Evaluation of the efficacy of ureteroscopic lithotripsy for proximal impacted ureter stones based on a new scoring standard: a bicentric matched-pair analysis.

OBJECTIVE: To evaluate the clinical efficacy of ureteroscopic lithotripsy (URSL) in the treatment of proximal impacted ureter stones (PIUS) based on a new scoring standard in two medical centers. METHODS: The data of 45 patients with Complicated PIUS (total stone score ≥ 3) and 350 with Simple PIUS (total stone score < 3) who underwent URSL were collected in this retrospective study between January 2015 and June 2022. The definition and scoring standards for preoperative high-risk factors associated with stones included whether the diameter of the stone was > 2 cm, stone density was > 1000 HU, there was a history of lithotripsy, the degree of hydronephrosis was greater than moderate, and there was an infection. Scores for stones were then assigned (yes = 1, no = 0), and the Complicated stone case was defined as a total stone score ≥ 3; the Simple stone case was defined as a total stone score < 3. During the same period, 45 patients were selected from the patients with Simple stone cases as the control group, matched at a 1:1 ratio to index Complicated stone cases with regard to age, sex, and BMI. Perioperative data were compared between the two groups. RESULTS: All 90 operations were successfully completed. Compared to the Simple cases group, the surgical duration of the Complicated group was significantly longer (59.69 ± 28.06 min vs. 73.46 ± 27.12 min, p < 0.05), and stone-free rate (SFR) was significantly lower (88.89 vs. 68.9%, p < 0.05). There was a significant difference in complication rate between the two groups regarding Clavien grade I, II, or III complications (20.0% in Complicated cases group vs. 8.9% in Simple cases group, p = 0.037). As for the length of the hospital stay and the total treatment cost, the two groups have no difference. CONCLUSION: For Simple stone cases, URSL had a better SFR and higher surgical efficacy, whereas complicated stone cases had a high complication rate and long operation time. Thus, we suggest that URSL is the preferred choice for Simple stone cases rather than complicated stone cases.

The manufacture and application of novel evaluating tool for renal vascular anatomy : the system of individualized reno-vasculature evaluation for nephrectomy / 中华泌尿外科杂志

Objective To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN).Methods Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively,including 154 males (61.4％) and 97 females (38.6％),aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2.The tumors were all isolated with the mean size of 5.4 cm.According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE),all the cases were divided into two groups:the common group (VCE,NTE ＜ 60 min)and the difficult group (no VCE,NTE ≥ 60 min).With the help of preoperative three-dimensional reconstruction,the specific and crucial arteriovenous anatomical features were recorded,which consist of side,count,spatial configuration and density of the vessel to be processed.After univariable analysis,muhivariable analysis with logistic regression was performed for the selected risk factors.Individualized renovasculature evaluation for nephrectomy were established,when the value of risk factors were assigned separately according to its correlation and clinical practice.Results There was no statistical significance between common group and difficult group in the aspects of gender,age,BMI,maximum diameter of the tumor,R.E.N.A.L.score and PADUA score.There were statistical significance between common group and difficult group in the aspects of N (number of total vessels),D (vascular anomalies density),C (3Dconformation),S (sides) of pending renal vessels (x2 =125.700,102.014,97.090,12.603,P ＜0.05).The correlation of N,D,C were closely related (standardized regression coefficient were 0.742,0.664,0.324,P ＜ 0.05),but S was not significant (P ＞ 0.05).SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy.Of the 5 components of SIREN,N,D were scored on 1 to 3 points,C was scored on 0 to 3 points,E was scored on 0 to 1 point,and S was not scored but showed in terms of L or R.All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores.There was a statistically significant difference during low (2-3 points),middle (4-6 points),and high (7-10 points) groups (x2 =126.927,P ＜ 0.05) according to the comparisons between low and middle,low and high,as well as middle and high (x2 =90.997,7.195,91.679,P ＜ 0.05).Conclusions In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing,the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation,the difficulty of vascular treatment can be predicted,the preoperative planning can be optimized,and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical safety and efficiency.

The manufacture and application of novel evaluating tool for renal vascular anatomy: the system of individualized reno-vasculature evaluation for nephrectomy / 中华泌尿外科杂志

Objective@#To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN).@*Methods@#Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively, including 154 males (61.4%) and 97 females (38.6%), aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2. The tumors were all isolated with the mean size of 5.4 cm. According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE), all the cases were divided into two groups: the common group (VCE, NTE <60 min) and the difficult group (no VCE, NTE ≥60 min). With the help of preoperative three-dimensional reconstruction, the specific and crucial arteriovenous anatomical features were recorded, which consist of side, count, spatial configuration and density of the vessel to be processed. After univariable analysis, multivariable analysis with logistic regression was performed for the selected risk factors. Individualized reno-vasculature evaluation for nephrectomy were established, when the value of risk factors were assigned separately according to its correlation and clinical practice.@*Results@#There was no statistical significance between common group and difficult group in the aspects of gender, age, BMI, maximum diameter of the tumor, R. E.N.A.L. score and PADUA score. There were statistical significance between common group and difficult group in the aspects of N (number of total vessels), D (vascular anomalies density), C (3D conformation), S (sides) of pending renal vessels (χ2=125.700, 102.014, 97.090, 12.603, P<0.05). The correlation of N, D, C were closely related (standardized regression coefficient were 0.742, 0.664, 0.324, P<0.05), but S was not significant (P>0.05). SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy. Of the 5 components of SIREN, N, D were scored on 1 to 3 points, C was scored on 0 to 3 points, E was scored on 0 to 1 point, and S was not scored but showed in terms of L or R. All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores. There was a statistically significant difference during low (2-3 points), middle (4-6 points), and high (7-10 points) groups (χ2=126.927, P<0.05) according to the comparisons between low and middle, low and high, as well as middle and high (χ2=90.997, 7.195, 91.679, P<0.05).@*Conclusions@#In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing, the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation, the difficulty of vascular treatment can be predicted, the preoperative planning can be optimized, and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical safety and efficiency.

Analysis and treatment of 45 platinum-allergic gynecologic malignant tumors.

BACKGROUND: This study aimed to explore the potential risk factors of platinum allergy and follow-up treatment to provide a reference for the clinical prevention and treatment of platinum allergic reactions in patients with gynecological tumors. METHODS: The study retrospectively analyzed 45 cases of platinum allergic reactions that occurred in Shengjing Hospital affiliated to China Medical University from August 2010 to July 2016. Analysis of risk factors included the cumulative dose, treatment course and time intervals. RESULTS: The cumulative carboplatin dose in allergic patients ranged from 900 to 10250 mg (average 4845 mg). The 45 allergic reactions occurred between the 3rd and 25th course of treatment (average 11.4 courses). The average re-treatment interval of carboplatin-allergic patients was 28.1 months, including 93.3% of patients with platinum re-treatment interval of more than 1 year. The allergic reaction occurred in the 2nd or 3rd course of re-treatment in 26 patients, accounting for 70.3% of all patients with recurrence. Seventeen patients were subjected to desensitization therapy, among which 13 cases were well tolerated. CONCLUSIONS: Patients who received more than 8 courses of carboplatin or a cumulative dose of more than 3500 mg were the high-risk population for platinum allergy. The 2nd and 3rd treatment course after restarting carboplatin treatment after an interval time of more than 1 year was the high incident period of carboplatin allergy. Skin tests should be conducted in patients with high risk of carboplatin allergy. In cases of carboplatin allergy, patients could receive carboplatin or oxaliplatin desensitization therapy.

Effects of multi-block reconstructive plate on the treatment of complex tarsometatarsal joint injury / 中国综合临床

Objective To evaluate the effect of multi?plate reconstruction plate in the treatment of partial complex tarsometatarsal joint injury injuries. Methods Seven patients treated complex tarsometatarsal joint injuries with multi?plate reconstruction plate in Nanjing Hospital Affiliated to Nanjing Medical University from September 2014 to July 2016 were selected in this study. According to Myerson classification,3 cases were A type,3 cases were B type,1 case was C type. The therapeutic effects were observed. Results The patients were followed up for 6-12 months,with an average of (8. 6±2. 0) months. According to the foot scoring criteria in American Orthopedic Foot and Ankle Society ( AOFAS) ,the function of the foot was evaluated,3 cases were in excellent condition,4 cases were in good condition. Conclusion In the case of multiple metatarsal fractures of the metatarsal base involved in the joint surface, the use of multiple reconstructive plates for joint fixation reduces the iatrogenic damage of the joint surface. The fixation effect and the functional recovery are satisfactory