Objective To evaluate the usefulness of magnetic resonance spectroscopic imaging in detecting local recurrence in patients with T3N0M0 prostate cancer after cryotherapy.Methods Sixty-five patients with T3N0M0 prostate cancer underwent cryotherapy.The preoperative data of conventional MRI,MRS,transrectal ultrasound (TRUS)-guided prostate biopsy were collected.After cryotherapy,the prostate specific antigen (PSA) of all patients was detected monthly.If PSA ＞5 μg/L,MRI,MRS,and TRUS-guided prostate biopsy were planned within a week.If PSA was unremarkable,MRI,MRS,and TRUS-guided prostate biopsy were planned 12 months after cryotherapy.The prostate was divided 6 regions and the cancerous and noncancerous were marked.The signal-to-noise ratio(S/N) of choline (Cho),citrate (Cit)and the ratios of Cho + creatine ( Cre)/Cit of each regions were measured in pre-operation and postoperation.The patients were divided into non-recurrence and recurrence group according to TRUS-guided biopsy.The S/N of Cho,Cit,and the ratio of Cho + Cre/Cit were compared between the groups before and after cryotherapy by using independent samples t-test.Results ( 1) Fifteen patients were confirmed local recurrence 12 months after cryotherapy,including 11patients with an evaluate PSA level and 4 patients with PSA umemarkable.(2) The S/N of Cho,Cit and the ratios of Cho + Cre/Cit in the cancerous and noncancerous regions before cryotherapy in the sixty-five patients were 25 + 9,11+ 5,and 18 + 5,and 39 ±12,2.33 +0.60,and 0.53 ± 0.19.There had significant difference between that of two groups ( t values were 11.36,9.81,and 13.39,respectively,P =0.00).(3) In the patients with non-recurrence,The S/N of Cho,Cit in the cancerous and noncancerous regions were 4 ± 2 and 3 ± 2 ( t =1.024,P =0.305 ),and 2 +2 and 4 ±3 (t =1.147,P =0.178) and no difference was found.In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.(4)In the patients with local recurrence after cryotherapy,the S/N of Cho and Cit in the cancerous and noncancerous regions were 17 ±3 and 3 ± 2 ( t =17.24,p =0.00 ),9 ± 2 and 3 ± 3 ( t =23.66,P =0.00 ) and a significant difference was found.The ratio of Cho + Cre/Cit in the recurrent area was no significant different compared with that of preoperation(t =1.214,P =0.256 ).In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.Conclusions MRS is a useful tool to evaluate the changes of the S/N of Cho and Cit,the ratios of the Cho + Cre/Cit and help diagnosis of local recurrence.

Objective To evaluate the medium-term outcomes of minimally invasive percutaneous nephrolithotomy in patients with renal function impairment.Methods Data of 811 patients who underwent minimally invasive percutaneous nephrolithotomy between Jan.2009 and Dec.2011 were retrospectively collected.Seventy-eight patients had a preoperative estimated GFR of 30-59 ml/(min · 1.73m2).The minimum follow-up was 1 year.Patients were divided into group 1 (improved or stable disease) and group 2 (worsened disease).Patient age was (42.8 ± 16.3) and (45.3 ± 14.2) separately,with male patients 41 and 7,female patients 25 and 5 respectively.Body mass index were (24.3 ± 4.1) kg/m2 and (25.4 ±5.2) kg/m2,history of open surgery or ESWL were 19 and 4.Mild hydronephrosis were 22 and 4.Staghorn stone were 22 and 5.Multiple access were 13 and 2.Operative time was (78.2 ± 30.4) min and (80.3 ±32.3) min.Stone-free rate 1 month postoperatively were recorded.Multiple regression analysis was used.Results The stone free rate at 1 month postoperatively was 85％ by CT scan.Preoperative eGFR was (38.4±12.8) ml/(min · 1.73m2),and 1 ycar postoperative eGFR was (45.1 ±15.8) ml/(min · 1.73m2)in 78 patients.Renal function had improved in 31％ of patients,but it remained the same or deteriorated in 54％ and 15％,respectively at 1 year follow-up.On multivariate regression analysis,diabetes was associated with the deterioration of renal function.Conclusions At medium-term follow-up,renal function was maintained or improved in 85％ of patients with chronic kidney disease who underwent minimally invasive percutaneous nephrolithotomy.Minimally invasive percutaneous nephrolithotomy could be an effective and safe option for the patients with chronic renal function impairment.Diabetes mellitus was independent predictive factor of renal function impairment.Therefore,patients with diabetes should be followed up carefully.Medical management is needed if necessassry.

Olfactory neuroblastoma is a rare malignant tumor. Although multiple therapeutic modalities including surgery, radio-therapy, or chemotherapy could be used in patients with olfactory neuroblastoma, no standardized treatment has been achieved. This re-view introduces a case of adult olfactory neuroblastoma treated by a multiple disciplinary team in Tianjin Medical University Cancer In-stitute and Hospital. This review also aims to explore a complete set of diagnostic and treatment practices for the benefit of future pa-tients.

Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI). Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features, interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients, VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure 6 months later. Among the 5 patients with successful closure, 4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them, one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure. Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.

Solitary brain metastasis in non-small cell lung cancer (NSCLC) patients was previously considered as Stage IV. Gen-erally, only chemotherapy or radiotherapy rather than surgery was considered the treatment for these patients;hence, achieving the de-sired effect was difficult. In recent years, the treatment benefit for these patients significantly increased. Several patients were even pro-vided the chance of being cured through standardized and individualized treatment by a multiple disciplinary team (MDT). This article introduces two solitary brain metastasis patients with NSCLC who were treated by MDT in Tianjin Medical University Cancer Institute and Hospital. This article aims to explore a complete set of diagnostic and treatment practices for the benefit of more patients.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.

Objective:To understand the current situation of robot-assisted patient rehabilitation training in neurological disease-related departments of ClassⅢ medical institutions across the country, so as to provide guidance and basis for promoting the improvement of robot-assisted training.Methods:In September 2021, convenience sampling was used to select neurological disease-related departments in Class Ⅲ hospitals from all provinces and cities across the country to conduct a survey on the status of robot-assisted rehabilitation training. A self-designed Hospital Robot-Assisted Training Questionnaire was used for investigation. The survey was conducted using an electronic questionnaire. A total of 250 questionnaires were distributed, and 236 valid questionnaires were recovered, with a valid recovery rate of 94.4%.Results:Among the 236 neurological disease-related departments, a total of 93 (39.4%) departments used robot-assisted rehabilitation training. The robot type was mainly wearable robot, which was mainly used to train lower limb motor function, upper limb motor function, gait ability and so on. A total of 55.9% (52/93) of departments believed that robot-assisted rehabilitation training was more effective than conventional rehabilitation training. Hospital type, department bed turnover times, and daily training time were the main factors affecting the effectiveness of robot-assisted training, and the differences were statistically significant ( P<0.05) . Among the 93 departments that had used robots, 22.6% (21/93) of the departments had not experienced any negative events in the robot-assisted rehabilitation training. The 143 departments that had not yet used robots had a positive attitude towards robots, and the main reasons for not using robots were that robots were too expensive, lacked the guidance of technicians, and were afraid to use them without professional training. Conclusions:Robot-assisted training has been concerned and tried to use by neurological disease-related departments, but the safety still needs to be further enhanced. Medical institutions should formulate robot-assisted rehabilitation training guidelines as soon as possible to guide the application and development of robot-assisted training.

Objective:To summarize the best evidence for prevention and management of aspiration in neurosurgical ICU patients and provide evidence for clinical nursing work.Methods:Relevant evidence on prevention and management of aspiration in neurosurgical ICU patients, including guidelines, consensus, system reviews, and randomized controlled trials (RCTs) which were published from 1st January, 2010 to 30th June, 2019 in any language was retrieved from guideline websites, relevant websites and databases. Two researchers evaluated the quality of the included literature and performed evidence extraction on those literatures that met the quality standards.Results:Totally 9 clinical practice guidelines, 8 expert consensus, 13 Meta analysis / systematic reviews and 10 RCTs were included, which were collected and extracted to form the final version of best evidence for aspiration prevention and management including 10 primary indicators and 29 secondary indicators.Conclusions:Medical staff should take effective measures in early assessment of aspiration risks, artificial airway management, position management, enteral nutrition management, sedation and analgesia management, etc., and reduce the incidence of aspiration in neurosurgical ICU patients by applying the best evidence. In addition, hospitals should provide various forms of education and training to medical staff, form transdisciplinary cooperation teams, and strengthen the prevention and management of aspiration.

Objective:To summarize the best evidence for the prevention and management of aspiration pneumonia in elderly patients to provide a basis for clinical nursing work.Methods:We systematically searched the domestic and foreign guide nets, websites of relevant institutions and databases on the relevant evidence for the prevention and management of aspiration pneumonia, including guidelines, expert consensus, systematic reviews, randomized controlled trials (RCT) , and the search time limit was from January 1, 2010, to June 30, 2020, and the language was not limited. Two researchers evaluated the quality of the included literature, and extracted, analyzed, and integrated evidence that met the quality evaluation criteria.Results:A total of 8 guidelines, 5 expert consensus, 10 systematic reviews, and 19 RCTs were included. The evidence was collected and extracted to form a prevention and management strategy for elderly patients with aspiration pneumonia including 11 first-level indicators and 32 second-level indicators.Conclusions:Medical and nursing staff should take effective measures in risk assessment, posture management, oral management, airway management, medication management, functional exercise and so on to reduce the risk of aspiration. Medical and nursing staff should also strengthen training for their own, elderly patients and main caregivers, and reduce the incidence of aspiration in elderly patients by applying the best evidence, so as to reduce the incidence of aspiration pneumonia.