Objective To summarize radiofrequency cather ablation (RFCA)of tachycardias with right sid-ed accessory atrioventricular pathway in 7 patients with persistent left superior vena cava (PLSVC). Methods RF-CA for right sided accessory atrioventricular pathway in 7 patients with PLSVC was carried out . Coronary sinus ac-cess was performed through the left subclavian and the left femoral vein respectively. Swartz sheath was used during ablation if neccesary. Results There was no siginificant differences in fluoroscopy time between the left subclavian approach and the left femoral vein approach[(2.8 ± 0.6)min vs (3.2 ± 0.3)min, P>0.05)]. No recurrence of ac-cessory pathway conduction was found during a mean follow-up of (23 ± 11) months. The mean discharging time and fluoroscopy time were (312 ± 67)s and (17 ± 5)min respectively. Conclusions Although RFCA of right sided accessory atrioventricular pathway in patients with PLSVC shows specialities in cather manipulation , mapping and ablation, high successful results can be achieved by experienced physician.

OBJECTIVE To make a research on the diagnostic value of Magnetic resonance image for preoperative localization of the parathyroid glands in secondary hyperparathyroidism patients.METHODS This retrospective study was on 51 patients with secondary hyperparathyroidism who underwent parathyroid gland resection and autoplastic transplantation and were examined with Magnetic resonance imaging 99mTC-MIBI nuclide imaging and Color doppler ultrasound in our hospital from 2010 to 2016.Compare to the gold standard of pathological diagnosis after operation,the sensitivity of various imaging examination on identifying the parathyroid glands were calculated.RESULTS The number of parathyroid glands diagnosed by pathology was 197,including 180 conventional parathyroid glands and 17 eetopic parathyroid glands.The sensitivity of MRI,99mTC-MIBI nuclide imaging and Color doppler ultrasound on identifying the conventional parathyroid glands was 76.67％,51.11％ and 44.44％ respectively,and the sensitivity on identifying the ectopic parathyroid was 29.41％,0 and 0 respectively.Sensitivity of the Magnetic resonance on identifying the conventional parathyroid and the ectopic parathyroid imagin were better than 99mTC-MIBI nuclide imaging and color doppler(P＜0.05).CONCLUSION Magnetic resonance imaging is an effective auxiliary examination on preoperative localization of the parathyroid glands in secondary hyperparathyroidism patients and can be the first choice of the image examination.

ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.

In order to characterize the immunogenicity and immunoprotection of the Staphylococcus aureus (S. aureus) surface protein Clumping factor A (ClfA), we amplified clfa genes from S. aureus Newman strain, Wood46 strain and HLJ23-1. The clfa gene from Newman strain was subsequently inserted into pQE-30 vector and the recombinant plasmid was transformed into Escherichia coli strain M15 (pREP4). The recombinant ClfA protein was expressed and purified. Then, we immunized mice with the purified recombinant protein. The antibody level and the concentration of cytokines were measured by enzyme-linked immunosorbent assay. Finally, immunized mice were challenged with S. aureus Newman, Wood46 and HLJ23-1. These results suggested that clfa gene sequences were highly conserved, and the recombinant ClfA was expressed correctly with good antigenicity. The antibody titer and the concentration of cytokines in the immunized groups increased significantly (P < 0.05) compared with control, and the mice in the immunized groups were protected against the challenge strains to some extent. These results showed that the ClfA had high immunogenicity and immunoprotective potential.
Animals ; Coagulase ; genetics ; immunology ; metabolism ; Escherichia coli ; genetics ; metabolism ; Immunization ; Mice ; Recombinant Proteins ; genetics ; immunology ; metabolism ; Staphylococcus aureus ; metabolism ; pathogenicity

Objective: To discuss the application experience and predictive value of circulating tumor cells for urothelial carcinoma. Methods: The clinical data of 96 patients with urothelial carcinoma treated by Beijing Cancer Hospital Urologic Department between September 2017 and September 2019 were analyzed retrospectively to evaluate relationship between the number of CTCs and pathological outcome. The mean age of the entire cohort was 62(40-87)years, with 74 males and 22 females. There were 13 cases of upper urinary tract tumors (pyelocarcinoma and ureteral carcinoma), 83 cases of bladder carcinoma, and 12 cases of lymph node metastasis. There were 77 cases of primary onset and 19 cases of recurrence. 68 cases in single focus group and 28 cases in multiple group. There were 29 cases in non infiltrative T_a stage, 42 cases in infiltrative lamina propria T₁ stage, 16 cases in infiltrative muscle T₂ stage, and 9 cases in extra-muscular≥T₃ stage. At least 3ml of peripheral blood was collected after fasting for at least 8 hours, After cleavage and centrifugation, immunomagnetic beads were added, folate probe was added, and then amplification was carried out. Then the copy number of CTCs in each ml of blood was calculated. Logistic linear regression was used to analyze the risk factors of lymph node metastasis. Results: The mean CNC of all patients was 12.3±7.3; the mean CNC of ≤62 years old group was 10.8±4.2; the mean CNC of >62 years old group was 13.7±9.2; the mean CNC of initial cases was 11.5±5.3; the mean CNC of recurrent cases was 15.5±12.2. Age (P=0.135) and frequency of onset (P=0.087) had no effect on the number of CTCs. The average CNC of single focus group was 10.5±5.2, multiple focus group was 16.5±9.7, T_a stage group was 8.2±2.3, T₁ stage group was 12.0±4.4, T₂ stage group was 16.4±6.8, and ≥T₃ stage group was 19.5±16.6. The number of lesions (P<0.001) was significantly correlated with pathological T stage (P<0.001) and the number of CTCs. Univariate regression analysis showed that T stage (P<0.001) and the number of CTCs (P=0.02) might be correlated with lymph node metastasis; multivariate analysis showed that only T stage could be used as an independent predictor of lymph node metastasis (P=0.002). Conclusions CTCs can be used to predict lymph node metastasis of urothelial carcinoma.

Objective To explore the application of nephron-sparing surgery in giant renal angiomyolipomas with the maximum diameter greater than 15 cm and its relevant surgical experience.Methods Between July 2014 to January 2017,5 patients with giant renal angiomyolipoma greater than 15 cm was admitted to our hospital for nephron-sparing surgery.The patients were all female ranging in age from 32-50 years (43.0 ± 7.1) years.According to the tumor imaging characteristics,we divided them into 3 different types including diffuse endogenous,exogenous and mixed type.All the tumors meet the criterion of exogenous type,ranging in diameter from 15.0-28.0 cm (20.4 ± 5.8) cm.4 patients harbored one single tumor and the other bilateral tumors.All the giant tumors located on the right side.Open transperitoneal nephron-sparing surgery was performed.Result During the operation,to find the joint site between the tumor and normal kidney is the key procedure in order to reserve more normal renal parenchyma.The operation time ranged from 105-175 min (125.4 ± 28.4) min,warm ischemia time 8-20 min (15.8 ±4.8) min,blood loss 50-400 ml (162.0 ± 141.5) ml.The average postoperative drainage volume ranged from 50-165 ml (99 ± 45) ml,the time of drainage tube removal 1-8 days (4.0 ± 2.6) days.The postoperative serum creatinine had no significant change compared to the value before operation (P =0.808).Postoperative hospital stay was 5-12 days (7.2 ± 2.9) days.Benign renal angiomyolipoma with negative margins was diagnosed as expected.No patient had a recurrence after a 1-32 months follow-up.Conclusion Nephron-sparing surgery could be used selectively in patients with giant renal angiomyolipoma greater than 15cm.For the tumors with the characteristic of exogenous type on imaging assessment before operation,open transperitoneal nephron-sparing surgery was an optional choice and could be implemented safely.

Objective:To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods:The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed. There were 13 males and 6 females. The average age was 46.2 years. The mean body mass index was (25.8±3.1) kg/m 2. The masses located in the left kidney in 7 cases and the right kidney in 12 cases. The ECOG scores were 0. The mean maximum diameter of the tumors was (2.8±1.3) cm. Five cases were diagnosed with Bosniak Ⅲ and 14 cases with Bosniak Ⅳ. According to R. E.N.A.L. scoring, 11 cases were of low difficulty (4-6 points), 7 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The cystic renal masses were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results:The mean duration of operation was (84.0±20.8) min. The median intraoperative blood loss was 20 (10-50) ml. The median duration of postoperative hospitalization was 3 (2-6) d, and no complications such as bleeding, infection, gross hematuria or urine leakage were observed. According to the malignant degree of cystic renal masses, the patients were divided into low-risk group and high-risk group. The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group, while the patients with high malignant pathology were considered as the high-risk group. In the low-risk group, there were 4 patients, including 1 patient with papillary adenoma, 1 patient with renal angiomyolipoma, 1 patient with low-grade malignant potential multilocular cystic renal tumor, and 1 patient with renal chromophobe carcinoma (stage T 1a). In the high-risk group, there were 15 cases, including 14 cases of clear cell renal cell carcinoma (AJCC pathological stage: T 1a stage 11 cases, T 1b stage 3 cases; WHO/ISUP classification: 7 cases in grade 1, 6 cases in grade 2, and 1 case in grade 3); 1 case of Type 2 papillary renal cell carcinoma (stage T 1b, grade 2). The median follow-up was 20 months (12-37 months). Both groups survived, and no signs of tumor recurrence, implantation or metastasis were found in chest and abdomen imaging. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions:The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses is satisfactory, and postoperative pathology is clear, providing a potential option for cystic renal masses treatment.

Objective: To investigate the relationship between SUVmax on preoperative 68Ga-PSMA PET-CT and the clinicopathological characteristics of patients treated with radical prostatectomy. Methods: The clinicopahtological data of patients evaluated with ⁶⁸Ga-PSMA PET-CT preoperatively and treated with radical prostatectomy between May 2016 and August 2019 were retrospectively reviewed. 31 patients with a mean age (63.1±4.9) and baseline PSA (72.71±173.15)ng/ml were enrolled. Their BMI mean (24.6±3.0)kg/m². Baseline testosterone of 14 patients was (4.72±1.64)ng/ml.Based on the Gleason scores related ISUP classification, all patients were classified into grade one in 5 cases, grade 2in 7 cases, grade 3 in 4 cases, grade 4 in 10 cases and grade 5 in 5 cases. The clinical classification included 6 cases in T_2a stage, 2 cases in T_2b stage, 17 cases in T_2c stage, 1 case in T_3a stage, 4 cases in T_3b stage and 1 case in T₄ stage. SUVmax was accessed by two independent professional nuclear medicine physicians. SUVmax was 12.49±9.38. SPSS 16.0 software was used to do statistic analysis. Results: The post-operative pathological results showed the surgical margin positive in 19 cases, negative in 12 cases, vascular positive in 5 cases, negative in 20 case, positive nerve invasion in 20 cases and negative in 11 cases. 2 patients were low risk, 7 patients were medium risk and 22 patients were high risk according to D′Amico classification. Based on the basis of PSA(≤10 or>10) and Gleason score(≤6 or>6), 6 patients were in group with low PSA and low Gleason score, 5 patients were low PSA and high Gleason score, 9 patients were high PSA and low Gleason score, 11 patients were high PSA and high Gleason score. SUVmax had a significant positive relationship with pathological ISUP(r=0.434, P=0.015) and SUVmax in patients with positive intravascular tumor emboli was significantly higher than those with negative intravascular tumor emboli(14.78±10.68 vs. 8.17±2.81, P=0.005). No significant correlation was found between SUVmax and baseline PSA, testosterone, pathologic T stage, surgical margin, nerve invasion, pelvic lymph node status as well as risk stratification. SUVmax could distinguish pathologic ISUP grade 5 with a maximum AUC 0.747 (P=0.033) and the sensitivity was 88.9%. The specificity was 77.3% when SUVmax≥11.34. SUVmax in patients with upgrading ISUP was significantly higher than that in patients with downgrading ISUP (16.01±5.40 vs. 4.98±2.11, P=0.007). Conclusions SUVmax measured on preoperative ⁶⁸Ga-PSMA PET-CT may have a clinical significance in predicting unfavorable pathological factors for patients treated with radical prostatectomy.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.