Using direct current-electropolishing technique, the present study investigated the function of components and effects of operating conditions on polishing quality direct current-electropolishing of 316L stainless steel stent materials. Smooth surface was obtained quickly using this technique.

Objective To analyze the effect of using standardized patient (SP) tutorial in the spe-cialized training of pancreatic surgery with WeChat platform. Methods 48 surgeons participating in resi-dent standardized training in Changhai Hospital (all for postgraduate education) were enrolled as teaching object. 48 surgeons were divided into two groups: SP group (n=24) receiving WeChat combined with SP tutorial which updates learning plan, learning contents, and clinical discussion by Wechat platform and performs practical teaching by SP method, control group (n=24) receiving traditional tutorial by using tradi-tional clinical teaching methods and video teaching followed by practical teaching. The theoretical exami-nation, questionnaires and expert assessment were used to evaluate the effect of the two teaching methods. Statistical analysis was performed using the SPSS 19.0. Continuous data were expressed as median±stan-dard deviation and compared using the Student's t-test. Categorical data were compared using the Pearson's chi-square test. Results The score of theoretical examination of the two groups showed no significant difference [(85.5±7.6) vs. (81.4±14.9), P=0.238]. The results of questionnaires and expert assessment in WeChat&SP group were significantly better than those in the control group (P<0.001) other than theoretical and analytical ability (P>0.05). Conclusion WeChat platform combined with standardized patient tutorial in the specialized training of pancreatic surgery is feasible and more effective than traditional tutorial to improve teaching effectiveness.

Objective To evaluate the safety and short-term efficacy of transrectal ultrasound-guided transperineal cryosurgical ablation(TRUSCSA) for localized prostate cancer. Methods The data of 26 patients who were diagnosed with clinically localized prostate cancer (T_(1a)N_0M_0 - T_(2x)N_0M_0) by biopsy were reviewed. The data of serum prostate-specific antigen (PSA) level, clinical stage and Gleason score were collected. The Gleason score of all cases was ≤7; among them 6 cases were 2 - 4 and 20 cases were 5 - 7. The average pretreatment value of PSA was 11. 9 ng/ml (4. 7 - 19. 2 ng/ml). All the patients were treated with TRUSCSA, with a dual freeze-thaw cycle by using ultrathin 17-gauge cryoneedles. Immediate and delayed morbidities were evaluated. The PSA level was obtained every 3 months for the first 2 years and then every 6 months thereafter, and failure was defined as the inability to reach a nadir of 0. 5 ng/ml or less. All patients were strongly encouraged to undergo routine biopsies despite a stable PSA level. Results The operative time was (102±32)min. The postoperative hospital stay was (6±2)d. After withdrawal of the catheter, 22 cases had good continence) 4 had temporary incontinence for 3 - 7 d. Before operation 9 cases had normal sex life, and among them 5 cases had erectile dysfunction after operation. No one developed urinary retention or urethro-rectal fistula. The follow-up ranged from 6 to 30 months (mean 22). The PSA level at the last follow up visit was less than 0. 5 ng/ml in 23 patients (88%) and 0. 5 ng/ml or more in 3(12%). Postoperative biopsies were taken in 20 cases and the results were negative at the 6th month. Conclusions Transrectal ultrasound-guided percutaneous cryosurgical ablation for clinically localized prostate cancer could be effective and safe. Additional studies with longer follow-up are necessary to determine the sustained efficacy of this procedure.

Objective To evaluate the clinical feasibility of radiofrequency ablation (RFA) for renal cell carcinoma in functional solitary kidney. Methods Five selected cases of primary renal cell carcinoma in a functional solitary kidney were retrospective analyzed. Three cases of left renal cell carcinoma and 2 cases of right renal cell carcinoma were diagnosed by B ultrasound and CT scanning. The maximum diameter of the tumors were 3.0- 6.0 cm. Three cases of which were T1a N0 M0 and the others Were T1bN0M0. All patients were followed up with enhanced-CT and contrast-enhanced ultrasonography. Results The mean time of the operation was 100.0+28.5 min, and the mean blood loss was 95.0±30.5 ml. No patients accepted blood transfusion post-operation. All patients after operation had fever (38.2±0. 7 ℃ ). All the lesions were completely ablated on contrast-enhanced ultrasonography. There was no statistic change of hemoglobin, serum creatinine (SCr), ECT-GFR and creatinine clearance after operation (P>0.05). All of the 5 cases survived. No recurrence were found by enhanced-CT and contrast-enhanced ultrasonography and SCr was retaining in the normal level during follow-ups (median, 11.5 months). Conclusion Radiofrequency ablation for renal cell carcinoma in a functional solitary kidney could be a treatment choice with a relatively low incidence of complications.

Objective To assess the contribution of transrectal realtime tissue elastography (TRTE) on the differential diagnosis of prostatic diseases. Methods A total of 88 prostatic disease patients with 95 lesions proved by pathology from May 2012 to January 2013 in the Afifliated Drum Tower Hospital of Medical College of Nanjing University were included. The elasticity grade and strain ratio were calculated by using TRTE. According to the gold standard of pathological results, the sensitivity, speciifcity, accuracy rate were calculated to evaluate the effectiveness of elasticity grade and strain ratio in distinguishing benign and malignant prostatic diseases;and the receiver operating characteristic (ROC) curves were made respectively. The accuracy of elasticity grade and strain ratio in diagnosing prostatic diseases was also compared using chi-square test. Results Forty-seven benign lesions were found in the 95 prostatic lesions and the other 48 lesions were malignant. The elasticity grades of the 95 prostatic lesions were as follows:GradeⅠ26, GradeⅡ19, GradeⅢ16, GradeⅣ21, and GradeⅤ13. Elasticity grade ≤Ⅱwas considered to be benign, while grade ≥Ⅲwas malignant. The sensitivity, speciifcity, accuracy rate of elasticity grade in diagnosis of prostatic malignant lesions was 79.17%(38/48), 74.47%(35/47) and 76.84%(73/95), respectively. According the ROC curve analysis, the cutoff point of strain ratio was 4.67, and Youden′s index was 0.622. The sensitivity, speciifcity, accuracy rate of strain ratio was 83.33%, 78.72%and 81.05%, respectively. The area under ROC curves of strain ratio was superior to that of elasticity grade. But the diagnosis accuracy of the two approaches was almost the same in statistics (χ2=0.51, P>0.05). Conclusions TRTE is valuable in the differential diagnosis of the prostatic benign and malignant lesions. Both strain ratio and elasticity grade are useful approaches, and have similar diagnostic accuracy.

Objective:To study the correction factor of the chamber wall of the reference air kerma rate reference ionization chamber (NIM-Ir-SG-100 type) for 192Ir radioactive source. Methods:The photon spectrum and ionization chamber wall correction factor of the radioactive source housing and irradiator model are calculated by Monte Carlo code. And then the photon energy, wall thickness and ionization chamber diameter, which affect the result of the chamber wall correction factor, are simulated.Results:After calculation, the simulation result of the correction factor of spherical graphite cavity ionization chamber wall was 1.037 7. Controlling a single variable, photon energy (0.3-1.3 MeV), wall thickness (0.2-0.5 cm), inner diameter (0.5 -15 cm), the maximum deviations of wall correction result were 1.62%, 3.30% and 2.86%, respectively.Conclusions:The self-made spherical graphite cavity ionization chamber has good performance, and the corrected kwall value of the chamber wall is within a reasonable range. The completion of the chamber wall correction factor is an important step to measure the reference air kerma rate of the 192Ir radioactive source and establish the measurement benchmark.

Objective To investigate the clinical effects and safety of terbutaline combined with budesonide atomized inhalation in the treatment of children with bronchiolitis obliterans .Methods 140 cases of children with bronchiolitis obliterans from June 2015 to June 2017 were selected as research subjects , and they were randomly divided into control group and observation group according to the digital table ,with 70 cases in each group .The control group was given budesonide atomized inhalation alone ,and the observation group was given terbutaline combined with budesonide atomized inhalation .The clinical effects ,disappeared time of symptoms ,levels of IL-4 and INF-γbefore and after treatment and incidence rate of adverse effects in the two groups were compared .Results The excellent effective rate and total effective rate of the control group were 28.57％,78.57％,respectively,which were significantly lower than those of the observation group (44.29％,95.71％) (χ2 =9.73,8.60,all P<0.05).The disappeared time of symptoms of the observation group was significantly shorter than those of the control group ( t=2.67,3.15,2.20, 2.36,all P<0.05).The levels of IL-4 and INF-γafter treatment of the observation group were significantly higher than those of the control group and before treatment (t=2.44,2.71,3.07,3.66,2.94,3.26,all P<0.05).The incidence rates of adverse effects of the control group and the observation group were 8.57％,11.43％,respectively, there was no statistically significant difference between the two groups (χ2 =1.49,P>0.05).Conclusion Terbutaline combined with budesonide atomized inhalation in the treatment of children with bronchiolitis obliterans can efficiently control the disease progression ,shorten the clinical disease course ,regulate the levels of IL -4 and IFN-γand not aggravate the adverse drug reactions .

OBJECTIVETo initially explore the clinical effect of cool-tip radiofrequency ablation combined with enucleation for the giant hamartoma of kidney with narrow base and export-oriented way of growth.

METHODSThe clinical date of 15 patients including 6 male and 9 female with special hamartoma of kidney underwent cool-tip radiofrequency ablation assisted enucleation from July 2011 to October 2014 were reviewed.The median age was 49 years (ranging from 35 to 71 years). There were 6 cases with left renal tumor, 8 cases with right renal tumor and 1 case with solitary kidney tumor.All patients were confirmed by B ultrasound or CT scan, the mean diameter of hamartoma of kidney was 9.7 cm(8.5-12.7)cm, all tumors were located distant from the collecting system and presents with a special way of growth.The preoperative hemoglobin was (129±18)g/L, SCr was (92±41)μmol/L, glomerular filtration rate (GFR) was (32±12)ml·min(-1)·1.73 m(-2).

RESULTSCool-tip radiofrequency ablation assisted enucleation was technically successful in all patients.The mean operative duration was (115±31)minutes, and the average intraoperative bleeding was (72±21)ml with no blooding transfusion.The postoperative hospital stay was(7±2)days, and the postoperative hemoglobin was(129±18)g/L, SCr (92±41)μmol/L, GFR(30±15)ml·min(-1)·1.73 m(-2). No statistic change of hemoglobin and SCr or glomerular filtration rate after operations(all P>0.05). Postoperative pathology showed that all cases were hamartoma of kidney.During a mean follow-up period of 19.5 months, none of them had local tumor recurrence or chronic renal insufficiency.

CONCLUSIONSCool-tip radiofrequency ablation assisted enucleation is both safe and effective in the treatment of huge hamartoma of kidney with a narrow base and export-oriented way of growth. The short-term follow-up shows a satisfactory therapeutic effect.

Adult ; Aged ; Angiomyolipoma ; surgery ; Blood Transfusion ; Catheter Ablation ; methods ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms ; surgery ; Length of Stay ; Lipoma ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Period ; Treatment Outcome

Objective To explore the clinical value of laparoscopic totally extraperitoneal herniorrhaphy (LTEP) and open to tally extraperitoneal (OTEP) for bilateral inguinal hernias.Methods From January 2015 to December 2017,61 male patients with bilateral inguinal hernias,who were in accordance with the inclusion criteria,were prospectively randomized into laparoscopic totally extraperitoneal herniorrhaphy group (LTEP group,n =31)or totally extraperitoneal herniorrhaphy via hypogastric midline incision group(OTEP group,n =30).Operative outcomes,postoperative complications,recurrence,the levels of C-reactive protein (CRP) were analyzed.The data were analyzed by statistical software.Results The operative baselines of patients in two groups were equivalent.In patients who received laparoscopic totally extraperitoneal herniorrhaphy,decreased levels of CRP on the 1th day after operation,postoperative ambulation and hospital stay [(88.7 ± 18.5) mg/L vs (102.0 ±25.1) mg/L,P=0.022];[(5.6±2.2) h vs (20.0±5.5) h,P＜0.001;(3.0±0.6) dvs (4.5±1.0) d,P ＜ 0.001],were found compared with the OTEP group significantly,LTEP group had more hospitalization expense than OTEP group [(14 779.3 ± 1450.1) yuan vs (13 650.0 ± 1 787.3) yuan,P ＜ 0.001].There were no mesh infection,chronic pain,scrotal edema and recurrence of inguinal hernia in two groups.No difference was found between the two groups in the other operative outcomes and postoperative complications.Conclusion Both laparoscopic totally extraperitoneal herniorrhaphy and totally extraperitoneal herniorrhaphy via hypogastric midline incision are effective and safe in the treatment of bilateral inguinal hernias,each has both advantages and disadvantages,and complement each other.

Objective To assess the disease burden for gynecological disease in China in 2016. Methods Data were extracted from the global burden of disease study 2016(GBD 2016). The burden of gynecological disease among age groups and provinces groups was assessed by prevalence rate, mortality rate, years lived with disability (YLD), years of life lost due to premature mortality (YLL) and disability-adjusted life years(DALY). An average world population age-structure for the period 2010-2035 was adopted to calculate age-standardized rates. Results In 2016, the prevalence rate of gynecological disease in women aged 15 years and above in China was 24.94%, of which was 36.71%to women of childbearing age. The number of DALY from gynecological disease was 2727637.82 life years in 2016, with the DALY rate was 411.12/100000 and standardized DALY rate was 341.80/100000. The first three gynecological diseases with highest DALY and DALY rate among Chinese women aged ≥15 years were premenstrual syndrome(815004.64 life years, 122.84/100000), uterine fibroids(281976.67 life years, 42.5/100000) and endometriosis (154792.89 life years, 23.33/100000). The DALY caused by gynecological disease in Guangdong (220871.19 life years), Shandong (190968.72 life years), Henan (171273.92 life years), Jiangsu(168404.27 life years)and Sichuan(144358.5 life years)were higher than other provinces. The standardized DALY rate attributable to gynecological disease were highest in Xinjiang Uygur Autonomous Region(404.00/100000), Shanghai(394.90/100000), Heilongjiang(382.00/100000), Beijing(365.70/100000)and Jiangsu (357.50/100000). Conclusions Gynecological disease is a great threat to women' s reproductive health. Effective measures should be taken to address the issue, especially to women of childbearing age.