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【Objective】 To effectively differentiate adrenal adenoma (AA) and small diameter pheochromocytoma (PCC) by establishing a clinical-radiomic nomogram model before surgery. 【Methods】 A total of 132 pathologically confirmed patients (45 PCC cases, 87 AA cases) were enrolled. After the features of enhanced CT were assessed, the radiomic features and related clinical indicators were extracted. Based on multiple Logistic regression, a clinical-radiomic nomogram with radiomic features and independent clinical predictors was developed. The area under the receiver operating characteristic (ROC) curve (AUC) was used for internal evaluation to compare the diagnostic effectiveness of the three models. The clinical effectiveness of the nomogram was verified with decision curve analysis (DCA). 【Results】 One of the 108 candidate features was used to construct the radiological feature score. Individualized clinical-radiomic nomogram included independent clinical factors (24 h urinary vanmandelic acid/renin/angiotensin I) and original first-order median radiological feature scores. Internal evaluation of the prediction model showed that the AUC was 0.945 (95%CI:0.906-0.984), superior to the single clinical model or radiological model in precise differentiation. DCA showed that the nomogram had the best clinical use. 【Conclusion】 The clinical-radiomic nomogram model can effectively differentiate adrenal adenoma from small diameter pheochromocytoma, which can improve the preoperative differential diagnosis and preparation.
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【Objective】 To investigate the predictive value of preoperative controlled nutritional status (CONUT) score and ratio of hemoglobin to red cell distribution width (HRR) for survival of patients with upper urinary tract urothelial carcinoma (UTUC) after radical surgery. 【Methods】 A retrospective analysis was performed on 145 UTUC patients who underwent surgical treatment in the Affiliated Hospital of Xuzhou Medical University during May 2011 and Jun. 2017. Clinic opathologic data were collected, the best cut-off values of CONUT score and HRR were determined with receiver operating characteristic (ROC) curve, and the CONUT-HRR scoring system was established. The correlation between different CONUT-HRR scores and clinic opathological indicators of UTUC patients was compared. The application value of CONUT-HRR score in predicting the prognosis of UTUC patients was evaluated with Kaplan-Meier survival curve and Cox proportional risk regression model. 【Results】 The optimal cut-off values of preoperative CONUT score and HRR for predicting cancer specific survival (CSS) were 3 and 10.41, respectively. The patients were divided into three groups: CONUT-HRR 0 group (n=62, CONUT score <3 and HRR ≥10.41), CONUT-HRR 1 group (n=51, CONUT score <3 and HRR <10.41, or CONUT score ≥3 and HRR≥10.41), and CONUT-HRR 2 group (n=32, CONUT score ≥3 and HRR <10.41). CONUT-HRR score was correlated with age, surgical method, pathological T stage, lymph node metastasis and vascular invasion (all P<0.05). Kaplan-Meier survival curve results showed that the 5-year CSS of CONUT-HRR 0, 1 and 2 groups were 96.4%, 65.8% and 30.9%, respectively, with statistically significant differences (P<0.001). Cox regression model showed that CONUT-HRR score, pathological T stage, lymph node metastasis and vascular infiltration were independent factors of CSS. 【Conclusion】 Preoperative CONUT-HRR score can be used as a simple and reliable indicator to evaluate the prognosis of UTUC patients. Higher score indicates worse prognosis.
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Objective:To explore the efficacy and safety of transvaginal anterior pelvic floor reconstruction with mesh in treatment of patients with cystocele and lower urinary tract symptoms.Methods:A retrospective analysis of 32 patients who underwent transvaginal anterior pelvic reconstruction with mesh from June 2015 to February 2019 was performed. The age of the patients was 57-86 years old, with an average of (67.8±7.6) years; body mass index(BMI) (22.6±3.0) kg/m 2; mean duration of disease (2.9±2.3) years; delivery 1-7 times, mean(3.0±1.5) times. All patients underwent transvaginal anterior pelvic reconstruction. The anterior wall of the vagina was incised, and the space between the pelvic floor and the bladder was bluntly separated. The mesh was placed under the guidance of the puncture needle after locating marks of body surface. Patients underwent the American Urological Association Symptom Scoring (AUASS) with (14.2±3.5) points, the residual urine (71.3±53.0) ml and the maximum urine flow rate (16.9 ± 3.8) ml/s were measured preoperative. The Pelvic Organ Prolapse Distress Inventory(POPDI-6), Urogenital Distress Inventory(UDI-6) and Pelvic Floor Impact Questionnaire(PFIQ-7) were recorded as the value of (48.0±7.3) points, (41.7 ± 8.2) points and (62.5 ± 16.4) points, respectively. Thirty-two patients were divided into 2 groups as the group of urinary storage symptom (22 patients) and the group of voiding symptom (10 patients) according to the preoperative lower urinary tract symptoms. The operative time, intraoperative bleeding volume and average hospital stay were recorded. The patients were followed up with AUASS, maximum urine flow rate, residual urine, POPDI-6, UDI-6, PFIQ-7 and complications during and after operations. Results:All the operations of 32 cases were successfull. The average operation time was (61.1±18.6) min, the average intraoperative blood loss was (41.5±12.3)ml, and the average hospital day was (9.1±1.8)d. There were no major organ injuries such as bladder, ureter, iliac vessels and rectum. 27 patients were followed up for 3 to 36 months, with an average of (24.7±10.8) months. There significant improvement of LUTS. At the last follow-up, the AUASS storage phase score (3.4±1.9) points in the urinary storage symptom group(19 patients) and the AUASS urinating phase score (3.9±1.7) points in the voiding symptom group(8 patients) were compared with the preoperative AUASS scores (11.6±1.9) points and (13.9±1.2) points which were significantly reduced. By the last follow up of all the 27 patients, residual urine (23.4±11.0)ml, POPDI-6(3.1±5.4) points, UDI-6 (3.2±5.1) points and PFIQ-7 (12.4±1.7) points were significantly lower than preoperative data. The maximum urinary flow rate(22.4±4.1)ml/s, was significantly higher than that before the operation. All the differences were statistically significant ( P<0.05). All patients had no recurrence of cystocele. One patient had anterior vaginal wall mesh exposure 3 months after surgery. After removing excess mesh in the outpatient clinic, she was cured by smearing with estrogen ointment. One patient experienced frequent urination and urgency who was cured by oral tolterodine tartrate. One patient with de novo mild SUI during the 1-year follow-up. The symptoms were improved in the outpatient clinic after pelvic floor muscle exercise. At 2-year follow-up, one patient was observed de novo mild posterior wall prolapse with no clinical manifestations and no treatment was carried out. Conclusions:Transvaginal anterior pelvic reconstruction with mesh could be effective in treating cystocele with lower urinary tract symptoms with less surgical trauma, fewer complications and lower recurrence rate. It could effectively improve lower urinary tract symptoms such as frequent urination, urgency and difficulty urinating.However, safety issues such as the incidence of long-term de novo SUI and mesh exposure still require further long-term follow-up.
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Objective To investigate the application efficacy of oral acetaminophen stapler with compound lidocaine cream combined with lidocaine injection in local anesthesia cystoscopy.Methods From January 2016 to June 2017,180 male patients aged from 60 to 86 years old,whose average age was 71 years old and treated by local anesthesia cystoscopy were collected in this study in the department of Urology of Xuzhou Medical University Affiliated hospital.They were divided into two groups according to the time sequence of visiting doctor.The patients in the research group were treated with oral acetaminophen stapler with compound lidocaine cream and lidocaine injection urethral infusion anesthesia before the examination.The control group was using lidocaine injection urethral infusion anesthesia.To compare the successful rate of operation,operating time and the visual analogue score (VAS) before and after the operation,the patients'limb twist and the tension were observed and recorded.The software of SPSS 16.0 was used for statistical analysis.Results The successful rate of operation in research group and control group was 97.78％ and 91.11％.The VAS score before the operation was (3.2 ± 1.8) and (6.8 ± 2.2).The incidence of complications after treatment was 5.55％ (5/90) and 27.78％ (25/90).The PSS score of 1 h after treatment was (1.1 ± 1.7) and (3.1 ± 1.2).The satisfaction rate was 90.0％ (81/90) and 57.8％(52/90).The differences between the two groups were statistically significant(P ＜ 0.05).However,the opertion time between the two groups was (6.2 ± 1.7) and (6.9 ± 2.1) min.One hour after the opertion,the VAS score was (1.2±0.7) and (1.5±1.1).The score of PSS before the opertionwas (3.4±1.5) and (3.8±1.1).There were no significant differences between the two groups (P ＞ 0.05).Conclusions Taking oral acetaminophen stapler with compound lidocaine cream combined with lidocaine injection in local anesthesia cystoscopy could obviously reduce urethral pain and the anxiety in the opertion of local anesthesia cystoscopy,which obviously superior to use lidocaine injection urethral infusion anesthesia only.The efficacy and safety were definitely and had got better clinical outcomes.
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Objeetive To investigate the effect of TURP on the quality of life of elderly PCa patients with LUTS symptoms.Methods A retrospective analysis of the clinical data from January 2012 to January 2014 of 75 patients admitted to our hospital after prostate puncture biopsy and pathological diagnosis of PCa in elderly patients,mean age (79 ± 7) years old,which 44 cases were associated with different degrees of LUTS symptoms,of which,20 underwent TURP.After the rule of endocrine therapy,we observe and record of patients before and after treatment and 3,12,6 months after the IPSS and QOL score,compared with the changes in the quality of life of patients.Results Forty-four cases of patients with IPSS score in treatment group after 3,6 and December were (6.25 ± 2.53),(5.15 ± 2.25),(5.00 ± 2.36).Compared with the preoperative IPSS basal value (30.55 ± 3.62),the difference was statistically significant (P ＜0.01).However,there was no significant difference in the postoperative patients (P =0.209,0.863,0.154).The QOL score of treatment group after 3,6 and 12 months were (1.35 ± 1.14),(0.85 ± 0.75) and (0.70 ± 0.87).Compared with the preoperative QOL basal value (4.70 ± 0.73),the difference was statistically significant (P ＜ 0.01).However,there was also no significant difference in the postoperative patients (P =0.078,0.023,0.593).Compared with the control group of IPSS and QOL score,there was no significant difference before treatment in the treatment group (F =0.105,P =0.747),however,there was significant difference after treatment(P ＜ 0.01).Conclusions TURP is a safe and effective method to improve the quality of life and improve the quality of life of patients with prostate cancer.
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Objective To investigate the application efficacy of disposable circumcision stapler with compound lidocaine cream combined with lidocaine injection in the circumcision.Methods From September 2013 to November 2014,120 cases (11 cases of redundant prepuce phimosis patients), were divided into disposable circumcision suture group (S group, 60 cases) and conventional circumcision (T group, 60 eases) ,two groups had no statistically significant difference at patient age and wrapping case (6 cases phimosis of S group,5 cases phimosis of T group) (P ＞0.05.Patient's age ranged from 11 to 49 years.30 patients in each group were treated with lidocaine cream combined with lidocaine injection,and another 30 patients were treated with a local anesthetic lidocaine injection.Comparisons were conducted among the four groups on the operation time, anesthesia, intraoperative and postoperative pain score, blood loss and postoperative complications, postoperative appearance satisfaction, wound healing time.Results For the disposable circumcision stapler with lidocaine cream combined with lidocaine injection group, disposable circumcision stapler with lidocaine injection group, sleeve circumcision with lidocaine cream combined with lidocaine injection group and sleeve circumcision with lidocaine injection group, the operation time was (5.3 ± 1.5) min, (4.9 ± 1.4) min, (31.6 ± 3.4) min, (32.0 ± 3.3) min respectively, blood loss was (0.6 ± 0.4) ml, (0.8 ± 0.5) ml, (6.9 ± 2.4) ml, (7.5 ± 2.1) ml respectively, narcotic pain score was 0.6 ± 0.6,3.2 ±3.9,2.5 ± 1.0,0.5 ±0.6,intraoperative pain score was 0.8 ±0.9,1.4 ±0.8,2.2 ± 1.1,3.1 ± 1.1,postoperative 24 h pain score was 1.6 ±0.9,2.2 ±0.8,2.6 ± 1.3,4.4 ± 1.1, postoperative 48h pain score was 0.7 ±0.6,0.8 ±0.9,2.4 ±0.8,2.8 ±0.7, wound healing time was (13.7 ±1.5)d,(13.5 ± 1.7)d, (14.2 ± 1.3) d, (14.1 ± 1.6) d, the rate of postoperative complications was 6.6％ (2/30), 10.0％ (3/30),26.6％ (8/30), 33.4％ (10/30), satisfaction rate of appearance was 93.4％ (28/30), 96.7％ (29/30),70.4％ (22/30), 80.0％ (24/30).Compared with sleeve circumcision with lidocain injection group,disposable circumcision stapler with lidocaine cream combined with lidocaine injection had a shorter operation time, less pain, less bleeding, higher appearance satisfaction rate and lower incidence of complications (P ＜ 0.05), wound healing time had no significant difference (P ＞ 0.05).Conclusion Application of the disposable circumcision stapler with lidocaine cream combined with lidocaine injection on circumcision is safe and has got better clinical outcomes.
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Purpose:To study the feasibility of GM CSF and the tumor antigen activated dendritic cells in treating bladder tumor in rats.Methods:The DCs isolated from the spleen of T739 mice which were stimulated in vitro by syngenic granulocyte macrophage colony stimulating factor (GM CSF) and irradiated inactivated BTT739 Bladder tumor cells(Group D),were transfused intravenously once a week when BTT739 tumor cells were inoculated in mouse. Group A was established as control,group B and C were injected with GM CSF activated DCs and inactivated tumor vaccine.Results:In group D, the CTL activity against the BTT739 tumor and cytokine IL 4 and IFN ? was significantly higher than those in other groups ( P