Objective:To analyze the clinicopathological features,prognostic value and surgical treat-ment experience in patients with adrenocortical carcinoma with venous tumor thrombus.Methods:We collected relevant data of the patients with adrenocortical carcinoma who had undergone surgery in Peking University Third Hospital from 2018 to 2023.The patients were divided into venous tumor thrombus group and non-tumor thrombus group.The Wilcoxon rank sum test was used to compare the quantitative varia-bles.The chi-squared test and Fisher's exact test were used to compare the categorical variables.The Kaplan-Meier method was used to estimate the survival rate.Results:A total of 27 patients with adreno-cortical carcinoma were included,of whom 11 cases(40.7％)had venous tumor thrombus.In the pa-tients with venous tumor thrombus,8 patients were female and 3 were male.The median age was 49(36,58)years.The median body mass index was 26.0(24.1,30.4)kg/m2.Seven patients presented with symptoms at their initial visit.Six patients had a history of hypertension.Elevated levels of cortisol were observed in 2 cases.Three tumors were found on the left side,while 8 were found on the right side.Median tumor diameter was 9.4(6.5,12.5)cm.On the left,there was a case of tumor thrombus limit-ed to the central vein of the left adrenal gland without invasion into the left renal vein,and two cases of tumor thrombus growth extending into the inferior vena cava below the liver.One case of tumor thrombus on the right adrenal central vein did not invade the inferior vena cava.Four cases of tumor thrombus inva-ded the inferior vena cava below the liver and three cases extended to the posterior of the liver.Ten pa-tients were in European Network for the Study of Adrenal Tumors(ENSAT)stage Ⅲ and one was in ENSAT stage Ⅳ.Open surgery was performed in 6 cases,laparoscopic surgery alone in 4 cases and ro-bot-assisted laparoscopic surgery in 1 case.Two patients underwent ipsilateral kidney resection.Median operative time was 332(261,440)min.Median intraoperative bleeding was 900(700,2 200)mL.Median hospital stay was 9(5,10)days.Median survival time for the patients with tumor thrombus was 24.0 months and median time to recurrence was 7.0 months.The median survival and recurrence time of 16 patients without tumor thrombus were not reached.The patients with tumor thrombus had worse 3-year overall survival(OS)rate(40.9％vs.71.4％;Log-rank,P=0.038)and 2-year recurrence-free sur-vival(RFS)(9.1％vs.53.7％;Log-rank,P=0.015)rates compared with the patients with non-tumor thrombus.Conclusion:Patients with adrenocortical carcinoma with venous tumor thrombus have poor prognosis.Different adrenal tumor resections and venous tumor thrombus removal procedures based on different tumor thrombus locations are safe and effective in treating this disease.

Objective:To investigate the prevalence and potential classification of symptoms after total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA), and to analyze the differences in demographic characteristics and surgical data, compare the different potential subgroups, in order to provide a basis for clinical symptom management plans.Methods:This study was a multicenter cross-sectional survey. Through convenience sampling, patients with KOA undergoing TKA in the orthopaedic wards of four tertiary hospitals in Urumqi were selected as the study from November 2023 to February 2024. The study subjects were surveyed using a general information questionnaire, the Visual Analogue Scale (VAS) for pain, the Hospital Anxiety and Depression Scale (HADS), and the Pitts Burgh Sleep Quality Index (PSQI), and the degree of postoperative joint swelling and size of ecchymosis were measured. Latent class analysis was performed using Mplus 8.3 software, and Logistic regression analysis was conducted using SPSS 26.0 software to explore the influencing factors of the latent classes.Results:Totally 337 effective questionnaires were collected, and the recovery rate was 94.7% (337/356), and the age distribution ranged from 47 to 85 (65.19 ± 6.99) years old, with 90 (26.7%) males and 247 (73.3%) females. There were 92.3% (311/337) of TKA patients with postoperative symptom cluster. The symptom cluster of patients with TKA were identified as 3 classes. They were named as "high level pain-psychological disorder group"(12.5%, 39/311), "high bruises-moderate psychological disorders group"(25.4%, 79/311) and "low symptom burden group" (62.1%, 193/311). The results of the unordered multi-class logistic regression analysis showed that age 45-59 years ( OR = 2.367), body mass index 24.0-27.9 kg/m 2 ( OR = 0.207), living with children/parents ( OR = 6.473), and this being the second joint surgery ( OR = 0.040) were the factors influencing the "high level pain-psychological disorders group" (all P<0.05). The factors influencing the "high bruises-moderate psychological disorders group" were living with children/parents ( OR = 4.023), comorbid chronic diseases ( OR = 1.979, 3.842), and intraoperative blood loss ≤100 ml ( OR = 2.342) (all P<0.05). Conclusions:The postoperative symptom cluster of TKA patients have a relatively high incidence, and there is heterogeneity within the symptom cluster, so nurses need to identify at-risk patients early according to the characteristics of different categories and give interventions.

Objective To analyze clinical factors influencing the choice of open radical nephrectomy and inferior vena cava thrombus excision surgery.Methods 47 patients who received open radical nephrectomy and inferior vena cava thrombus excision were enrolled between January,2015 to March,2017 retrospectively.Among the 47 patients,37 were nale,10 were female.The average age was 61 years (29-84 years),with 33 patients younger than 65-year old,14 above this age.The tumor located in left in 10 patients,right in 37 patients.The average maximum diameter of tumor was 9.1 cm (3.6-23.0 cm),with ≥10 cm in 17 patients,less than 10 cm in 30 patients.The enhanced abdominal CT showed 5 patients with suspected of extra-organ invasiveness.Pre-surgery images showed 29 patients were suspected of enlarged lymph nodes.13,21,9 and 4 patients have Ⅰ,Ⅱ,Ⅲl or Ⅳ grade tumor thrombus respectively.The average major axis of tumor thrombus was 6.2 cm(1.0-20.0 cm),＞7.0 cm in 17 patients,≤7.0 cm in 30 patients.Results There were 31 patients underwent open surgery,and the other 16 underwent laparoscopic surgery.Multivariate analysis showed Ⅲ or Ⅳ grade of tumor was associated with the choice of open surgery (OR-13.476,95 ％ CI 1.044-173.882,P =0.046),but age ＞ 65 years (P =0.679),maximum diameter of tumor ≥ 10 cm (P =0.330),the side of tumor (P =0.220),suspected of enlarged lymph nodes (P =0.308) and suspected of extra-organ invasiveness (P =0.255) were not significantly associated with the choice of open surgery.Conclusions Ⅲ or Ⅳ grade of tumor was the major factor affecting the choice of open surgery,while age ＞ 65 years,maximum diameter of tumor ≥ 10 cm,the side of tumor were not the trigger for open sugcry.Suspected of enlarged lymph nodes and suspected of extra-organ invasiveness remained to be studied.

Objective: To evaluate the effectiveness and safety of radical nephrectomy and inferior vena cava thrombectomy in the treatment of patients with Mayo Ⅲ tumor thrombus, and to introduce our experience and surgical technique.Methods: The clinical data of 8 patients with Mayo Ⅲ tumor thrombus from October 2014 to September 2016 were analyzed retrospectively.Of the 8 patients, 3 were male and 5 were female.The average age was (50.8±18.7) years (18 to 77 years).The average body mass index (BMI) was (22.7±4.4) kg/m2 (15.2 to 30.8 kg/m2).Imaging suggested the right renal tumor in all the 8 cases.The average tumor size was (7.9±2.5) cm.Open radical nephrectomy and inferior vena cava thrombectomy was conducted in 5 cases and laparoscopic surgery in 3 cases, and 1 case was converted to open surgery.Results: All the 8 surgeries were completed successfully with no death case.The average surgery time was (370.3±101.6) min, ranging from 272-567 min.The average vena cava blocked time was (41.0±12.1) min, ranging from 17-55 min.The blood loss volume was (1 181.3±915.7) mL, ranging from 200-3 000 mL.During the operation, 5 cases were infused with suspended red blood cells, the amount of blood transfusion was 800-2 000 mL.3 cases were infused of plasma with 400-1 000 mL.The average hospital stay was 9-23 d, with an average of (14.1±4.0) d.In the 8 patients, 4 cases underwent inferior vena cava wall resection because of invasion by tumor thrombus.Preoperative serum creatinine was 60-101 μmol/L, with an average of (76.4±15.3) μmol/L.Serum creatinine 1 week after the operation was 74-127 μmol/L, with an average of (100.8±21.1) μmol/L.Pathological diagnosis showed 6 cases of clear cell carcinoma, 1 case of papillary carcinoma type Ⅱ, and 1 case of Ewing''s sarcoma.Among the 8 patients, early postoperative complications occurred in 5 cases.Postoperative complications were graded as level Ⅱ, according to the Clavien classifications.The 8 cases were followed up for 2 to 24 months with an average of 11.3 months.There was 1 patient who suffered from lung metastasis.Conclusion: Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo Ⅲ tumor thrombus.The wide extension of grade Ⅲ vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation, rich operative experience and skills can improve the safety of operation.

Objective To investigate the safety and feasibility of radical nephrectomy and Mayo 0-Ⅳ venous thrombectomy.Methods The clinical data of 52 patients with Mayo 0-Ⅳ tumor thrombus from February 2015 to January 2017 were analyzed retrospectively.Of the 52 patients,42 were male and 10 were female.The average age was (59.8 ± 13.6) years old (2.5 to 84.0 years).The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 12 cases,type Ⅰ thrombus in 11 cases,type Ⅱ thrombus in 15 cases,type Ⅲ thrombus in 9 cases,type Ⅳ thrombus in 5 cases (Mayo Medical Center classification).Imaging suggested the right renal tumor in 36 cases and left tumor in 16 cases.The average tumor size was (8.5 ±2.0) cm(2.0-21.1 cm).There were 2 cases of ASA Ⅰ,40 cases of ASA Ⅱ and 10 cases of ASA Ⅲ according to the American Society of Anesthesiologists (ASA).In laparoscopic radical nephrectomy and Mayo 0 venous thrombectomy,we clamped the vena cava vessel wall nearby the renal vein entrance.The vena cava blood flow was blocked partially.Then we cut the vessel wall arcuately.Mayo Ⅰ tumor thrombus requires the use of a non traumatic auricle clamp to control blood flow by the block of vena cava above thrombus,vena cava below the renal vein level,and the contralateral renal vein.Right kidney tumors with Mayo Ⅱ could be completed by retroperitoneal surgery.At the time of vascular occlusion,the distal inferior vena cava,the left renal vein and the proximal inferior vena cava were interrupted sequentially.For left renal tumors with Mayo Ⅱ,the retroperitoneal approach combined with transperitoneal approach was used.The technique of "milking" can shrink the tumor thrombus and reduced the difficulty of the operation.For Mayo Ⅲ tumor thrombus just at the hepatic vein level,we cut off 3-5 hepatic short veins,and separated inferior vena cava long enough to provide surgical field.For Mayo Ⅲ tumor thrombus much higher than the hepatic vein level,we used open surgeries to free the liver and porta hepatis.We first blocked the distal inferior vena cava,followed by the left renal vein,the hepatic artery and portal vein,at last the proximal inferior vena cava.Mayo Ⅳ tumor thrombus often required a median incision to open the chest and establish an extracorporeal circulation.Results All the 52 surgeries were completed successfully without intraoperative and perioperative mortality.Open radical nephrectomy and inferior vena cava thrombectomy was underwent in 22 cases.Pure laparoscopic surgery was under went in 30 case.Two cases were converted to open surgery.The average surgery time was(333.7 ±80.1)min(136-694 min).The average blood loss volume was (1339.0 ± 508.1) ml(20-10 000ml).During the operation,the amount of suspended red blood cells transfusion was(761.5 ± 394.8)ml(0-10 400ml).28 cases underwent regional lymph node dissection,and postoperative pathological diagnosis showed lymph metastasis in 4 cases.24 cases underwent ipsilateral adrenalectomy,and 2 cases showed tumor invasion of adrenal gland.7 cases with right tumors underwent inferior vena cava wall resection because of invasion by tumor thrombus.The average postoperative hospitalization of all 52 cases was (9.7 ± 4.7) d.Among 27 patients,early postoperative complications occurred in 18 cases (34.6％).There were 1 case of Clavien Ⅰ,12 cases of Clavien Ⅱ,1 case of Clavien Ⅲ a,2 cases of Clavien Ⅳ a and 2 cases of Clavien Ⅴ according to modified Clavien classifications.44 cases (84.6％) were followed up for 1 to 22 months with a median of 8 months.Postoperative recurrence occurred in 3 cases,and distant metastasis occurred in 9 cases.9 cases (20.5％) had tumor specific death.Conclusions Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo 0-Ⅳ tumor thrombus,but the wide extension of vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation,rich operative experience and skills can improve the safety of operation.

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation.Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016,including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old.The PADUA score ranged from 6-10,with an average of 7.6.The tumor diameter ranged from 1.0 to 7.4 cm,with an average of 3.2cm.Results 7 cases underwent laparoscopic surgery.3 cases underwent open surgery.Mean operation time was 168min (ranged 103-217min).Mean blood loss was 135ml (ranged 20-400ml).The renal arteries were blocked in all patients.The ischemia time ranged from 9 to 33min,with an average of 20.6min.The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(main · 1.73 m2)] decreased 44.7％ compared with pre-operation [73.6 ml/(min · 1.73 m2)].Acute kidney injury developed in 2 patients.One required temporary dialysis.The other improved after conservative treatment.There were no other complications such as urinary fistula and hemorrhage.The pathology analysis confirmed that 2 cases were angiomyolipoma,one case was benign cyst,6 cases were renal clear cell carcinoma,and one case was multilocular cystic renal cell carcinoma.4 cases were stage pT1a,one case was stage pT1b,one case was stage pT2a,and one case was stage pT4.Positive margin was found in one case.The average follow-up period was 28.2 months(ranged 3-58months).Only one patient need long-term dialysis 20 months after surgery at the latest follow up.Another patient had local recurrence and ipsilateral adrenal metastasis.Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney,which prevent or delay the occurrence of hemodialysis effectively.

Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.

Objective To evaluate specific clinical and imaging features of osteogenesis imperfecta V and to improve diagnostic accuracy of this disease. Methods Data of 15 patients with osteogenesis imperfecta type V were retrospectively analyzed for their clinical and imaging features. There were 10 males and 5 females, aged from 1 year and 30 years old (median age,12.5 years ). All 15 patients had plain X-ray, and 4 of 15 had CT. All data were analyzed by 3 experienced deputy chief doctors in OI according to OI V standard. Results X-ray:calcification of the interosseous membrane between radius-ulna was detected in all patients and calcification of the interosseous membrane between tibia-fibula was detected in 2 of 15 patients. Dislocation of the radial head was seen in 13 of 15 patients,bilateral in 9 and utilateral in 4.All patients showed restriction in the pronation and supination of the forearm and restricton in the flexion and extention of the elbow joint. Patients with dislocation of raidal head were associated with large coronoid process and olecranon of the ulna. Hyperplastic callus of the extremities were detected in 7 of 15 patients (7 at femur , 3 at humerus, 1 at tibia.In early stage, hyperplastic callus showed thin cortice, and clear boundares with the diaphysis showing and low density, irregular, mesh-like lamellation inside. In the later stage, there were dense calcification inside hyperplastic callus, and no difference in density with the diaphysis. Diaphysis surrounded by hyperplastic callus had clear boundaries with the hyperplastic callus. No cortical destruction was detected. CT:there were sparse needle-dot calcification inside hyperplastic callus, with the patterns of granular, ring-and-arch,irregular streaky mineralization. The cross section of proximal femoral shaft showed irregular shape , flat square shape and tiny medullary cavity, with no calcification on the edge of hyperplastic callus. CT value:-91 HU inside hyperplastic callus; 283 HU in femoral shaft. Conclusions Interosseous membrane between radius-ulna or tibia-fibula, hyperplastic callus ,dislocation of the radial head are specific features in osteogenesis imperfecta V. X-ray can make a definitive diagnosis of osteogenesis imperfecta V. CT scan is helpful in the differential diagnosis of osteogenesis imperfecta V from osteosarcoma.

Objective To assess the safety and feasibility of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus.Methods We retrospectively analyzed 6 cases of renal cell carcinoma with inferior vena cava tumor thrombus from December 2010 to October 2014.The patients were all male.Their age ranged from 50 to 69 years and the body mass index ranged from 21.6 to 30.9 kg/ m2.Clinical manifestations included painless hematuria in 4 cases,low back pain in 1 cases and physical examination noticing in 1 cases.Imaging suggested the right renal tumor in 4 cases and left renal tumor in 2 cases.The tumor size ranged from 4.0 to 10.6 cm.The inferior vena cava tumor thrombus was found in all patients,including type Ⅰ thrombus in 3 cases and type Ⅱ thrombus in 3 cases.The length of type Ⅱ tumor thrombus ranged from 4.0 to 4.2 cm.We completed pure laparoscopic nephrectomy and inferior vena cava tumor thrombectomy in all patients.We chose retroperitoneal laparoscopic surgery to treat right renal tumor with inferior vena cava thrombus and chose retroperitoneal combined with transperitoneal laparoscopic surgery to treat left renal tumor with inferior vena cava thrombus.Results All surgery were successful.Cancer embolus defluxion didn't occur during the opearation.The operation time was 224-873 min and the intraoperative blood loss was 200-5 000 ml.There were 4 patients get transfusion,which the transfusion volume ranged from 400 to 2 800 ml.For 1 case of left renal cell carcinoma with level Ⅱ inferior vena cava tumor,the operation time was 873 min,the blood loss was 5 000 ml,and the transfusion volume was 2 800 ml.Postoperative hospital stay was 7-14 days.And the pathological results were all renal clear cell carcinoma.In those patients,the Fuhrman grade classification was Ⅱ-Ⅲ.All patients were treated by targeted medicine to control tumor recurrence and metastasis.During the 6-48 months following up,no recurrence and metastasis were reported.Conclusions Pure laparoscopic surgery for right renal cell carcinoma with inferior vena cava tumor thrombus and left renal cell carcinoma with level Ⅰ inferior vena cava tumor thrombus is safe and feasible.However,long learning curve should be necessary for performing the left renal cell carcinoma with level Ⅱ inferior vena cava tumor thrombus.The effect of total laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus is definite.

BACKGROUND:Bilateral-sagitta-split-ramus-osteotomy (BSSRO) has become a conventional method to correct facial deformities, and the finite element method is a significant way to study biomechanics of the mandible and temporomandibular joint (TMJ) after BSSRO. OBJECTIVE: To establish a precise and high simulation model of mandible containing TMJ after BSSRO with internal fixation, which is the base to study the biomechanics of the mandible and TMJ after BSSRO. METHODS: Spiral CT scan was used to get the data of DICOM that were input into MIMICS to establish the three-dimensional model of the mandible. The three-dimensional model was wrapped into a single closed shel for mesh generation and conversion in ANSYS. Then, the model was input into the ANSYS software for temporomandibular joint reconstruction and simulation of BSSRO and internal fixation. RESULTS AND CONCLUSION: The three-dimensional finite element model of mandible containing TMJ after BSSRO was established using MIMICS and ANSYS. This model had biological similarity and geometric similarity in comparison with the human tissues. The model could undergo various internal fixations through antedisplacement, retroposition and rotational movement of the distal end. Based on different experimental purposes, the established model can apply a load to al parts to study changes in stress and displacement of different tissues after BSSRO and internal fixation, and it also can be used to study the effect of different fixation materials on the rear stability after internal fixation.