[Objective] To observe the effect of computer-aided detection (CAD) system in improving lung nodule detection sensitivity and inter-observer variation.[Methods] 300 PA digital radiographs including 100 normal cases and 200 cases with pulmonary nodules confirmed by CT were enrolled.Two senior chest radiologists referenced CT images and marked the sizes and locations of all nodules with consensus as the gold standards.Four senior radiologists and four junior radiologists interpreted the digital chest radiographs independently without and with CADand recordtheir results.Pair t test and coefficient of variation (CV) was used to compare the difference of lung nodule detection sensitivity and inter-observer variation between withoutand with CAD.[Results] The mean lung nodule detection sensitivity of senior and junior radiologists withoutand with CAD were (41.1 ± 2.0)％,(28.0 ± 2.0)％ and (45.0 ± 1.8)％,(39.2 ± 0.9)％,respectively,statistical analysis showed there was statistically significant difference.Moreover,CV of all radiologists without and with CAD were 20.9％ and 8.1％.[Conclusion] Both lung nodule detection sensitivity and inter-observer variation of senior and junior radiologists can be improved by CAD.

Objective: To evaluate the correlation between ultrasound features of papillary thyroid carcinoma (PTC) and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules. Methods: Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed. According to the presence or absence of lymph node metastasis, they were divided into central and lateral lymph node metastasis group and non-metastasis group. Independent risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were analyzed by χ² test and multivariate Logistic regression. Results: Multivariate analysis showed that the posterior margin of the cancer was <0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM (P=0.025). Compared with the tumor volume ≤0.38 cm³, the cancer volume >0.38 cm³ (P=0.000), was more prone to CLNM. And multivariate analysis showed that the anterior margin of the cancer was <0.17 cm (P=0.006) from the anterior thyroid capsule and the inner wall of the foci was <0.26 cm (P=0.014) as independent risk factors for LLNM. Compared with the maximum diameter of the tumor lesion ≤1 cm, the maximum diameter >2 cm (P=0.001) group was more prone to LLNM. Compared with the tumor volume ≤0.38 cm³, the tumor volume >0.38 cm³ (P=0.000) was more prone to LLNM. Conclusions The larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM. The larger volume and diameter of single focal PTC, and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.

BACKGROUNDIt is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model.

METHODSA patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group (SG, n = 20) and a control group (CG, n = 18). Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy (single layer discontinuous anastomosis with absorbable suture). Dogs of each group were divided into 4 subgroups according to time of death (1, 3, 6, and 12 months postoperatively) to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography (MRCP) to assess the stricture.

RESULTSAll procedures were completed successfully. The surgical time of the SG was significantly less than the CG (SG: (19.2 ± 4.3) minutes, vs. CG: (29.2 ± 7.1) minutes, P = 0.000). One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction during months of follow-up.

CONCLUSIONThe technique of sutureless choledochoduodenostomy with a degradable intraluminal stent is feasible and a safe procedure in this dog model.

Animals ; Choledochostomy ; methods ; Dogs ; Female ; Male ; Stents

Female ; Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Liver Neoplasms ; surgery ; Middle Aged

Objective: To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi. Methods: The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications. Results: All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ²=29.569, P<0.05) and position (χ²=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013). Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.

Objective To evaluate the safety and efficacy of flexible ureteroscopy lithotripsy (FURL) for the treatment of renal stone in solitary kidney patients.Methods The clinical data of 46 patients of solitary kidney,who were treated with FURL from March 2015 to May 2018 in our hospital,were analyzed retrospectively.There were 34 males and 12 females,aged (48.6 ± 9.6) years.Maximum diameter of stone was (15.3 ±4.8) mm,and 29 cases in left kidney and 17 cases in right.34 cases were non-renal calcaneal calculi,12 cases were subrenal calyceal stones.There were 3 cases of congenital solitary kidney,31 cases of functional solitary kidney (contralateral kidney GFR ＜ 10 ml/min) and 12 cases of acquired solitary kidney (7 cases of renal calculi,4 cases of tumor,1 case of tuberculosis).The mean reoperative serum creatinine was (116.38 ± 25.77)μmol/L.All patients were treated with general anesthesia,lithotomy,soft ureteroscopy combined with holmium laser lithotripsy,and assisted lithotripsy.All operations were performed by the same surgeon.The data of operation time,hospital stay,blood loss,renal function before and after operation,postoperative complications and stone clearance rate were recorded.Results In this study,46 cases of the operation were successfully completed.The mean operation time was (58.6 ±16.4) min,the average hospitalization time was (5.6 ± 1.4) days.The mean hemoglobin was decreased (1.4 ± 0.9) g/L.The mean operative time was (58.6 ± 16.4) min.The average postoperative hospitalization time was (5.6 ± 1.4) days.The Postoperative hematuria occurred in 32 cases,low back pain in 3 cases and fever in I case.Stone-free reached in 39 of 46 patients,the stone-free rate(SFR)of primary operation was 84.8％ (39/46).There were 7 cases of residual calculi,five patients were treated with secondary FURL,2 patients were required conservative treatment.The SFR was 95.7％ (44/46) after the second stage operation.The mean serum creatinine was (112.29 ± 20.62) μ mol/L on the first day after operation,which was not different statistically with that before operation (P =0.177).The mean serum creatinine was (81.54 ± 10.75) μmol/L one month after operation,which was significantly lower than preoperative and 1 day postoperative (P ＜ 0.05).Conclusions FURL could be a safe and effective treatment for renal stone in solitary kidney patients.It has a definite stone-free effect,low incidence of complications.

BACKGROUNDLaparoscopic splenectomy (LS) shows many advantages compared with open surgery except for the high cost. This study was aimed to recommend secondary pedicle division strategy as a method with high cost-effectiveness.

METHODSFrom January 2003 to June 2005, 14 consecutive patients underwent laparoscopic splenectomy. The splenic pedicle was controlled by secondary pedicle division strategy in 8 cases and by Endo-GIA in the other 6 cases. A retrospective study was carried out to evaluate the operative time, blood loss, time to diet, operative morbidity, postoperative stay, and operative cost.

RESULTSLS was performed successfully in a total of 14 cases. There was no significant difference between the two strategies in operative time, blood loss, time to diet, operative morbidity and postoperative stay. The operative cost of secondary pedicle division strategy group (RMB 8354.38 +/- 752.10) was significantly lower than that of Endo-GIA group (RMB 11053.33 +/- 602.27) (P < 0.01).

CONCLUSIONSLaparoscopic splenectomy by secondary pedicle division strategy is a safe, effective and economical procedure with the value of popularization in developing countries.

Adolescent ; Adult ; Aged ; Cost-Benefit Analysis ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Splenectomy ; methods

BACKGROUNDReadmission rates after pancreaticoduodenectomy (PD) for malignant diseases have a significant impact on survival rate. Identification of risk factors for readmission may improve discharge plans and postoperative care. Data exist on the morbidity and mortality of patients undergoing PD, but there are few reports about hospital readmissions after this procedure. Our aims were to evaluate the proportion and reasons for readmissions after PD for malignant diseases, the factors influencing readmissions, and to analyze the relationship between readmission rate and survival rate.

METHODSFour hundred and thirty-six patients, who had undergone PD for malignant diseases in our centre from October 1999 to October 2009, a 10-year period, excluding perioperative (30-day) mortality, were identified. All readmissions within 1 year following PD were analyzed with respect to timing, location, reasons for readmission and outcome. We reviewed the hospitalization and readmissions for patients undergoing PD, and compared patients requiring readmission to patients that did not require readmission.

RESULTSOne hundred and forty-five patients (33.26%) were readmitted within 1 year following PD, for further treatment or complications. In those cases, diagnoses associated with high rates of readmission included radiation and/or chemotherapy (48.96%), progression of disease (11.72%), infection (11.72%), gastrointestinal dysfunction/obstruction (6.20%), surgery-related complications (2.76%) and pain (4.14%). The proportion of T4 in readmission group was lower than no readmission group (P < 0.05). The proportion of node positive cases in readmission group was much higher than no readmission group (P < 0.01). The number of readmission for complications reduced gradually in the first three months, and reached a second peak in the sixth and seventh month. Median survival was lower for the readmission group compared with the no readmission group (21 versus 46 months, P = 0.024).

CONCLUSIONThese results may assist in both anticipating and facilitating postoperative care as well as managing patient expectations.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreaticoduodenectomy ; adverse effects ; Patient Readmission ; statistics & numerical data ; Postoperative Complications

The aim of this study was to explore the clinical effect and complications of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) in hematologic malignancies through retrospective analysis of 75 patients (42 male, 33 female; aged from 13 to 72 years old) received allo-PBSCT from HLA matched (n=61) or haploidentical donors (n=14). 75 patients included 35 patients with chronic myeloid leukemia (CML), 30 patients with acute myeloid leukemia, 5 patients with severe aplastic anemia, 3 patients with acute lymphocytic leukemia, one patients with multiple myeloma and one patients with paroxysmal nocturnal hemoglobinuria. Conditioning regimens were (1) Cy/TBI or Bu/Cy; (2) Cy/TBI+Ara-C; (3) fludarabine+TBI/or (CTX+ATG). Minimal residual disease has been monitored regularly by PCR and FISH. Patients received cyclosporine A and methotrexate or ATG and anti-CD25 monoclonal antibody and mycophenolate mofetil for graft-versus-host disease (GVHD) prophylaxis. Relapsing patients after transplantation received DLI and/or chemotherapy. Patient with CML were treated with imatinib. The results showed that 74 patients had hematopoietic reconstitution, and eventually converted to full donor chimerism by FISH or PCR-STR. The median time for the initial hematopoietic reconstitution was 15 (5-25) days. 46 out of 75 patients were alive and median duration was 23 (2-61) months. Among 29 dead patients, 9 died of disease relapse, 7 died of III-IV grade of acute GVHD and 7 died of severe infection (2 patients developed interstitial pneumonia). 9 out of 14 patients received haploidentical transplantation were alive, and the time of event-free survival was 30 (6-53) months, the mean survival time of 5 died patients was 7 (2-17) months. 16 patients were infected by cytomegalovirus, 2 of them died of interstitial pneumonia. None of them suffered from veno-occlusive disease in the liver. It is concluded that allo-PBSCT is effective to treat refractory hematologic diseases, and DLI/or chemotherapy should be used in the patients relapsing after transplantation.
Adolescent ; Adult ; Aged ; Female ; Hematologic Neoplasms ; surgery ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Leukemia, Myeloid ; surgery ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; methods ; Retrospective Studies ; Transplantation Conditioning ; Transplantation, Homologous ; Young Adult

OBJECTIVETo investigate the efficacy and adverse effects of dapoxetine in the treatment of premature ejaculation.

METHODSWe randomly assigned outpatients with premature ejaculation in the proportion of 2:1 to receive 30 mg dapoxetine on demand (n =78) or 50 mg sertraline qd for one month (n = 39). Follow-up was accomplished in 95 cases, 63 in the dapoxetine group and 32 in the sertraline group. We recorded the intravaginal ejaculatory latency time (IELT), clinical global impression of change (CGIC) score, and adverse reactions of the patients and compared them between the two groups.

RESULTSIELT was significantly increased in both the dapoxetine (from [0.87 ± 0.31] to [2.84 ± 0.68] min, P < 0.05) and the sertraline group (from [0.84 ± 0.28] to [2.71 ± 0.92] min, P < 0.05) after medication. Based on the CGIC scores in premature ejaculation, the rate of excellence or effectiveness was 36.5% in the dapoxetine and 37. 5% in the sertraline group, and the rate of improvement was 63.5% in the former and 71.9% in the latter. The incidence rates of dizziness, nausea, headache, and diarrhea were slightly higher (P > 0.05) while those of fatigue, somnolence, and dry mouth significantly higher (P < 0.05) in the sertraline than in the dapoxetine group.

CONCLUSIONOn-demand oral medication of dapoxetine is effective and well-tolerated for the treatment of premature ejaculation.

Benzylamines ; adverse effects ; therapeutic use ; Double-Blind Method ; Ejaculation ; drug effects ; physiology ; Humans ; Male ; Naphthalenes ; adverse effects ; therapeutic use ; Outpatients ; Premature Ejaculation ; drug therapy ; Reaction Time ; drug effects ; physiology ; Serotonin Uptake Inhibitors ; adverse effects ; therapeutic use ; Sertraline ; administration & dosage ; adverse effects ; Time Factors ; Treatment Outcome