Objective To assess the effect of variable durations of warm ischemia on renal function early after laparoscopic partial nephrectomy ( LPN ) and make the definite safety duration of renal warm ischemia.Methods The clinical data of 76 patients treated with LPN from October 2012 to June 2014 were retrospectively analyzed.The patients were divided into 3 groups based on warm ischemic time,namely group A (28 cases) with warm ischemia time less than 20 min,group B (34 cases) with warm ischemia time more than 20 min and less than 30 min, group C ( 14 cases ) with warm ischemia time more than 30 min.LPN was performed with renal artery clamping alone in all the patients.Preoperative and postoperative renal scintigraphic scan was performed to access glomerular filtration rate ( GFR) in all patients.The GFR values were compared among before, 1 week, 1 month and 3 months after operation.The factors predicting the early renal injury were assessed by multivariate regression analysis.Results The renal GFR of the kidney underwent LPN decreased 19.43(17.70,22.06) ml/min at 1 week,17.04(13.94,20.70) ml/min at 1 month,13.82(10.72,18.73) ml/min at 3 months after the surgery in group C,respectively.In group A, the renal GFR of the operated-side decreased 12.07(10.91,13.42) ml/min,10.04(9.16,11.75) ml/min, 8.44(7.07,9.72) ml/min,respectively.In group B, the renal GFR of the operated-side decreased 13.64 (12.48,16.72) ml/min,10.29(9.17,14.27)ml/min,9.63(7.85,12.59) ml/min,respectively.The GFR decreased greater in group C than that in group A and B(P<0.05).The total renal GFR decreased (10.70 ± 4.93)ml/min at three months in group C,compared with (5.64 ±4.12)ml/min in group A and (6.37 ± 4.32)ml/min in group B,respectively.The decreased value in group C was greater than that in group A and B(P<0.05).However,the differences of the total renal GFR among the 3 groups were not significant at 1 week and 1 month(P>0.05).The multivariate regression analysis revealed that warm ischemia duration was the independent risk factor of the early renal injury.Conclusions Warm ischemia duration is the major factor regarding the early renal recovery after LPN.Warm ischemia time more than 30 min may not only greatly affect the renal function but also the renal function recovery rate.

Objective To investigate the feasibility of differentiating lymph node metastases of four types of primary tumors (lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma) using gemstone spectral imaging (GSI) . Methods Three cases with lymphoma (28 lymph node), five cases with lung adenocarcinoma(30 lymph node), four cases with lung squamous cell carcinoma(24 lymph node) and two cases with cholangiocarcinoma( 10 lymph node) were evaluated by germstona spectra imaging CT scans. Imaging protocol included unenhanced conventional CT scan (120 kVp) ,enhanced GSI (80/140 kVp) on arterial phase and conventional CT scan (120 kVp) on portal phase. CT attenuation values of lymph nodes in the monochromatic images at 11 sets of keV levels (40-140 keV, 10 keV step) and the iodine and water contents of these lymph nodes were measured. All results were analyzed with ANOVA and t test. Results The optimal monochromatic level was 70 keV for the optimal contrast-noise ratio (CNR) of metastatic lymphadenopathy. The CT attenuation values of metastatic lymphadenopathy were (81.36 ±9. 81 ), (58.33 ± 21.55 ), (56. 47 ± 10.62) and (73. 57 ±4. 43 ) HU,respectively, at 70 keV( F = 17.29, P ＜0. 01 ). There were significant differences in CT attenuation values between lymphoma and lung adenocarcinoma, between lymphoma and lung squamous cell carcinoma and between lung squamous cell carcinoma and cholangiocarcinoma (P ＜ 0. 05 ). The differences in CT attenuation values were significant between cholangiocarcinoma and lung squamous cell carcinoma, between cholangiocarcinoma and lymphoma ( P ＜ 0. 05 ). There was no difference in CT attenuation values at all 11 sets of keV levels between lung squamous cell carcinoma and lung adenocarcinoma ( P ＞ 0. 05 ). The iodine contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were ( 1. 93 ± 0. 04 ), ( 1.16 ± 0. 15 ), ( 1.25 ± 0. 21 ) and ( 1.44 ± 0. 04 ) g/L, respectively. The water contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were (1029.40 ± 20. 85), (1024.98 ± 11.19), (1022.12 ± 12. 94) and (1030.87 ± 10.10) g/L,respectively. Except between lung squamous cell carcinoma and lung adenocarcinoma, the differences in the iodine contents of metastatic lymphadenopathy were significant among tumors ( P ＜ 0. 05 ). There was no difference in the water contents of metastatic lymphadenopathy among tumors ( P ＞ 0. 05 ). Conclusions Although CT spectral imaging fails to differentiate metastatic lymphadenopathy of lung adenocarcinoma and lung squamous cell carcinoma, it is also a promising method of distinguishing metastatic lymphadenopathy of malignant tumors by CT attenuation values in monochromatic images and iodine contents in material density images. The optimal monochromatic level was determined to be at 70 keV for providing the optimal CNR of metastatic lymphadenopathy.

Objective To investigate the effectiveness and feasibility of endovascular treatment (EVT) in acute large vessel occlusion (LVO) of anterior circulation,and explore its influencing factors.Methods The clinical data of 302 patients with acute LVO of anterior circulation treated with EVT in our hospital from October 2010 to December 2016 were analyzed retrospectively.Collateral blood flow classification (American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology collateral circulating grading),interventionaI treatment methods,thrombolysisin cerebral infarction (TICI) grading,and National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment were recorded.Incidence and mortality rate of intraoperative and postoperative symptomatic intracranial hemorrhage (sICH) were recorded.The recovery of neurological outcomes was classified by modified Rankin scale (mRS) 90 d after treatment:patients with mRS scores≤2 were divided into a good prognosis group,and those with 3 ≤mRS scores ≤ 6 were divided into a poor prognosis group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of prognosis were further analyzed by multivariate Logistic regression analysis.Results (1)After the operation,ASITN/SIR grading 0-2 was noted in 201 patients,ASITN/SIR grading 3-4 was noted in 101 patients.Two hundred sixty-nine patients (89.0％) had good re-canalization (TICI grading 2b-3) after EVT:66.2％ patients were TICI grading 3,22.8％ patients were TICI grading 2b,5.6％ patients were TICI grading 2a,and 5.4％ patients were TICI grading 1-0.The NIHSS scores on discharge (8.4±3.9) were lower than those on admission (16.8+4.7);sICH rate was 10.9％.(2) On 90 d of follow-up,149 patients (49.3％) enjoyed good prognosis,and 153 patients (50.7％) had poor prognosis;and the mortality was 8.3％.(3) Single factor analysis showed that the differences in age,associated atrial fibrillation,NIHSS scores on admission,times of thrombectomy,and collateral circulating grading between good prognosis group and poor prognosis group were statistically significant (P＜0.05);multivariate Logistic regression analysis showed that NIHSS scores on admission and time from symptom onset to vessel recanalization were prognostic risk factors (OR=1.162,95％CI:1.018-1.329,P=0.016;OR=1.008,95％CI:1.003-1.019,P=0.007).Conclusion EVT is an effective and safe approach for acute LVO of anterior circulation.

Objectives:To establish a comprehensive system of Cardiovascular Academic Performance Evaluation(CAPE)and rank global TOP100 medical institutions in the fields of cardiovascular diseases(CVD). Methods:CVD-related terms were extracted from Medical Subject Headings(MeSH),Embase thesaurus(EMtrees)and International Classification of Diseases(ICD)by CVD-related professionals,as well as by librarians and information professionals.Terminology databases(named as Fuwai Subject Headings)were established,and nine sub-disciplines were proposed,including ischemic heart diseases,hypertension,vascular diseases,arrhythmia,pulmonary vascular diseases,heart failure,congenital heart diseases,cardiomyopathy,and valvular heart diseases.The mapping patterns of sub-discipline,cardiovascular terminology and entry terms were pre-defined.The CVD-related research literature published from January 1,2016 to December 31,2022 were retrieved from Web of Science,PubMed and Scopus.Based on this,metadata were fused and duplicates were excluded.Fuwai Subject Headings were searched and matched into four respects for each literature,including subject words,titles,keywords,and abstracts,which was used to generate an information table of"Position—CVD terminology—Frequency",and to calculate CVD correlation scores and sub-discipline scores.We standardized the names of medical institutions and scholars,and make a ranking system for CAPE based on original articles with strong cardiovascular correlation(correlation score≥4).When evaluating the science and technological performance for Chinese hospitals in cardiovascular diseases,National Natural Science Foundation Projects,authorized invention patents,prize achievements,research platforms,and registered data of drug clinical trials in Center for Drug Evaluation(CDE)were considered besides research papers. Results:During 2016 and 2022,1 545 103 CVD research literatures were found worldwide.After excluding meeting abstracts,books,biographies,news,videos,audio texts,retracted publications,and corrections,1 178 019 CVD research literatures were further evaluated.518 058 literatures were indexed as"strongly correlated to CVD"using Fuwai Subject Headings.Besides papers,other data sources were also collected,including 11 143 CVD-related Natural Science Foundation Projects,19 382 CVD-related effective authorized invention patents,103 CVD-related national prize achievements,24 CVD-related national research platforms,and 2 084 CDE registered data of CVD-related drug clinical trials.Research teams from nine sub-disciplines reviewed and validated research literature in respective fields,and classification rules of corresponding sub-disciplines were created and improved based on their opinions.Finally,eleven individual indexes were chosen to construct CAPE system for ranking global TOP100 medical institutions in overall CVD field and TOP30 in nine sub-disciplines.From 2016 to 2022,the number of cardiovascular disease research papers published by Chinese institutes has increased by 123.5%,with a total of approximately 76.8 thousands papers published(about 30 papers per day on average),ranked the second under the United States(approximately 114.1 thousands papers).However,the proportion of papers published by the Chinese Journal Citation Reports(JCR)and the Chinese Academy of Sciences only ranked eighth in the world.In the comprehensive academic performance of original cardiovascular research papers in global hospitals from 2020 to 2022,only two Chinese medical institutions ranked in the TOP20 as evaluated by CAPE system. Conclusions:Based on multi-source data from 2016 to 2022,CAPE initiated to establish a cardiovascular academic performance evaluation system.

Objective:To comprehensively analyze the medical resources and services supply in the cancer field of China.Methods:Data of 2018 were sampled from 41 tertiary public cancer hospitals in China, and the factor analysis method was used to extract common factors in resources or services, scoring respectively. Pearson correlation analysis was used in the collinearity test of the variables of both groups of common factors, while the second-order clustering method was used to analyze characteristic differences between the hospitals, and category difference was compared with t test. Results:Resource evaluation covered the two dimensions of basic resources(medical service and basic assurance resources)and high-end resources(high-end talents and academic resources). Service evaluation covered the two dimensions of medical service assurance(clinical services and basic assurance)and disciplinary sphere of influence(discipline construction and clinical efficiency). The factor of basic manpower and beds was significantly correlated with that of medical service and basic assurance( r=0.811, P<0.001), while the factor of high-end talents and academic resources was significantly correlated with that disciplinary construction and resource efficiency( r=0.906, P<0.001). The second-order cluster analysis found the 41 cancer hospitals as two categories, with the first category of five in Guangdong, Shanghai, Beijing and Tianjin, and the second category of the rest 36 hospitals. Significant differences were found between the two categories in terms of resource scoring, service scoring, high-end resources and disciplinary sphere of influence( P<0.001). Meanwhile, the GDP per capita of the cities in which these hospitals are located also had significant differences( P<0.001). Conclusions:Development of public tertiary cancer hospitals in China was imbalanced, as their differences were mainly found in levels of disciplinary development and efficiency of clinical services, which were closely related to the high-end talents and academic resources of the hospital in question.Furthermore, high quality medical care was mostly located in regions of higher development. The authors recommend to take a balanced consideration of the differences and distribution of cancer care services in China, in terms of performance classification of public hospitals and establishment of regional cancer centers of the country.