OBJECTIVE: To investigate the effect of intraoperative blood salvage autotransfusion on local recurrence and long-term metastasis of patients after carotid body tumor resection. METHODS: We retrospectively reviewed a consecutive series of 61 patients undergoing elective carotid body tumor resection from August 2009 to December 2020. Among them, 14 received intraoperative blood salvage autotransfusion (autotrasfusion group) and 47 did not (non-autotransfusion). Data of general information, surgical status and postoperative follow-up results were collected. RESULTS: The proportion of Shamblin Ⅲ in the autotransfusion group was 85.7%, which was significantly higher than 31.9% in the non-autotransfusion group (P=0.003). The average operation time of the 14 patients in the autotransfusion group was (264±84) min, intraoperative blood loss was 1 200 (700, 2 700) mL, and autologous blood transfusion was 500 (250, 700) mL. Of these, 8 patients (57%) required concomitant allogeneic blood with 400 (260, 400) mL of allogeneic blood. The average operation time of the 47 patients in the non-autotransfusion group was (153±75) min, and the intraoperative blood loss was 300 (100, 400) mL. Of these, 6 (13%) required allogeneic blood transfusion, and 520 (400, 520) mL of allogeneic blood was used. Compared with the non-autotransfusion group, the average operation time in the autologous blood transfusion group was significantly longer (P < 0.001), and the intraoperative blood transfusion volume was larger (P=0.007). Of the 14 patients undergoing autotransfusion, 8 (57%) needed allogeneic blood at the same time; while in the 47 non-autologous transfusion patients, 6 (13%) needed allogeneic blood transfusion. The proportion of autotransfusion group using allogeneic blood at the same time was even higher (P=0.002). The incidence of nerve injury within 30 days after surgery was 29.5%, and there was no significant difference between the two groups. No early deaths occurred. The average follow-up was (76±37) months. One case of local recurrence occurred in the non-autotransfusion group. There was no distant metastasis. There were no tumor-related deaths. The estimated 5-year and 10-year overall survival rates were 96.4% and 83.8%, respectively. There was no significant difference in overall survival between the two groups (P=0.506). CONCLUSION The use of intraoperative blood salvage autotransfusion increased no risk of local recurrence and distant metastasis in patients with carotid body tumor, which is safe and effective in carotid body tumor resection.
Humans ; Blood Transfusion, Autologous/methods* ; Operative Blood Salvage/methods* ; Retrospective Studies ; Male ; Female ; Carotid Body Tumor/pathology* ; Middle Aged ; Prognosis ; Neoplasm Recurrence, Local ; Blood Loss, Surgical ; Aged ; Adult ; Operative Time

Objective:To investigate the enhancement effect of deep progressive reconstruction (DPR) algorithm on image quality and standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in obese patients. Methods:The images of a total of 27 obese patients,who underwent 18F-FDG PET/CT in Affiliated Nanjing Hospital of Nanjing Medical University from September 2023 to May 2024,were retrospectively enrolled. The images of all patients were collected by using uMI 780 PET/CT. Ordered subset expectation maximization (OSEM) iterative algorithm and DPR algorithm were adopted to reconstruct PET images,and measure counting rate of scattering coincidence of PET/CT images,counting rate of true coincidence,noise equivalent counting rate (NECR) and scattering fraction (SF). The quality indicators of PET images included signal-to-noise ratio (SNR),the maximum SUV (SUVmax) of lesions,the tumor-to-background ratio (TBR),the contrast-to-noise ratio (CNR) and the visual scores of 18F-FDG PET/CT images on livers were evaluated. The differences and consistency of various indicators between DPR and OSEM reconstruction algorithms were further analyzed. Results:The average 18F-FDG PET/CT injection activity of 27 patients was (0.12±0.01) mCi (1 mCi=37 MBq)/kg,and the counting rate of true coincidence,NECR and SF of PET images were respectively (153.73±25.09),(44.81±8.47) kcps and (36.77±1.91)％. The SNR of liver obtained by DPR algorithm was (15.83±3.60),which was significantly higher than that (9.06±1.87) of OSEM algorithm,with statistically significant (t=20.6,P<0.05),and there was significantly correlation in liver SNR between two algorithms (R2=0.91,P<0.05). In 27 uptake 18F-FDG PET/CT lesions,the SUVmax,TBR and CNR of lesions that were obtained from OSEM algorithm were respectively (5.86±1.49),(1.95±0.49) and (17.74±4.77),which were lower than corresponding those of DPR algorithm,and the differences were significant (t=9.03,8.79,15.49,P<0.05),respectively. There were significant correlations in SUVmax,TBR and CNR between the two algorithms (R2=0.71,0.70,0.76,P<0.05),respectively. The visual scores of PET images obtained from the DPR algorithm was 4 (3,5) scores,which was significantly higher than 3 (2,4) scores of OSEM algorithm,and the difference of that between two algorithms was significant (U=396,P<0.05). Conclusion:The scattering effect of 18F-FDG PET/CT imaging is stronger in obese patients,whose counting rate of equivalent effect of noise is lower. The DPR reconstruction algorithm can significantly improve the SNR and lesion contrast of PET images than the OSEM algorithm,which has significant gain effect on the SUVmax of lesions,and it can significantly improve the quality of 18F-FDG PET/PET images in obese patients.

Objective To observe the effect of automatic segmentation of prostate cancer(PCa)in 68Ga-prostate specific membrane antigen(PSMA)-11 PET/MRI based on diffusion models.Methods A dataset contained 68Ga-PSMA-11 PET/MRI of 125 cases of PCa was preprocessed.Segmentation network was designed based on Faster-RCNN and spatial and channel reconstruction convolution(SCConv)Diffusion cascade,in which the first-level was used to coarsely localize the prostate and seminal vesicle glands using Faster-RCNN,and the second-level SCConv Diffusion network based on diffusion model was used to segment PCa.The effect of the above models for segmenting PCa in 68Ga-PSMA-11 PET/MRI were observed.Results The Dice similarity coefficient(DSC),intersection over union(IoU),and 95％Hausdorff distance(HD)of the Faster-RCNN+SCConv Diffusion model for segmenting PCa in 68Ga-PSMA-11 PET/MRI was 0.76,0.63 and 20.02 mm,all superior to those of nnU-Net(0.73,0.62 and 21.20 mm)and Faster-RCNN+nnU-Net(0.75,0.62 and 20.70 mm)models,and the segmentation for both single and multiple PCa were all accurate,with less missegment non-tumor tissue.Conclusion Diffusion model based on Faster-RCNN+SCConv diffusion cascade network could be used to completely and accurately segment PCa in 68Ga-PSMA-11 PET/MRI.

Objective:To investigate the enhancement effect of deep progressive reconstruction (DPR) algorithm on image quality and standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in obese patients. Methods:The images of a total of 27 obese patients,who underwent 18F-FDG PET/CT in Affiliated Nanjing Hospital of Nanjing Medical University from September 2023 to May 2024,were retrospectively enrolled. The images of all patients were collected by using uMI 780 PET/CT. Ordered subset expectation maximization (OSEM) iterative algorithm and DPR algorithm were adopted to reconstruct PET images,and measure counting rate of scattering coincidence of PET/CT images,counting rate of true coincidence,noise equivalent counting rate (NECR) and scattering fraction (SF). The quality indicators of PET images included signal-to-noise ratio (SNR),the maximum SUV (SUVmax) of lesions,the tumor-to-background ratio (TBR),the contrast-to-noise ratio (CNR) and the visual scores of 18F-FDG PET/CT images on livers were evaluated. The differences and consistency of various indicators between DPR and OSEM reconstruction algorithms were further analyzed. Results:The average 18F-FDG PET/CT injection activity of 27 patients was (0.12±0.01) mCi (1 mCi=37 MBq)/kg,and the counting rate of true coincidence,NECR and SF of PET images were respectively (153.73±25.09),(44.81±8.47) kcps and (36.77±1.91)％. The SNR of liver obtained by DPR algorithm was (15.83±3.60),which was significantly higher than that (9.06±1.87) of OSEM algorithm,with statistically significant (t=20.6,P<0.05),and there was significantly correlation in liver SNR between two algorithms (R2=0.91,P<0.05). In 27 uptake 18F-FDG PET/CT lesions,the SUVmax,TBR and CNR of lesions that were obtained from OSEM algorithm were respectively (5.86±1.49),(1.95±0.49) and (17.74±4.77),which were lower than corresponding those of DPR algorithm,and the differences were significant (t=9.03,8.79,15.49,P<0.05),respectively. There were significant correlations in SUVmax,TBR and CNR between the two algorithms (R2=0.71,0.70,0.76,P<0.05),respectively. The visual scores of PET images obtained from the DPR algorithm was 4 (3,5) scores,which was significantly higher than 3 (2,4) scores of OSEM algorithm,and the difference of that between two algorithms was significant (U=396,P<0.05). Conclusion:The scattering effect of 18F-FDG PET/CT imaging is stronger in obese patients,whose counting rate of equivalent effect of noise is lower. The DPR reconstruction algorithm can significantly improve the SNR and lesion contrast of PET images than the OSEM algorithm,which has significant gain effect on the SUVmax of lesions,and it can significantly improve the quality of 18F-FDG PET/PET images in obese patients.

Objective To observe the effect of automatic segmentation of prostate cancer(PCa)in 68Ga-prostate specific membrane antigen(PSMA)-11 PET/MRI based on diffusion models.Methods A dataset contained 68Ga-PSMA-11 PET/MRI of 125 cases of PCa was preprocessed.Segmentation network was designed based on Faster-RCNN and spatial and channel reconstruction convolution(SCConv)Diffusion cascade,in which the first-level was used to coarsely localize the prostate and seminal vesicle glands using Faster-RCNN,and the second-level SCConv Diffusion network based on diffusion model was used to segment PCa.The effect of the above models for segmenting PCa in 68Ga-PSMA-11 PET/MRI were observed.Results The Dice similarity coefficient(DSC),intersection over union(IoU),and 95％Hausdorff distance(HD)of the Faster-RCNN+SCConv Diffusion model for segmenting PCa in 68Ga-PSMA-11 PET/MRI was 0.76,0.63 and 20.02 mm,all superior to those of nnU-Net(0.73,0.62 and 21.20 mm)and Faster-RCNN+nnU-Net(0.75,0.62 and 20.70 mm)models,and the segmentation for both single and multiple PCa were all accurate,with less missegment non-tumor tissue.Conclusion Diffusion model based on Faster-RCNN+SCConv diffusion cascade network could be used to completely and accurately segment PCa in 68Ga-PSMA-11 PET/MRI.

Objective:To evaluate the diagnosis and surgical treatment of abdominal aortic vascular endograft infections.Methods:Clinical data of 13 patients of abdominal aortic vascular endograft infections undergoing surgical treatment at Department of Vascular Surgery, Peking University People's Hospital from Jan 2015 to Jan 2021 was retrospectively analyzed.Results:All 13 patients underwent infected graft resection under axillobifemoral bypass. Three patients died perioperatively and 10 recovered. Eight patients were followed-up,with bypass graft being occluded and another one with bypass graft infections exposure.Conclusions:Abdominal aortic vascular endograft infections are catastrophic diseases with high surgical difficulty and risk. Extra-anatomic reconstruction with graft removal is a safe and effective treatment for the eradication of infection.

Objectives:To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA).Methods:The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People′s Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively.Results:All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification( HR=3.804, 95% CI:2.460 to 5.883), popliteal artery involvement ( HR=2.104, 95% CI:1.368 to 3.236), long lesion ( HR=1.824, 95% CI:1.196 to 2.780), poor runoff( HR=1.736, 95% CI:1.025 to 2.940), chronic kidney disease( HR=1.601, 95% CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions:The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.

Objective:To explore the outcomes of standard endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex neck anatomical features.Methods:Clinical data of AAA patients received standard EVAR from Jan 2004 to Dec 2018 were retrospectively collected. Based on pre-operative computed tomography angiography (CTA) data, patients were divided into complex neck group and non-complex neck group to compare the results between them.Results:There were 88 patients (66.2%) in complex neck group and 45 patients (33.8%) in non-complex group. There was no significant difference in peri-operative characters (blood loss, contrast volume used, hospital stay time, technical success rate) and follow-up results (late re-intervention, late endoleak, aneurysm enlargement, survival rate),all P>0.05.Multivariant logistic regression analysis revealed neck diameter larger than 31 mm was related with late re-intervention ( OR=24.975, P=0.02). Conclusion:Standard EVAR for AAA with complex neck characters does not cause higher perioperative complications and less favorable long term survival rate.

Objectives:To establish a grading model on prognosis of drug-coated balloon (DCB) treatment on femoropopliteal de novo lesions, and assess whether patients at high risk could benefit from combination of directional atherectomy(DA).Methods:The clinical data of 114 patients with femoropopliteal de novo lesions admitted to Department of Vascular Surgery, Peking University People′s Hospital from October 2015 to January 2019 were collected retrospectively. There were 95 patients(108 limbs) underwent DCB treatment, including 66 males and 29 females, aged 71.9 years old(range:48 to 91 years), and 19 patients (21 limbs) underwent DA combined with DCB treatment, including 13 males and 6 females, aged 69.5 years old(range: 62 to 80 years). The demographic data, intraoperative and postoperative conditions of the patients were collected. Cox regression model was performed for modeling and then goodness of fit was tested. Kaplan-Meier estimate was carried out between the two groups for patients at high risk and low risk, respectively.Results:All patients were followed up for more than 24 months. Restenosis occurred on 34 limbs in DCB group and 3 limbs in DA+DCB group. Severe calcification( HR=3.804, 95% CI:2.460 to 5.883), popliteal artery involvement ( HR=2.104, 95% CI:1.368 to 3.236), long lesion ( HR=1.824, 95% CI:1.196 to 2.780), poor runoff( HR=1.736, 95% CI:1.025 to 2.940), chronic kidney disease( HR=1.601, 95% CI:1.040 to 2.463) were independent risk factors of restenosis after DCB treatment, and were defined 3, 2, 1, 1 and 1 points, respectively. Total points≥3 was regarded as high risk group. Kaplan-Meier analysis showed that patients in low risk group did not benefit from DA+DCB comparing with DCB with regard to primary patency at 24 months (77.78% vs. 90.31%, P=0.271) while patients benefited from DA+DCB comparing with DCB in high risk group(88.26% vs. 20.80%, P<0.01). Conclusions:The grading model shows satisfying clinical value. The clinical effect of DA+DCB is better than DCB along in high risk group. Patients at high risk are supposed to receive aggressive vessel preparation like DA.

Objective To investigate the effect of left subclavian artery (LSA) coverage on ischemic stroke complications in thoracic aortic cavity repair (TEVAR).Methods The clinical data of 69 patients undergoing TEVAR with LSA coverage from Jun 2013 to Jan 2018 were retrospectively analyzed.Results There were 56 males and 13 females,average age of S1.1(32-76).Perioperative mortality was 4.3％ (3/69) and stroke related mortality was 1.4％ (1/69).There were 2 cases (2/66,3.0％) of symptomatic stroke in perioperative period and 5 cases (5/66,7.6％) of cryptogenic stroke,inclucling 2 cases of anterior circulation ischemia (2/66,3.0％),3 cases of posterior circulation ischemia (3/66,4.5％),and 2 cases of multiple ischemia (2/66,3.0％).48 cases (72.7％) of vertebral blood steal were grade Ⅰ,15 cases (22.7％) were Ⅱ and 3 cases (4.5％) were Ⅲ.No new stroke related deaths happened in 6 months,there were 3 cases of symptomatic stroke (3/66,4.5％) and 13 cases of cryptogenic stroke (13/66,19.7％).There were 3 cases of anterior circulation ischemia (3/66,4.4％),8 cases of posterior circulation ischemia (8/66,12.1％) and 5 cases of multiple ischemia (5/66,7.6％)respectively.Conclusion The compensation mechanism of LSA itself reduces the serious ischemic stroke risk caused by LSA coverage.