Objective:To develop the instrument for the evaluation of the report quality of clinical trials with the modified Delphi method in combination with panel discussions, and assess its validity and reliability. Method: For the development of the instrument, the modified Delphi method in combination with a panel discussion was applied. The consulting panel included pharmacologists, clinical doctors, epidemiologists, statisticians and editors of journal. 30 reports for the therapy of hypertension published in 2000 were selected for the estimation of the instrument of the validity and reliability. The interclass correlation coefficient (ICC) was used to test the reliability. The CONSORT statement was used as a control, and a Kendall correlation was worked out to estimate the validity. Result:A total of 10 specialists took part in the consultation. During the first round of consultation, the expert harmonious coefficient (W) reached to 0. 505 and 19 items were identified. A total of 100 scores were distributed to the 19 items in the second round, and finally the scale was completed. After scoring the 30 reports on hypertension therapy by two readers independently, the interclass correlation coefficients (ICC) of the total score were 0.921,and 0.987 in the introduction part, 0.875 in materials and methods, 0.902 in results, and 0.966 in the discussion and others, P

Objective To investigate the differences between indocyanine green (ICG) fluorescence imaging plus methylene blue and plus Carbon Nanoparticles Suspension Injection for sentinel lymph node biopsy (SLNB)in breast cancer patients. Methods A total of 134 cases of early breast cancer patients performed SLNB from November 2013 to November 2016 were involved,of which 48 cases were performed with ICG fluorescence imaging plus methylene blue,and another 86 cases plus Carbon Nanoparticles Suspension Injection. Results There was no significant difference between ICG plus Methylene Blue group and ICG plus nano carbon group in terms of detection rate(P>0.05),detected numbers(P>0.05),sensitivity(P>0.05),accuracy(P>0.05)and false negative rate(P > 0.05). Age,and body mass index(BMI)exerted no influence on the detection rate and accuracy of SLNB in two groups(P>0.05). Conclusion ICG Fluorescence Imaging plus Methylene Blue showed similar detection rate , detected numbers , sensitivity , accuracy and false negative rate as it plus Carbon Nanoparticles Suspension Injection for SLNB in breast cancer patients ,and both of them can be performed easily and conveniently.

Objective To investigate the clinical applications of 64-MSCTA for the follow-up of endovascular stent-graft exclusion (EVE). Methods Between Oct 2006 and Feb 2008, forty-four 64-MSCTA examinations were performed in 30 patients with aortic dissection (AD) and 5 patients with abdominal aortic aneurysm (AAA) who underwent EVE. Imaging reconstruction including MPR, MIP and VR were finished on workstation. The outcomes and complications after EVE of aortic dissection and aortic aneurysm were evaluated. Results (1) Of 30 patients with aortic dissection, large thrombosis in false lumen was observed in 28 cases and small thrombosis in 2 cases. The cavity of aortic aneurysm outside the stent was thrombosed completely in 5 patients with AAA. (2) Thrombosis in the innominate artery on follow-up CTA after EVE was found in 1 AD patient with the innominate artery involved, Thrombosis in the superior mesenteric artery was observed on 15 days follow-up CTA but thrombolysis on 3 months after EVE in 1 case, lntimal tear in right common iliac artery was found in 1 case. Of 5 patients with AAA, occlusion of right inner iliac artery was observed in 1 case, and instent thrombosis in distal right common iliac artery was found in 1 case. (3) Endoleak was found in 14 patients with AD, including 8 with type Ⅰ and 6 with type Ⅲ endoleaks, one type Ⅲ endoleak was disappeared on follow-up CTA after 3 months. Conclusions 64-MSCTA with fast, non-invasive and effective merits, combining multiple reconstructive methods, has become one of preferred imaging methods in post-operative evaluation of EVE.

Objective To investigate the risk factors for death within 30 days of stroke associated pneumonia(SAP) in elderly patients of the intensive care unit (ICU).Methods Clinical data of 116 patients with SAP who were admitted to ICU were reviewed.The predicting factors of death within 30 days were analyzed through variable analysis method.Results The hospitalization periods of the SAP group and control group were (27±8) d and (12±5) d,the difference was statistically significant(t =1 1.30,P =0.002).The most common pathogenic bacteria in SAP were Klebsiella pneumoniae,Bauman Acinetobacter,Escherichia coli,and gram negative bacteria.There was significant difference between the two groups in term of mortality rate(37.9％(44/ 116) of SAP group,22.0％ (22/100) of control group,x2 =6.423,P =0.011).Logistic regression analysis showed that basic diseases(OR =2.778,95％ CI:1.205-6.401),high CRUB-65 score (OR =1.978,95％ CI:0.871-11.098),lower Glasgow coma score(GCS) (OR=3.601,95％CI:0.244-9.477),bucking(OR=3.020,95％CI:1.305-10.603),mechanical ventilation(OR=2.654,95％CI:1.176-5.990),shock(OR=2.636,95％ CI:1.164-5.969) and high plasma CRP level(OR=2.333,95％CI:1.046-5.206) were risk factors for SAP (all P＜0.05).In Cox regression analysis,a GCS score of ＜ 9 was an independent risk factor for 30 d mortality of patientswithSAP(HR=7.23,95％Cl:2.24-20.11,P=0.001).Conclusion SAP is one of the serious complications of the elderly hospitalized for the acute stroke in the ICU,which may affect the prognosis of the patients.

Objective:To access the efficacy of monoenergetic imaging from spectral CT combined with metal artifact reduction for orthopedic implants (O-MAR) on reducing contrast hardening artifacts in the vein on the injection side, and determining the optimal monoenergetic spectral range to improve the display of axillary lymph node.Methods:A total of 35 patients with breast cancer who underwent chest-enhanced CT scans were enrolled in this retrospective study. The original data were reconstructed to obtain a total of 35 sets of images, including one conventional image, 17 groups of monoenergetic images, and 17 groups of monoenergetic+O-MAR images. The areas of interest were delineated in the high and low-density artifact area on the injection side of the same layer contrast agent, and the contralateral ectopectoralis. The CT value and its standard deviation (SD) were recorded respectively, the artifact area was measured, and the number of axillary lymph nodes was recorded. The difference in CT values (ΔCT 1, ΔCT 2) and the artifact index (AI1 and AI 2) of the high and low-density artifact areas relative to the contralateral ectopectoralis in the same layer were calculated respectively. Friedman test and Wilcoxon signed-rank test were used to compare the differences of ΔCT, AI, artifact area, and number of lymph nodes among the three imaging modalities, and the Kappa test was used to compare the differences in subjective evaluation. Results:As the energy level increased, compared to the conventional image, monoenergetic image, ΔCT 1 absolute value, ΔCT 2 absolute value, AI 1, and AI 2 showed a trend of initially low and then high, artifact area decreased, and the number of detected lymph nodes increased ( P<0.01). Compared to other energy levels, when the monoenergetic image was 100 keV, ΔCT 1 value, 140 keV for ΔCT 2 value, 120 keV for AI 1 value, and 130 keV for AI 2 value were close to zero, and the number of detected lymph nodes was highest at 110-200 keV. In contrast, in the monoenergetic+O-MAR images, ΔCT 1 absolute value showed a trend of initially low and then high, but, ΔCT 2 absolute value, AI 1, AI 2, and artifact area all significantly decreased, whereas the number of detected lymph nodes significantly increased (χ 2 values were 916.23, 895.93, 387.08, 519.41, 890.10, and 1027.98, respectively. All P<0.01). Compared to other energy levels, when the monoenergetic+O-MAR image was at 100 keV, ΔCT 1 value was close to zero, while ΔCT 2 value became close to zero with increasing energy level, and the number of detected lymph nodes was highest at 110-200 keV. As the energy level increased, the ΔCT 1, AI 1, AI 2, and artifact area of monoenergetic+O-MAR images were significantly smaller than those of monoenergetic images at the same energy level, and the number of detected lymph nodes was significantly higher than that of monoenergetic images ( P<0.01). The subjective scores for 110-200 keV monoenergetic images and 100-200 keV monoenergetic+O-MAR images were both higher than 4, and the score for monoenergetic+O-MAR images was significantly higher than that of single-energy spectrum images. The agreement between the two radiologists in assessing subjective scores was good. Conclusion:At 100-120 keV level, spectral CT monoenergetic combined with O-MAR imaging technique has the best performance in removing hardening-induced artifacts of chest-enhanced CT contrast agent and detecting and displaying axillary lymph nodes.

OBJECTIVES: To explore the method and significance of prenatal counseling in cardiac surgery for fetal congenital heart disease (CHD). METHODS: The prenatal counseling should be provided by experienced CHD experts. The preliminary clinical diagnosis based on relevant data was carried out, the prognosis risk for fetal CHD was graded, and the pathophysiological process and potential hazards of the disease were analyzed. The current condition of CHD in the treatment plan, the long-term quality of life, and the special requirements of parturition in place, period and mode were described. A reliable follow-up system of the fetuses was established, the diagnosis after delivery was verified, and surgical treatment was carried out timely. RESULTS: From January 2016 to December 2018, 225 parents with fetal CHD received prenatal counseling, including 60 fetuses (26.7%) with simple CHD and 165 (73.3%) with complex CHD, among which 59 cases (98.3%) and 93 cases (56.4%) decided to continue the pregnancy, respectively. During the follow-up, 118 fetuses were born, of which 66 infants received surgical treatment within 6 months after birth, 63 infants (95.5%) recovered and 3 infants (4.5%) died. The rest 52 infants continued to be followed up. CONCLUSIONS The prenatal counseling for fetal CHD can provide the parents a comprehensive medical information about CHD, which is beneficial to making appropriate pregnancy decisions, and can turn the fetuses from unreasonable birth and passive treatment to selective birth and active treatment in CHD.
Cardiac Surgical Procedures ; Counseling ; Female ; Fetus ; Heart Defects, Congenital ; surgery ; Humans ; Pregnancy ; Prenatal Diagnosis ; Quality of Life ; Ultrasonography, Prenatal

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy (ELRC) through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space, the expansion of the peritoneal space, the operation steps of bladder resection and lymph node dissection through the peritoneal channel, and how to shorten the operation time and reduce the difficulty of the operation. During the surgery, the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support, secretion, protection and lubrication, which has little impact on the abdominal organs, reduces the incidence of complications, and provides favorable conditions for subsequent treatment.