias sought medical advice in our department from 1998 to 2003. The giant prostatic utricles were repaired using the novel approach of divesting of utricular mucosa followed by muscular tunnel obliteration through the opening of the pseudovagina in the dorsal lithotomy position. RESULTS: Follow-up ranges from 3 to 8 years. The divesting of the prostatic utricle mucosa was successful, and the pseudovagina muscular tunnel was closed completely in all 3 patients. One patient underwent urethroplasty and another repair of urethrocutaneous fistula at the same setting. The third patient underwent a second-stage urethroplasty separately. On follow-up, both the urethral reconstruction and the pseudovagina repair remained successful in all the patients. CONCLUSIONS: The technique of the divesting of the prostatic utricle mucosa and closure of the muscular wall is an effective alternative approach for repairing giant prostatic utricles. It is safe and simple. The surgical exposure is very good.

Penile torsion repair by suturing tunica albuginea to the pubic periosteum.

PURPOSE: The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children. METHODS: Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. RESULT: Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation. CONCLUSION: The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.

Access to urologic care for children in California: Medicaid versus private insurance.

OBJECTIVES: To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by private insurance. Medi-Cal (California State Medicaid) is a joint state and federal health insurance program that plays a significant role in providing healthcare coverage to low-income children. METHODS: A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with private insurance. RESULTS: Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with private insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal (P < 0.0001). Of the offices that would not see a child with Medi-Cal, 75% were unable to recommend a urology office that might accept Medi-Cal. CONCLUSIONS: Children insured by Medi-Cal have significantly less access to necessary urologic care compared with children with private insurance.

The management of old urethral injury in young girls: analysis of 44 cases.

BACKGROUND/PURPOSE: Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience. METHODS: Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients). RESULTS: Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up. CONCLUSIONS: Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.