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With the rapid development of artificial intelligence technology, researchers have applied it to the diagnosis of various tumors in the urinary system in recent years, and have obtained many valuable research results. The article sorted the research status of artificial intelligence technology in the fields of renal tumors, bladder tumors and prostate tumors from three aspects: the number of papers, image data, and clinical tasks. The purpose is to summarize and analyze the research status and find new valuable research ideas in the future. The results show that the artificial intelligence model based on medical data such as digital imaging and pathological images is effective in completing basic diagnosis of urinary system tumors, image segmentation of tumor infiltration areas or specific organs, gene mutation prediction and prognostic effect prediction, but most of the models for the requirement of clinical application still need to be improved. On the one hand, it is necessary to further improve the detection, classification, segmentation and other performance of the core algorithm. On the other hand, it is necessary to integrate more standardized medical databases to effectively improve the diagnostic accuracy of artificial intelligence models and make it play greater clinical value.
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Humans , Male , Algorithms , Artificial Intelligence , Prognosis , Prostatic Neoplasms/diagnosis , TechnologyABSTRACT
Objective: To evaluate the therapeutic effects of visual standard channel combined with F4.8 visual puncture super-mini percutaneous nephrolithotomy [SMP] on multiple renal calculi
Methods: The clinical data of 46 patients with multiple renal calculi treated in Affiliated Hospital of Hebei University from October 2015 to September 2016 were retrospectively analyzed. There were 28 males and 18 females aged from 25 to 65 years old, with an average of 42.6. The stone diameters were 3.0-5.2 cm, [4.3 +/- 0.8] cm on average. F4.8 visual puncture-assisted balloon expansion was used to establish a standard channel. After visible stones were removed through nephroscopy combined with ultrasound lithotripsy, the stones of other parts were treated through F4.8 visual puncture SMP with holmium laser. Indices such as the total time of channel establishment, surgical time, decreased value of hemoglobin, phase-I stone clearance rate and surgical complications were summarized
Results: Single standard channel was successfully established in all cases with the assistance of F4.8 visual puncture, of whom 24 were combined with a single microchannel, 16 were combined with double microchannels, and six were combined with three microchannels. All patients were placed with nephrostomy tube which was not placed in the microchannels. Both F5 double J tubes were placed after surgery. The time for establishing a standard channel through F4.8 visual puncture was [6.8 +/- 1.8] min, and that for establishing a single F4.8 visual puncture microchannel was [4.5 +/- 0.9] min. The surgical time was [92 +/- 15] min. The phase-I stone clearance rate was 91.3% [42/46], and the decreased value of hemoglobin was [12.21 +/- 2.5] g/L. There were 8 cases of postoperative fever which was relieved after anti-inflammatory treatment. Four cases had 0.5-0.8 cm of stone residue in the lower calyx, and all stones were discharged one month after surgery by in vitro shock wave lithotripsy combined with position nephrolithotomy, without stone streets, delayed bleeding, peripheral organ damage or urethral injury
Conclusion: Combining visual standard channel with F4.8 visual puncture SMP for the treatment of multiple renal calculi had the advantages of reducing the number of large channels, high rate of stone clearance, safety and reliability and mild complications. The established F4.8 visual puncture channel was safer and more accurate
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Humans , Male , Female , Adult , Middle Aged , Kidney Calculi/surgery , Nephrolithotomy, Percutaneous/standards , Retrospective StudiesABSTRACT
Objective: To compare the therapeutic effects of visual standard channel combined with visual superfine precision puncture channel or super-mini percutaneous nephrolithotomy [PCNL] on multiple renal calculi
Methods: A total of 86 patients with multiple renal calculi were retrospectively analyzed. According to different working channels, they were divided into a visual puncture channel group [visual puncture standard channel combined with visual superfine precision puncture channel, n=38] and a conventional puncture channel group [standard channel combined with super-mini channel, n=48]. The two groups were compared in terms of time of channel establishment, surgical time, reduction of hemoglobin, phase I clearance rate of calculi, and surgical complications
Results: The time of establishing visual/conventional standard channel was [4.5+/-1.5] min vs. [6.8+/-1.8] minutes [t=6.326, P=0.000], and the time of establishing visible superfine/super-mini channel was [4.52+/-0.97] minutes vs. [7.76+/-1.35] minutes [t=2.017, P=0.000]. The surgical time was [92+/-15] minutes vs. [115+/-13] minutes [t=26.640, P=0.000]. The Phase-I clearance rate was 86.7% [33/38] vs. 87.5% [42/48] [?2=0.008, P=0.928], the reduction of hemoglobin was [12.21+/-2.5] g/L vs. [13.22+/-3.5] g/L [t=2.017, P=0.137], the blood transfusion rate was 13.16 [5/38] vs. 8.33% [4/48] [?2=0.006, P=0.941], the postoperative fever rate was 7.89% [3/38] vs. 14.58 [7/48] [?2=0.006, P=0.941], and the hospitalization stay length was [6.5+/-1.0] vs. [6.6+/-1.2] [t=0.413, P=0.681]. There were no significant differences between the two groups
Conclusion: Both surgical approaches had high clearance rates of multiple renal calculi, safety, reliability and few complications. However, compared with the conventional puncture channel, the visual one was easy to operate and dramatically shortened the time of establishment, thus being safer and more accurate
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Objective To investigate the long-term outcome of radical prostatectomy (RP) in the patients with incidental prostate cancer (IPCa) detected by surgery of benign prostatic hyperplasia (BPH) and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP (pT0,pT2,pT3),Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 (15.6％) patients had no residual tumor (pT0).PSA before BPH surgery (RR =2.58,95％ CI 1.27-5.42,P =0.04),PSA after BPH surgery (RR =4.26,95％ CI 2.57-7.64,P =0.01) and Gleason score after BPH surgery (RR =3.98,95％ CI 1.85-5.77,P =0.02) were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months(ranging 5-144 months),the 5-and 10-years.biochemical recurrence-free survival rates were 95.6％ and 86.7％,respectively.PSA after surgery for BPH (RR =4.79,95％ CI 2.57-7.64,P =0.02) and Gleason score after RP(RR =2.01,95％ CI 1.74-5.21,P =0.04) were the only independent risk factors for biochemical recurrence.Stage (T1a-T1b) did not predict residual cancer or the rate of biochemical recurrence (P ＞ 0.05).Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.
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Objective To investigate the long-term outcome of radical prostatectomy (RP) in the patients with incidental prostate cancer (IPCa) detected by surgery of benign prostatic hyperplasia (BPH) and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP (pT0,pT2,pT3),Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 (15.6％) patients had no residual tumor (pT0).PSA before BPH surgery (RR =2.58,95％ CI 1.27-5.42,P =0.04),PSA after BPH surgery (RR =4.26,95％ CI 2.57-7.64,P =0.01) and Gleason score after BPH surgery (RR =3.98,95％ CI 1.85-5.77,P =0.02) were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months(ranging 5-144 months),the 5-and 10-years.biochemical recurrence-free survival rates were 95.6％ and 86.7％,respectively.PSA after surgery for BPH (RR =4.79,95％ CI 2.57-7.64,P =0.02) and Gleason score after RP(RR =2.01,95％ CI 1.74-5.21,P =0.04) were the only independent risk factors for biochemical recurrence.Stage (T1a-T1b) did not predict residual cancer or the rate of biochemical recurrence (P ＞ 0.05).Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.
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Objective To observe the clinical effect of modified laparoscopic adrenalectomy for adrenal pheochromocytoma. Methods 23 patients with adrenal pheochromocytoma were treated with modified posterior laparoscopic adrenalectomy. The changes of blood pressure, heart rate, operation time and blood loss during and after operation were observed. Results 23 patients were successfully operated, the operation time was (62.3 ± 11.7) min, the intraoperative blood loss was (34.4 ± 17.7) ml, there has no hemorrhage occurred while 3 cases were transferred to ICU for intraoperative blood pressure and heart rate fluctuation significantly, and back to general ward after 2 days, while there was no significant difference in blood pressure and heart rate preoperatively. Conclusion Modified laparoscopic adrenalectomy is safe and effective for pheochromocytoma and holds the advantages of clear anatomy, short operative time, less bleeding and less change in blood pressure and heart rate.
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Objective To evaluate the efficacy and safety of percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction simultaneously. Methods 32 patients with unilateral solitary parapelvic cyst complicated with UPJO, including 25 cases with ipsilateral kidney stones. After percutaneous holmium laser lithotripsy for patients complicated with calculi, then performed incision and drainage through the channels for parapelvic cyst by holmium laser, and antegrade high pressure balloon dilatation for UPJO, drainage by hippocampal tube in 3 ~ 6 months postoperatively. The operation time of fenestration drainage of cyst, narrow hypertensive dilatation and postoperative hospital stay were analyzed. Results Compared with 1 month (46.17 ± 6.33), 3 months (40.47 ± 6.06), 6 months (33.81 ± 7.05), 9 months (28.95 ± 7.92) after surgery, there was a marked improvement of the separation coefficient of renal convergence, the difference was statistically significant (P < 0.05). And compared with 6 months after surgery, the data of 9 months after surgery has statistical significant differences (P < 0.05). The separation coefficient of renal convergence decreases as time goes on. Conclusions Percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction by the same time can effectively relieve symptoms and decrease the separation coefficient of renal convergence. It is safe and effective.
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Objective To evaluate the safety and effectiveness of modular flexible ureteroscope combined with holmium laser lithotripsy in treatment of bilateral renal calculi smaller than 1.5 cm. Methods Clinical data of 24 patients from August 2013 to March 2016 using a modular flexible ureteroscope in treatment of bilateral renal calculi smaller than 1.5 cm was retrospectively analyzed. The clinical data included operation time, stone clearance rate and occurrence of complications. Results All the 24 patients were successfully placed in bilateral ureteral sheath soft lenses, and enter lithotripsy smoothly. The operation time was 40~105 (71.0 ± 21.5) min. Lithotripsy success rate was 100.00% and 1 month stone clearance rate was 89.50% (43/48), 5 sides with residual stones diameter 7~10 mm, were given extracorporeal shock wave lithotripsy, 3 months stone clearance rate was 93.75% (45/48), 3 sides with residual stones 5~7 mm located lower calyx accepted regular review. 4 cases with postoperative fever were cured after anti-inflammatory treatment. There was no bleeding, ureteral perforation, postoperative avulsion, renal dysfunction, septic shock and other complications. Conclusion Modular flexible ureteroscope lithotripsy in treatment of bilateral renal calculi smaller than 1.5 cm is safe and effective.
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Objective To investigate the clinical efficacy and safety of visual standard channel combined with visual ultrafine channel PCNL precision puncture in treatment of complex renal calculi. Methods From June 2015 to October 2016, 48 cases of complicated renal calculi were treated with multi-channel lithotripsy with visual standard channel ultrasonic pneumatic lithotripsy combined with visual superfine channel PCNL precision puncture holmium laser lithotripsy. Including 10 cases of staghorn stone, 38 cases of multiple renal stones. Results 110 channels were established in 48 patients. 4 cases of preoperative renal insufficiency with infection in the puncture found in the pus and stones load larger, intraoperative diarrhea and PCNL simple treatment of obstruction site stones; 44 cases to complete one of the surgery: There were single channel established in every one of 5 cases, and double channels established in every one of 24 cases, three channels in established in every one of 15 cases; There were two cases of surgery in 8 cases and there were 12 new channels established. The average time of unilateral first operation was 75 (35 ~ 125) min. The first clearance rate was 79.2% (38/48), and the total clearance rate of postoperative stone was 87.5% (42/48). 6 cases of residual stone combined with ESWL and drug row of stone, followed up for 3 months, 6 cases of stone row net, the total stone clearance rate of 100.0% (48/48). Two consecutive postoperative no sepsis, bleeding, ureteral injury and other serious complications. Conclusions Visual standard channel combined with visual superfine channel PCNL precise puncture for the treatment of complex renal calculi is safe and effective, with high fruiting rate and low complication, which can be popularized in clinical practice.
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Objective To explore the feasibility and safety of visualization puncture combined with flexible ureteroscopy in the treatment of lower calyx stones.Method Visualization puncture combined with flexible ureteroscopy to treat the lower calyx stones was done in our center from January to August 2016 in our hospital.32 cases of patients were enrolled to have a retrospective analysis.There were 18 males and 14 females,aged from 25 to 65 years,with an average age of 43 years.The diameter of stone was 1.0-2.0 cm,with an average of (1.4 ± 0.6) cm.We used general anesthesia and then adjusted the surgery bed to operation side lateral elevation was 30 °-35.Flexible ureteroscopy with 200μm holmium laser was used firstly to break calculi as much as possible.Ultrasound-guided F4.8 visualization puncture system was used to establish F4.8 channel.The power option was 2001μm hohnium laser to crush calculus of the renal calculi to treat the calculus of the distal end of soft lens which still can not be touched by ureteroscopy.Routine nephrostomy tube was not placed.The soft ureter sheath F5 double-J tube,and indwelling balloon catheter were routinely placed.We removed the catheter after 1-2 days and the double J tube after 4 to 6 weeks.Results The flexible ureteroscopy lithotripsy operation time was 8-25 mins in all of the 32 patients.Visualization puncture channels were successfully established in 3-7 mins,and the visualized puncture stone search rate of 100％ (32/32).The success rate of first stage lithotripsy was 93.8％ (30/32).Two cases of lower calyx stones diverticulum diverted to PNCL due to poor visibility by bleeding.The operation time was 30-60 mins and the average of 45 mins.KUB review at day one after the surgery showed that there were residual stones in 5 cases.The stone free rate at one month after the surgery is 100.0％.The average postoperative hospital stay was (2.0 ± 1.5) days.There were uo bleeding,ureteral avulsion and perforation,septic shock,pleural effusion and intestinal injury and other serious complications.Conclusions Navigation ultrasound-guided visualization puncture combined with flexible ureteroscopy is safe and effective to treat lower calyx stones.
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Objective: To investigate the effect of losartan on angiotensin II (Ang II) expression and myocardial remodeling in myocardial infarction (MI) rats’ model. Methods: A total of 32 SD male rats were divided into 4 groups, Sham operation group, MI group, MI with losartan 10mg/(kg·d) group and MI with losartan 20mg/(kg·d). n=8 in each group. MI model was established and the electrocardiogram changes before and after MI were recorded, hemodynamic indexes were detected at 4 weeks after MI, pathological changes of myocardial tissue were examined by HE staining. The myocardial mRNA and protein expressions of ACE2 and Ang II were detected by RT-PCR and Western Blot analysis. Results: Compared with Sham operation group, MI group showed increased LVMI and decreased LVEF P Conclusion: Losartan could increase ACE2 expression and therefore, inhibit Ang II expression and improve the ventricular remodeling in MI rats’ model.
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Objective To evaluate the value of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods From March 2003 to May 2008,78 patients with adrenal tumors received retroperitoneal laparoscopic adrenalectomy in our hospital. During the operation,three trocars were introduced into the lumbar region to establish retroperitoneal space by blunt dissection with the camera. Afterwards,the tumor was removed by using a harmonic scalpel. Results The procedures were successfully completed in all the 78 cases without blood transfusion,the operation time ranged from 45 to 180 min (mean,90 min). Drainage tubes were removed 24 hours after the operation. And the patients were discharged from hospital in 3 to 5 days postoperation. One patient showed regional subcutaneous emphysema after the surgery and was cured spontaneously. The patients were followed up for 3 to 24 months with a mean of 10 months,during which 36 patients achieved normal blood pressure in 3 months,while in the other 7 patients,oral antihypertension drugs were still needed. No patients had recurrent tumor during the follow-up. Conclusions Retroperitoneal laparoscopic can be the first choice for adrenal tumors,as it is safe and effective with minimal invasion,quick recovery,and short postoperative hospital stay.
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<p><b>OBJECTIVE</b>To evaluate the long-term efficacy and safety of lamivudine therapy for the treatment of chronic hepatitis B and the clinical influence of emergence of tyrosine methionine aspartic acid (YMDD) motif mutation of hepatitis B virus (HBV).</p><p><b>METHODS</b>This multicenter, double-blind, randomized, placebo controlled trial began in 1996. A total of 429 patients with HBsAg, HBeAg and HBV CNA positives were enrolled. They were randomized to receive either lamivudine 100 mg daily (n = 322) or placebo (n = 107) on 3 : 1 ratio for the first 12 weeks. Thereafter all patients were offered open label lamivudine treatment and assessed every 4 weeks for a total of 104 weeks.</p><p><b>RESULTS</b>After 1 year treatment 72.7% patients (285/392) had a sustained serum HBV DNA response. HBV DNA continued to be substantially suppressed at the second year, except in patients with the emergence of YMDD mutation whose mean HBV DNA levels increased to 86 Meq/ml (bDNA assay) but were much more lower than that of pre-treatment baseline level. lamivudine therapy resulted in increased HBeAg loss and HBeAg/anti-HBe seroconversion, which were correlated with both baseline alanine transaminase (ALT) levels and also with duration of lamivudine treatment. HBeAg loss was achieved in 26.8% of patients with ALT > 1-fold upper limit of normal at 2 yeas and in 35.6% and 55.6% of patients with ALT > 2-fold upper limit of normal and ALT > 5-fold upper limit of normal, respectively. For HBeAg seroconversion, these figures were 17.4%, 22.2%, and 33.3% respectively. By the end of 2 years, ALT levels were remained in normal ranges in 50.3% whose ALT were abnormal before treatment, and in 83% whose ALT were mormal before treatment. YMDD mutation were developed in 49.7% of the patients. Their serum HBV DNA levels were slightly increased to bDNA median level 86 Meq/ml and 15% of the patients they were ALT exceeded baseline levels. Four patients clinically flared-up and recovered after stop treatment. The adverse drug reactions (ADRs) of lamivudine were mild to moderate, only two patients were reported as drug related severe ADR.</p><p><b>CONCLUSION</b>Sustained HBV replication and clinical improvement could be obtained by the long-term lamivudine therapy with good tolerance and safety.</p>