Objective:To investigate the effect of perineal single-port robot-assisted radical prostatectomy.Methods:A retrospective analysis was conducted on clinical data from 60 patients who underwent perineal single-port robot-assisted laparoscopic radical prostatectomy at our hospital between July 2019 and July 2022. The mean age of the patients was (65.9±7.6) years and the mean BMI was (24.1±2.9) kg/m 2. The median (IQR) prostate volume was 32.7 (23.8, 41.2) ml, and the median (IQR) preoperative PSA value was 8.8 (6.8, 12.6) ng/ml. Preoperative pathology revealed a Gleason score of 6 in 21 patients, Gleason score of 7 in 35 patients and Gleason score of 8 in 4 patients. There were 12 patients clinically staged as T 1 and 48 patients as T 2. A total of 18 patients underwent a total of 23 previous abdominopelvic surgeries. The patient is placed in an exaggerated lithotomy position with the head down and feet elevated approximately 15°. A 3-5 cm incision was made approximately 2 cm above on the mid-perineum between the bilateral ischial tuberosities. Next, the rectourethral muscle was divided, and the space anterior to the rectum was developed by blunt dissection. The levator ani muscles were separated to expose Denonvilliers’ fascia. Then, the disposable multi-channel laparoscopic surgical access system is inserted with a surgical wound protector. Denonvilliers’ fascia was incised transversely and the ampulla of the vas deferens, which were subsequently divided. Blunt separation is performed on both sides along the capsule of the prostate, and then, the vascular pedicles of the prostate are ligated. The membranous urethra was severed after complete urethral separation at the tip of the prostate at the urethral junction. The bladder neck was freed and dissected. The prostate and seminal vesicles were removed and a vesicourethral anastomosis is performed. A perineal drain were left in place. Preoperative and postoperative variables, complications, early urinary continence rate(Return of urinary continence status was defined as using no more than one safety pad per day) and oncological outcomes of patients were recorded. Results:All 60 surgeries were successfully completed without conversions or additional incisions. The median (IQR) total operative time was 200.0(153.8, 236.3) min, the median (IQR) console operating time was 107.5(90.0, 150.0) min and the median (IQR) estimated blood loss was 50.0(50.0, 100.0) ml. Positive surgical margins were detected in five patients (8.3%). The continence rate was 43.1%(22/51), 64.7%(33/51), 92.0%(46/50) and 98.0%(49/50), and the PSA undetectable rate was 94.6%(48/51), 98.2%(49/51), 96.6%(47/50) and 100%(50/50) at the 1, 3, 6, and 12 months after surgery. Only 1(1.7%) patient experienced biochemical recurrence 9 months after surgery. The overall complication rate was 20%, including two cases of acute respiratory distress syndrome, one case of rectal injury, one case of urinary tract injury, two cases of poor wound healing, three cases of incision infection, two cases of urinary tract infection and one case of bladder neck-urethral orifice anastomotic stricture.Conclusions:Perineal single-port robot-assisted radical prostatectomy might be safe and feasible surgical treatments for localized prostate cancer, especially for patients with a history of complex abdominal or pelvic surgery. It also showed advantages in early continence. The anatomical structure of the perineal region should be considered, and the correct incision position should be chosen. Specific incision protection measures should also be used for the incision in this particular area of the perineal region to reduce the risk of perioperative complications.

Objective:To explore the effect of online appointment system of standardized patients (SP) in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing SP database and typical case database, online appointment system of SP for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

Objective:To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning.Methods:Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board′s approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient′s side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A “W”-shape, three robotic-arm configurations was used for port placement.Results:The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57).Conclusion:Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

Objective:To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning.Methods:Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board′s approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient′s side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A “W”-shape, three robotic-arm configurations was used for port placement.Results:The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57).Conclusion:Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.

Objective:To explore the effect of online appointment system of standardized patient in cardiology practice teaching.Methods:The undergraduate students who entered the cardiology department for clinical practice in 2018 and 2019 were selected as teaching objects, and they were divided into traditional teaching group ( n=30) and appointed SP teaching group ( n=30). After the teaching, SPSS 19.0 software was used for data analysis to compare the teaching effect of the two groups. Results:The scores of SP teaching group were higher than those of traditional teaching control group, with statistical significance ( P<0.05). Conclusion:Through constructing standardized patient database and typical case database, online appointment system of standardized patient for medical history inquiry and doctor-patient communication skills training can effectively solve the problems such as lack of clinical practice cases and doctor-patient contradiction, and greatly improve the teaching efficiency.

Objective:To study the association of gastric hyperplastic polyps (GHPs) and autoimmune metaplastic atrophic gastritis (AMAG).Methods:A retrospective analysis was conducted on data regarding 56 GHPs patients who underwent endoscopic resection at Beijing Friendship Hospital, Capital Medical University from January 2011 to June 2017, including 17 patients with neoplasia and 39 patients without neoplasia. The characters of GHPs in serology, gastroscopic manifestation and pathology were analyzed.Results:The data of patients including 34 females and 22 males were collected in the study. The age was 61.88±9.01 years. The increase rate of fast serum gastrin was 50.0% (28/56), the positive rate of serum gastric parietal cell antibody (PCA) was 62.5% (35/56), the rate of anemia was 37.5% (21/56), and the negative rate of Helicobacter pylori was 64.3% (36/56). Compared with the patients with negative serum PCA, the patients with positive serum PCA were mostly female ( P=0.034), prone to hypergastrinemia ( P<0.001), anemia ( P=0.001), especially iron deficiency anemia ( P=0.044), and multiple GHPs ( P=0.019). There were 108 GHPs in 35 PCA positive patients, GHPs were more distributed in the gastric fundus and corpus (91/108, 84.3%) than in antrum (17/108, 15.7%, P=0.005). There were 63 GHPs in 21 anemia patients, 54 (85.7%) GHPs located in the gastric fundus and corpus, and 9 (14.3%) GHPs in antrum ( P=0.075). There were total 142 GHPs in 56 patients, 73.2% GHPs (104/142) were pedunculated, 69.0% (98/142) were "strawberry-like" polyps. Among 17 patients of GHP with neoplasia, there were 6 high differentiated adenocarcinomas, 2 moderate adenocarcinomas, 3 high grade dysplasia, and 6 low grade dysplasia. Conclusion:GHPs are associated with AMAG. GHP with AMAG is probably one of the reasons of neoplastic transformation.

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.

Objective To explore the value of radiomics in stratifying the Gleason score (GS) of prostate cancer based on vast image features from biparametric MRI. Methods Three hundred and sixteen patients were enrolled in this study from October, 2015 to December, 2018 and their results of surgical pathology were obtained. The lesions were manually depicted by 3D?Slicer. Then, 106?dimensional features extracted by radiomics were used to conduct Spearman non?parametric correlation test with the high and low risk stratification of GS. The constructed Neural Network was trained with the features after dimension reduction by principal component analysis as the input. Then, the testing set was fed in to get the predictive capability of the model. In the end, 10?fold cross?validation and shuffle of 100 times were used to test the accuracy of the prediction and the generalization ability of the model. Results Seventy seven?dimensional features with significant correlation were found at the level of P valued=0.05 (two?tailed). After dimensional features were reduced, 21 dimensional new feature spaces with 99% original feature information were obtained. The results on the testing data after the 10?fold validation and shuffle were AUC=0.712 with T2WI, AUC=0.689 with DWI(b=1 000 s/mm2), AUC=0.689 with DWI (b=2 000 s/mm2) and AUC=0.691 with DWI (b=3 000 s/mm2). Conclusion The neural network after extracting features from biparametric MRI images can accurately and automatically distinguish the high risk and low risk groups of Gleason grade of prostatic cancer.

Objective: To explore the value of radiomics in stratifying the Gleason score (GS) of prostate cancer based on vast image features from biparametric MRI. Methods: Three hundred and sixteen patients were enrolled in this study from October, 2015 to December, 2018 and their results of surgical pathology were obtained. The lesions were manually depicted by 3D-Slicer. Then, 106-dimensional features extracted by radiomics were used to conduct Spearman non-parametric correlation test with the high and low risk stratification of GS. The constructed Neural Network was trained with the features after dimension reduction by principal component analysis as the input. Then, the testing set was fed in to get the predictive capability of the model. In the end, 10-fold cross-validation and shuffle of 100 times were used to test the accuracy of the prediction and the generalization ability of the model. Results: Seventy seven-dimensional features with significant correlation were found at the level of P valued=0.05 (two-tailed). After dimensional features were reduced, 21 dimensional new feature spaces with 99% original feature information were obtained. The results on the testing data after the 10-fold validation and shuffle were AUC=0.712 with T₂WI, AUC=0.689 with DWI (b=1 000 s/mm²), AUC=0.689 with DWI (b=2 000 s/mm²) and AUC=0.691 with DWI (b=3 000 s/mm²). Conclusion The neural network after extracting features from biparametric MRI images can accurately and automatically distinguish the high risk and low risk groups of Gleason grade of prostatic cancer.

Objective To identify the influencing factors for rural doctors′ training effect,and suggest on the improvement of such training.Methods On the basis of rural doctors′ survey,the theory of pre-intervention was used to probe into the influencing factors for such training in five dimensions of attention notice,mega-cognitive strategies,advance organizer,goal orientation,and preparatory information.Results 73.2% of the groups were found with satisfying effect.In the single factor analysis,comparison of training effect involving such factors as age,gender,length of work life and pre-intervention revealed statistical significance(P<0.05).As shown in the logistic regression analysis,High motivation in meta-cognitive strategies,Clear goals in goal orientation,Tiered and categorized training in advance organizers,and Practical learning in preparatory information,as well as variants like age would influence rural doctors′ training effect significantly.Conclusions The key to better training effect lies in better motivation of the trainee,setting correct training goals,emphasis on the practicability of training contents and,the pertinence of the training objects.