Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P

Objective To evaluate the detenia cecocolon urinary reservoir for 30 patients with bladder cancer after total cystectomy. Methods A detenia continent cecocolon urinary reservoir was constructed for 30 patients with bladder cancer after total cystectomy. Results The patients have been followed up for 8～40 months. The capacity of the reservoir has been 360～580 ml with a maximum pressure of 19.5～78.5 cmH 2O one year later .Good continence has been achieved during day time in 93% and at night in 90%. Unileteral ureter stenosis and slight hydronephrosis was found on ultrasonography,IVU and pouch photography in 1 case. There has been no evidence of ureter reflux or impairment of renal function and serum electrolytes have been normal in all. Conclusions Detenia continent cecocolon pouch is fairly good for urinary diversion and the technique is simpler, easier with minimal complications.

Objective To examine the effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. Methods A total of 73 consecutive male patients underwent cystectomy and construction of a colonic reservoir with low pressure.Of them nerve sparing were attempted in 48 cases (study group) and non nerve sparing in 25 (control group).The patients were followed up for 3 to 28 months.Postoperative continence was compared between the 2 groups through questionnaires and urinary pad test. Results After removal of the urinary catheter the continence rate was 65% in nerve sparing group and 34% in non nerve sparing group during the day;and it was 40% and 26%,respectively,at night.The mean time from post operation to continence during the day and at night in nerve sparing group was 2 and 4 months,respectively;while it was 5 and 10 months,respectively in non nerve sparing group.Twelve months after operation,the continence rate of nerve sparing group and non nerve sparing group was 96% and 79% during the day;and it was 87% and 64% at night,respectively.Continence differed significantly between the two groups (day, P =0.002;night, P =0.001). Conclusions Nerve sparing cystectomy is associated with improved urinary continence after orthotopic bladder substitution.

Objective:To investigate the clinical significance of MRI dynamic enhancement in defining the upper edge of adenocarcinoma of esophagogastric junction.Methods:The clinical data of 73 patients with adenocarcinoma on the esophagogastric junction operated from Jul 2018 to Aug 2019 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. All patients underwent MRI examination within one week before surgery. First, the T 2WI, diffusion-weighted imaging and dynamic enhanced images of each patient were carefully observed to define the tumor location, size, shape, signal and enhancement mode, then the distances between the upper edge of the tumor and the cardiac incisure on MRI dynamic enhancement were measured independently, and compared with the measured distance in surgical fresh specimens. Results:The mean location of tumor upper edge measured in MRI of 73 patients was (1.75±1.98)cm, while measured in the surgical specimen was (1.72±1.97)cm. There was no significant difference between the two groups ( t=0.572, P=0.569). The intraclass correlation efficient between the two groups was excellent (ICC=0.974, 95% CI: 0.959-0.984, P<0.01). Conclusion:The measurement result of tumor upper edge in MRI is basically consistent with that of surgical specimens. MRI can be used to locate the tumor upper edge for adenocarcinoma of esophagogastric junction before operation.

Metastatic seminal vesicle carcinoma is rare in clinic. The case of renal clear cell carcinoma metastasis to the seminal vesicle gland is more rare, which is difficult to be identified with bladder, prostate and colorectal tumors. In November 2017, 1 case of renal clear cell carcinoma metastasis to the left side of the seminal vesicle gland was admitted in our hospital.Laparoscopy seminal vesicle metastasis tumor resection was performed. Regular bladder irrigation and sunitib oral intake were conducted. No evidence of local recurrence was found within 19 months follow-up.

Objective:To evaluate perioperative coagulatory parameters and transfusion rates of lung transplantation recipients.Methods:Clinical data were retrospectively reviewed for 178 lung transplant recipients at China-Japan Friendship Hospital from March 2017 to July 2019. According to whether extracorporeal membrane oxygenation(ECMO)was used during perioperative period, they were divided into two groups of ECMO(131 cases)and without ECMO(47 cases). Clinical data, laboratory examinations and blood transfusion status of two groups were compared. In ECMO group, excluding secondary thoracotomy for hemostasis(7 cases)and incomplete data(2 cases), the remainders were divided into the groups of no red blood cell transfusion(63 cases), red blood cell transfusion(59 cases), plasma transfusion <1 000 ml(99 cases)and plasma transfusion≥1 000 ml (23 cases), no platelet transfusion(93 cases)and platelet transfusion(29 cases). Clinical data, laboratory examinations and ECMO-related parameters of recipients were analyzed by Bary Logistic regression.Results:Statistically significant inter-group differences existed in body mass index(BMI), disease course, primary disease, bilateral lung transplantation, laboratory examinations, postoperative blood transfusion volume, postoperative red blood cell and plasma transfusion ratio between groups with and without ECMO( P<0.05). Bilateral lung transplantation, ASA grade, differences in BMI, disease course, postoperative hemoglobin<100 g/L, postoperative PT/APTT/INR abnormalities and postoperative PLT count <100×10 9/L were independent risk factors for postoperative transfusion during ECMO. Conclusions:The application of ECMO during lung transplantation may affect the perioperative transfusion volume and demand.Fully assessing blood transfusion requirements, optimizing coagulation monitoring and identifying the independent influencing factors of postoperative blood transfusion facilitate clinical scientific and rational blood transfusions.

Objective:To investigate the application value of intravoxel incoherent motion (IVIM) imaging in preoperative evaluating perineural invasion (PNI) of esophageal squamous cell carcinoma (ESCC).Methods:The prospective study was conducted. The clinicopathological data of 63 ESCC patients who underwent IVIM imaging before surgery in the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital from January 2016 to April 2019 were selected. Patients underwent routine magnetic resonance imaging scan and IVIM sequence examination. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*) and pseudodiffusion fraction (f) values were measured. Observation indicators: (1) situations of enrolled patients; (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. The interclass correlation coefficient (ICC) was used to evaluate cosistency of results. The receiver operating characrteristic curve was used to evaluate diagnostic efficiency. Results:(1) Situations of enrolled patients. A total of 63 patients were selected for eligibility. There were 41 males and 22 females, aged 60(range, 43?74)years. Of the 63 ESCC patients, 17 cases had PNI and 46 cases had no PNI. Cases with well differentiated tumor, moderate differentiated tumor or low differentiated tumor, cases in stage T1, T2, T3, T4 of infiltra-tion depth, cases with or without lymph node metastasis were 0, 6, 11, 0, 3, 13, 1, 15, 2 in patients with PNI, versus 6, 24, 16, 1, 22, 23, 0, 12, 34 in patients without PNI, showing significant differences between them ( Z=?2.32, ?2.49, χ2=19.58, P<0.05). (2) IVIM examination of PNI of ESCC and its diagnostic efficiency. The ADC, D, D*, f values were (2.21±0.33)×10 ?3 mm 2/s, (1.46±0.31)×10 ?3 mm 2/s, 32.50 (15.55,46.75)×10 ?3 mm 2/s, (0.34±0.09)×10 ?3 mm 2/s in patients with PNI, versus (2.45±0.45)×10 ?3 mm 2/s, (1.72±0.38)×10 ?3 mm 2/s, 34.85(23.43,51.20)×10 ?3 mm 2/s, (0.42±0.13)×10 ?3 mm 2/s in patients without PNI, showing significant differences in the ADC, D and f values between them ( t=?2.03, ?2.52, ?2.34, P<0.05) and no significant difference in the D* value between them ( Z=?0.84, P>0.05). The cosistency of ADC, D, D* and f values in the 63 ESCC patients measured by 2 radiologists was good, with the ICC as 0.96, 0.92, 0.89 and 0.95. The receiver operating characrteristic curve demons-trated the best cut-off value of ADC, D and f values were 2.50×10 ?3 mm 2/s, 1.68×10 ?3 mm 2/s and 0.41, with the areas under the curve as 0.67 (95% confidence interval as 0.54?0.79), 0.70 (95% confidence interval as 0.58?0.81) and 0.69 (95% confidence interval as 0.57?0.80), respectively. The combina-tion of D and f value for diagnosing PNI of ESCC had the area under the curve as 0.74 (95% confidence interval as 0.62?0.84), with the cut-off value as 0.20, sensitivity and specificity as 94.1% and 56.5%. Conclusions:IVIM parameters D and f values can evaluate and predict the PNI of ESCC preopera-tively. The combination of D and f values can further improve the diagnostic efficiency.

Objective:To explore the value of intravoxel incoherent motion (IVIM) DWI in preoperative prediction of angiolymphatic invasion in esophageal squamous cell carcinoma (ESCC).Methods:From April 2016 to April 2019, 63 ESCC patients who planned to undergo resection of esophageal cancer were prospectively collected at Henan Cancer Hospital.According to the postoperative pathological results, 63 patients were divided into angiolymphatic invasion group (30 cases) and no angiolymphatic invasion group (33 cases). All patients underwent IVIM sequence and routine MRI examination before operation. The ADC, true diffusion coefficient (D), pseudodiffusion coefficient (D *) and pseudodiffusion fraction (f) were measured. The differences of parameter values between ESCC with and without angiolymphatic invasion were analyzed using Student′s t test or Wilcoxon rank sum test.The logistic regression was used to analyze the significance of various parameters. For the parameters with statistical significance, the ROC curves were performed to evaluatethe diagnostic performance of parameters for identifying angiolymphatic invasion.The Z test was used to compare the area under the ROC curves(AUC) of parameters. Results:The difference of ADC, D and f values between angiolymphatic invasion group and no angiolymphatic invasion group were statistically signi?cant ( t=4.476, 5.033 and 5.712 respectively, all P<0.001). The D * values showed no statistically signi?cant di?erence ( Z=0.184, P=0.854). The logistic regression analysis showed that D (OR=9.042) and f (OR=26.221) were in correlation with angiolymphatic invasion. The ROC analyses demonstrated that the AUCs of ADC, D and f values in predicting angiolymphatic invasion of ESCC were 0.787, 0.822 and 0.853, respectively. D combined with f had highest AUC (0.917) in predicting the angiolymphatic invasion of ESCC, sensitivity and specificity were 93.3% and 75.8%. D combined with f showed better diagnostic performance than the D and the f value, and the difference were statistically significant ( Z=2.403, 2.289, P=0.016, 0.022). Conclusions:IVIM can be used as an effective functional imaging modality for preoperative evaluation and prediction of the angiolymphatic invasion of ESCC. D value combined with f value can further improve prediction performance of angiolymphatic invasion.

Objective To investigate the correlation between quantitative parameters of dynamic contrast?enhanced MRI (DCE?MRI) after neoadjuvant chemotherapy and pathological grades in esophageal squamous cell carcinoma. Methods Fifty?six patients with esophageal squamous cell carcinoma who were confirmed by esophagoscope and received neoadjuvant chemotherapy before operation between September 2015 and December 2017 in the Affiliated Cancer Hospital of Zhengzhou University were prospectively analyzed, and MRI examination was performed within one week before operation. All patients underwent routine chest MRI and DCE?MRI scanning, and quantitative parameters of DCE?MRI, including volume transfer constant (Ktrans),exchange rate constant (Kep) and extravascular extracellular volume fraction (Ve) were measured. Pathological grading was assessed as highly differentiated, moderately differentiated, poorly differentiated,and undifferentiated. Intraclass correlation coefficient (ICC) was calculated from the results of two radiologists. Kruskal?Wallis H test was used to compare the differences of quantitative parameters between different pathological grade groups of DCE?MRI,and Mann?Whitney U test was utilized to compare the intraclass differences among pathological grades. Spearman rank correlation analysis was performed for evaluating the correlation between DCE?MRI parameters and pathological grade of esophageal squamous cell carcinoma. The receiver operating characteristic (ROC) curves were used to evaluate the diagnosis accuracy of different DCE?MRI parameters in pathological grade of esophageal squamous cell carcinoma after neoadjuvant chemotherapy. Results The 56 patients were divided into four groups according to pathological findings: well differentiated group (n=8), moderately differentiated group (n=39), poorly differentiated group (n=9) and undifferentiated group (n=0). The differences of Ktransmean,Ktrans75%,Kepmax, Kepmean,Kep75% between different pathological grading groups were statistically significant (all P<0.05),and these parameters showed positive correlation significantly with pathological grading (r values were 0.778, 0.632, 0.594, 0.725, 0.489 respectively, all P<0.05). The ROC curve area of Ktransmean, Ktrans75% in the diagnosis of pathological grade for esophageal squamous cell carcinoma was 0.750,0.856,respectively. The diagnostic efficiency of Ktrans75% was the best with the diagnostic threshold of 0.693/min,sensitivity of 87.5%, specificity of 78.5%, respectively. Conclusion The quantitative parameters of DCE?MRI after neoadjuvant chemotherapy in esophageal squamous cell carcinoma have the potential value for predicting pathological grade.

Objective To evaluate the value of 3T magnetic resonance imaging (MRI) in the preoperative T staging of potentially resectable esophageal cancer(EC), compared with endoscopic ultrasonography (EUS). Methods Patients with resectable EC pathologically confirmed by biopsy from March 2015 to September 2016 were prospectively enrolled. All patients underwent MRI (including T2-TSE-BLADE,DWI and radial-VIBE)and EUS one week after the biopsy,and MRI were performed prior to EUS, both MRI and EUS were acquired within one week before surgery. Two readers with more than 5 years experiences in the MRI diagnosis evaluated the MR image quality using a 5-point score independently. T staging was assigned on MRI and EUS by the two MRI readers using double-blind method and one endoscopist in accordance with the 7th edition of AJCC TNM Classification for EC, and any disagreement between two MRI readers was resolved by consensus with discussion to the third senior MRI doctor. The inter-observer agreement between two MRI readers were calculated using Kappa test for image quality scores and T staging results. Considering postoperative pathological T staging results as the gold standard, the performances of MRI and EUS were evaluated based on the accuracy rate and analyzed by χ2 test. Results A total of 70 patients were enrolled in the study, the good image quality cases (≥ 3 scores) were 66 in reader 1 and 68 in reader 2. The inter-observer agreement of the image quality scores by two readers was excellent (Kappa=0.824, P<0.05). The pathological results revealed 16 cases of T1 stage, 18 cases of T2 stage, 30 cases of T3 stage, and 6 cases of T4a stage. The inter-observer agreement of the preoperative T staging of EC by two readers was excellent (Kappa=0.809, P<0.05). The accuracy rates of MRI and EUS for preoperative T staging of EC were 92.9% (65/70) and 67.1% (47/70), respectively, and the difference in accuracy rates of two techniques was statistically significant (χ2=14.5, P<0.05). Conclusions The accuracy rate of MRI for preoperative T staging of EC is significantly higher than that of EUS. MRI can be used as a noninvasive method for preoperative T staging of EC.