Objective To evaluate the efficacy and safety of standard percutaneous nephrolithotomy(PCNL)guided by ultrasonography for calculi within horseshoe kidneys.Methods From September 2005 to January 2008,44 patients with calculi within horseshoe kidneys(51 sides)underwent ultrasonography-guided F24-tract PCNL in our hospital.Among the cases,single calculus was found in 24 kidneys,multiple calculi were detected in 18,and staghorn calculi in 9.The stones sized(24.4?5.8)mm in length.Results All the operations were completed in one session,single tract was established in 49 kidneys,while double tracts were used in the other 2;31 of the tracts were made through the upper calyx,20 via the middle calyx,and 2 through the lower calyx.The mean operation time was(48.4?11.9)min.The stone-free rate after one-session operation was 88.2%(45/51),3 cases received a second-session PCNL to remove the residual calculi.After the operation,the hemoglobin decreased by(11.3?3.7)% in the patients,none of them received blood transfusion.Postoperative rate of surgery-related infection was 5.9%(3/51).No pleural or abdominal injury occurred.44 patients were followed up for 11.4 months,during the period one of the 3 patients who received the second-session surgery achieved stone-free.The rate of recurrence at 6 months was 2.0%(1/51),and 6.5% at 1 year(3/46).Conclusions Ultrasonography-guided standard PCNL is effective and safe for calculi within horseshoe kidneys.

Background and purpose:As a minimally invasive procedure, video-assisted thoracospic surgery for definitive resection of lung cancer is the focus of thoracic surgeons controversy.We studied the application of video-assisted thoracospic surgery and conventional thoracotomy for definitive resection of lung cancer from viewpoint of lymphadenectomy. Methods:From January 2001 to December 2005,549 patients with lung cancer underwent video-assisted thoracospic surgery lobectomy or pneumonectomy with systematic thoracic lymphadenectomy. The total number and average of dissected lymph nodes were recorded. Some studies on VAT and conventional lobectomy or pneumonectomy with systematic thoracic lymphadenectomy for lung cancer were compared.Results:In all 549 cases,7360 lymph nodes were dissected. The average of dissected lymph nodes was 13.41. There were no significant difference between video-assisted thoracospic surgery and conventional thoracotomy.Conclusions:Video-assisted thoracospic surgery should fulfill the same quality of lymphadenectomy WT5"and lung cancer radical resection. WT5"HZ

Objective To study the features of pulmonary cryptococcosis and the curative effect of thoracoscopic operation for it. Methods The authors retrospectively analyzed the clinical data of 11 patients with pulmonary cryptococcosis in this hospital between January 1996 and December 2002, consisting of 8 cases of thoracoscopic wedge resection, 2 cases of thoracoscopy-assisted modified posterolateral mini-lobectomy, and 1 case of pulmonary wedge resection. Results Ten patients were preoperatively misdiagnosed. Solitary lesions were found in 8 patients and multiple lesions in both lungs in 3 patients. Complete removal of lesions was achieved in 8 patients and pulmonary biopsy was conducted in 3 patients. Except for 3 cases of wound effusion, there were no other postoperative complications. Follow-up for (38.6?10.8) months (range, 12～72 months) found no pyothorax, bronchopleural fistula, or recurrence of cryptococcosis. Conclusions Pulmonary cryptococcosis usually makes its appearance as a solitary lesion without underlying diseases or symptoms, which is difficult to diagnose preoperatively. Video-assisted thoracoscopic surgery can remove the lesion completely, giving a minimal invasion and rapid recovery.

1.5 mm were included for the analysis. The results were compared with catheter coronary artery angiography. Results In all patients, 16-slice CT were performed without complications. 1?267 segments were considered as stenosis by 16-slice CT. With the results of conventional coronary angiography as the golden standard, the sensitivity of 16-slice CT was 75.43% and its specificity was 95.88%. Its positive predicted value was 74.58% while its negative predicted value was 96.01% and its accuracy was 93.05% for stenosis of greater than 50%. Conclusion 16-slice CT provides a good visualization of the coronary tree in most patients, allowing accurate non-invasive detection of significant coronary stenosis.

Objective:To evaluate the efficacy and morbidity of 24F-tract percutaneous nephrolithotomy(PNL) accessed by two-step dilation.Methods:A total of 3 052 patients with 3 366 kidneys or upper ureter calculi underwent 24F-tract PNL accessed by two-step dilation between Aug.,2003 and Jan.,2008,including 108 patients with solitary kidney,68 with kidney cysts,44 with horseshoe kidney,26 with vertebral column deformity,24 with medullary sponge kidney and 1 transplanted kidney.Stone burdens were(47.2?35.6) mm in length.Results:99.4% of 3 740 operations were successful in one-session access,in which 3 348 PNLs were accessed by single tract(89.5%),366 by double tracts(9.7%) and 26 by triple tracts(0.7%).The mean operating time was(68.4?30.9) min,the mean first accessing time were(17.6?11.1) min.and the mean calculi-dealing time were(35.0?55.3) min.The stone-free rate after one session operation was 100% for single calculus and 72.3% for multiple or staghorn calculi.of all the kidneys,374(11.1%) accepted another PNL to remove the residual calculi,and the last stone-free rate of PNL was 88.6%.During and after operation,52 cases(1.4%)needed transfusion,12(0.3%)underwent selective embolization of renal artery and 1(0.03%)accepted nephrectomy for bleeding control.No injury of organs occurred except for 3 cases with pneumatothorax and 19(0.5%)with urinary extravazation.No septic shock occurred.Conclusion:24F-tract PNL accessed by two-step dilation wtih ultrasound-guided puncture is effective and safe.

Objective　To modify the Guy's stone score system and evaluate the validation of the modified score system in grading the complexity of percutaneous nephrolithotomy (PCNL) and predicting the stone-free rate after PCNL.　Methods　The modified system comprises 4 grades:grade Ⅰ,solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade Ⅱ,solitary stone in upper pole or multiple stones (located in 2 or more 2 calyces) in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade Ⅲ,multiple stones in patients with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade Ⅳ,staghorn calculus or any stone in a patient with spinal injury or spine malformation ( e.g.spina bifida,scoliosis,lordosis) ; kidney dysplasia ( e.g.duplex kidney,horseshoe kidney).It was validated on a database of 145 PCNL procedures performed by a single surgeon in a stone center.The clinical outcomes were retrospectively assessed with multivariate analysis.Results Of the 145 PCNL patients,according to Guy's stone score system and the modified score system,there were 22 G1 cases (15.2％) and 22 SFR cases (100.0％) ; 27 G2 cases (18.6％) and 25 SFR cases (92.6％); 36 G3 cases (24.8％) and SFR(31,86.1％); 60 G4 cases (41.4％) and 49 SFR cases ( 81.7％ ).Showing that the modified Guy's stone score was more accurate in predicting stone-free rate after PCNL ( P ＜ 0.05 ).　Conclusions　The modified Guy' s stone score system can accurately predict the stone-free rate after PCNL than the old system.

Objective To discuss the clinical features and significance of the difference between the preoperative plan and the actual procedure of the treatment of staghorn calculi with standard access PCNL under ultrasound guidance.Methods From Feb 2011 to May 2011,56 patients withsimple staghorn calculi after standard PCNL under ultrasound guidance were enrolled.The same urologist made the operation plan preoperatively and performed the procedure.The difference between the preoperative plan and the actual procedure were analyzed.The factors leading to the difference were evaluated.Results First puncture calyx,the number of access and stage were changed in 9 (16.1％),15 (26.8％),and 10 (17.9％) patients,respectively.The factors leading to the changes include:flexible,compliance,local inflammation of calyx and texture of stone,efficiency of fragmentation.Conclusions The factors which cannot be clearly known preoperatively may change the procedure of PCNL,which is important to know the clinical features and significance of these factors.

Objectives To explore the influence of standardized treatment and technical flow improvement on the diagnosis and treatment of congenital diaphragmatic hernia (CDH) after prenatal diagnosis. Methods The clinical data of neonates diagnosed with CDH who were hospitalized in neonatal intensive care unit from January 2005 to August 2016 was analyzed retrospectively. Based on the start time of standardized treatment implementation, 93 cases of CDH hospitalized from January 2010 to August 2016 were divided into the intervention group while 15 cases of CDH hospitalized from January 2005 to December 2009 were divided into the control group. The survival rate and complications of clinical outcomes between two groups were compared. Results There was no significant difference in sex, gestational age, birth weight, Apgar score, and CDH position between two groups (P >0.05). The total survival rate was 81.7％ in the intervention group and 53.3％ in the control group, and there was statistical difference (P<0.05). The difference of mechanical ventilation mode and pneumothorax rate between two groups also had statistical difference (P >0.05). The median operation time in the control group was 4.5 h and the intervention group was 49.5 h. The postoperative survival rate was 61.5％ in the control group and 90.5％ in the intervention group, and the differences between two groups were significant (P >0.05). The first blood gas analysis of deaths cases in both groups showed that there were significant differences in pH and PCO2 values (P >0.05). Conclusions Optimization of the clinical management during perioperative period can improve the survival rate of CDH and reduce complications. However, the dead cases in the intervention group had more severe pulmonary hypoplasia.

Objective To analyze the changes of ultrasonography and Ki-67 before and after neoadjuvant chemotherapy for breast cancer ,and to assess the value of ultrasonography and Ki-67 in the evaluation of neoadju-vant chemotherapy for breast cancer. Methods The focus changes of 122 cases of breast cancer before and after neoadjuvant chemotherapy were observed by Color Doppler ultrasonography. The therapeutic effect was evaluated by RECIST standard,and the changes of Ki-67 before and after chemotherapy were observed. Results There were significant differences in size and internal blood flow signal of breast cancer before and after chemotherapy (P <0.05). The sensitivity of ultrasonography in the evaluation of neoadjuvant chemotherapy for breast cancer was 89.3%and specificity 53.8%. The clinical efficiency of neoadjuvant chemotherapy for breast cancer with high Ki-67 expression was higher than that with low Ki-67 expression. Conclusion Ultrasonography shows high clinical value in the evaluation of neoadjuvant chemotherapy for breast cancer ,and the expression of Ki-67 could predict the effi-cacy of neoadjuvant chemotherapy.

Objective To investigate the clinical features and gene mutation of a newborn with neonatal-onset ornithine transcarbamylase deficiency (OTCD) and report the multidisciplinary perinatal management of the mother with late-onset OTCD.Methods The clinical features,biochemical data and the treatment of a newborn boy with OTCD and his mother admitted by Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in April,2013,were collected.The ornithine transcarbamylase (OTC) gene in the family was analyzed.Results Serum ammonium in the male newborn gradually increased to 1 020 μ mol/L at 48 h after birth.His blood amino acids level and urine organic acid level showed a pattern indicative of OTCD [blood arginine (97.43 μ mol/L,reference 1.00-25.00 μ mol/L),citrulline (27.43 μ mol/L,reference 4.00-30.00 μ mol/L),ornithine (161.66 μ mol/L,reference 10.00-120.00 μ mol/L) and methionine (70.45 μ mol/L,reference 10.00-50.00 μ mol/L); urine uracil (67.11 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (1 372.66 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol Crea)].DNA studies revealed a c.583G ＞ A (G195R) homozygous mutation of the OTC gene.His mother was heterozygous for OTCD and developed acute hyperammonemia during pregnancy.Her blood showed a normal-leveled arginine (8.44 μ mol/L,reference 1.50-25.00 μ mol/L),a normal-leveled citrulline(8.41 μ mol/L,reference 7.00-35.00 μ mol/L),an elevated glutamate(279.15 μ mol/L,reference 45.00-200.00 μ mol/L).Her urine uracil (51.55 μ mol/mol Crea,reference 0.00-7.00 μ mol/mol Crea) and orotic acid (38.75 μ mol/mol Crea,reference 0.00-1.50 μ mol/mol) were elevated.Successful management of her prenatal and postpartum blood ammonia level was achieved after administration of pharmacologic nitrogen scavengers and protein limitation.DNA studies revealed a c.583G ＞ A (G195R) heterozygous mutation in the newborn's mother and grandmother.Conclusions General management on pregnant OTCD women is effective.Male newborn patients often have a poor prognosis.