Objective:To analyze clinical application effect of color Doppler flow imaging(CDFI)combined with multi-slice spiral computed tomography(MSCT)examination under real-time ultrasound monitoring for upper urinary tract calculi.Methods:A total of 90 patients with suspected upper urinary tract calculi admitted to the 3201th Hospital were selected between June 2022 and January 2025.According to different examination methods,they were divided into MSCT group(45 cases)and combination group(45 cases,CDFI combined with MSCT examination under real-time ultrasound monitoring).Taking pathological diagnosis as the golden standard,diagnostic efficiencies of the two examination methods on upper urinary tract calculi were compared by Kappa consistency test.The coincidence rates of the two examination methods for upper urinary tract calculi and its size at different sites were observed.Results:The results of pathological diagnosis showed that 38 cases were confirmed in 45 patients of MSCT group,including 11 cases with kidney calculi and 27 cases with ureteral calculi.In them,20 cases'stone diameters were<5mm,and 18 cases'stone diameters were≥5mm.In 45 patients of combination group,40 cases were confirmed,including 16 cases with kidney calculi and 24 cases with ureteral calculi.In them,19 cases'stone diameters were<5mm and 21 cases'stone diameters were≥5mm.In MSCT group,32 cases were true positivity,2 cases were false positivity,5 cases were true negativity and 6 cases were false negativity.In combination group,39 cases were true positivity,1 case was false positivity,4 cases were true negativity and 1 case was false negativity.Compared with the golden standard,Kappa values of MSCT and combined examination were respectively 0.451 and 0.775 in diagnosing upper urinary tract calculi,and the sensitivity and accuracy of combined detection were respectively 97.50%and 95.56%,which were higher than those(84.21%and 82.22%)of MSCT examination,and the differences were significant(x2=4.213,4.050,P<0.05).There was no significant difference in detective coincidence rates of two groups of examination methods for kidney calculi and ureteral calculi(P>0.05),but detection coincidence rate of combination group for patients'calculi diameters<5mm was significantly higher than that of MSCT group,and the difference was significant(x2=4.048,P<0.05).Conclusion:CDFI combined with MSCT under real-time ultrasound monitoring has high diagnostic efficiency for upper urinary tract calculi,and its detection effect is better in detecting microcalculi with diameter of<5mm,especially.

Objective:To analyze clinical application effect of color Doppler flow imaging(CDFI)combined with multi-slice spiral computed tomography(MSCT)examination under real-time ultrasound monitoring for upper urinary tract calculi.Methods:A total of 90 patients with suspected upper urinary tract calculi admitted to the 3201th Hospital were selected between June 2022 and January 2025.According to different examination methods,they were divided into MSCT group(45 cases)and combination group(45 cases,CDFI combined with MSCT examination under real-time ultrasound monitoring).Taking pathological diagnosis as the golden standard,diagnostic efficiencies of the two examination methods on upper urinary tract calculi were compared by Kappa consistency test.The coincidence rates of the two examination methods for upper urinary tract calculi and its size at different sites were observed.Results:The results of pathological diagnosis showed that 38 cases were confirmed in 45 patients of MSCT group,including 11 cases with kidney calculi and 27 cases with ureteral calculi.In them,20 cases'stone diameters were<5mm,and 18 cases'stone diameters were≥5mm.In 45 patients of combination group,40 cases were confirmed,including 16 cases with kidney calculi and 24 cases with ureteral calculi.In them,19 cases'stone diameters were<5mm and 21 cases'stone diameters were≥5mm.In MSCT group,32 cases were true positivity,2 cases were false positivity,5 cases were true negativity and 6 cases were false negativity.In combination group,39 cases were true positivity,1 case was false positivity,4 cases were true negativity and 1 case was false negativity.Compared with the golden standard,Kappa values of MSCT and combined examination were respectively 0.451 and 0.775 in diagnosing upper urinary tract calculi,and the sensitivity and accuracy of combined detection were respectively 97.50%and 95.56%,which were higher than those(84.21%and 82.22%)of MSCT examination,and the differences were significant(x2=4.213,4.050,P<0.05).There was no significant difference in detective coincidence rates of two groups of examination methods for kidney calculi and ureteral calculi(P>0.05),but detection coincidence rate of combination group for patients'calculi diameters<5mm was significantly higher than that of MSCT group,and the difference was significant(x2=4.048,P<0.05).Conclusion:CDFI combined with MSCT under real-time ultrasound monitoring has high diagnostic efficiency for upper urinary tract calculi,and its detection effect is better in detecting microcalculi with diameter of<5mm,especially.

Objective:To explore the application value of MRI texture analysis in combination with imaging features to predict the WHO/International Society of Urological Pathology (ISUP) nuclear grading in pre-operative patients with clear cell renal carcinoma (ccRCC).Methods:MRI images of 78 patients diagnosed as ccRCC by surgical pathology from July 2016 to July 2020 in First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. According to the WHO/ISUP grading system, the patients were divided into low grade group (49 cases, grade Ⅰ in 2 cases and grade Ⅱ in 47 cases) and high grade group (29 cases, grade Ⅲ in 25 cases and grade Ⅳ in 4 cases), and then were assigned to training set ( n= 63) and validation set ( n=15) in a ratio of 7∶3 using random indicator method. MRI radiological features were evaluated and MRI imaging texture features were extracted. The largest-diameter slice of lesion on cross-sectional images was selected and ROIs were drawn on T 2WI and corticomedullary phase (CMP) images, respectively. Quantitative texture analysis software MaZda was used to extract texture features, including gray-scale histogram, co-occurrence matrix, run-length matrix, gradient, autoregressive model and wavelet transform. The extracted texture features were preliminarily selected by the combination of Fisher, probability of classification errorand average correlation coefficient, and interaction information, and then the reduced texture parameters or imaging features were tested by the independent sample t test, Mann-Whitney U test or χ 2 test. Parameters with statistically significant differences were used to construct a multi-factors binary logistic regression model and the ROC curve was used to analyze its effectiveness in predicting high grade ccRCC. Results:In training set, there were significant differences intumor length, shape and margin, enhancement degree of CMP, vein thrombosis and 47 texture features between the low and high grade ccRCC groups. In the training set, 7 multi-factors binary logistic regression model were constructed, including radiological features model (M1), T 2WI texture features model (M2), CMP image texture features model (M3) and combination radiological features of T 2WI texture features model (M4), combination radiological features of CMP images texture features model (M5), combination T 2WI texture features of CMP images texture features model (M6) and combination of all features model (M7). The area under ROC curve of M7 in predicting nuclear grading of ccRCC was the largest, which were 0.901 (95% CI 0.828-0.974) and 0.820 (95% CI 0.564-0.974) in the training set and validation set, respectively. Conclusion:MRI texture analysis combined with imaging features is hopeful to be an effective preoperative noninvasive method in predicting WHO/ISUP grading of ccRCC.

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.

OBJECTIVE:To study the accuracy of infusion of Midazoloam with plasma concentration as target. METHODS:The parameters of Midazoloam obtained from our researches were inputted into target-controlled infusion(TCI) system with C language. The clinical anesthesia of 12 patients undergoing selective operations was completed with plasma concentration as target-controlled infusion. Predicted value of plasma concentration of Midazoloam was compared with measured value. Parameters of Midazoloam sample were calculated such as performance error(PE),absolute performance error(absPE),median performance error(MDPE),median absolute performance error(MDAPE),constancy error(CE),absolute constancy error(absCE),median constancy error(MDCE) and median absolute constancy error(MDACE). RESULTS:PE,absPE,MDPE and MDAPE of plasma concentration were -2.57%,14.16%,-3.28% and 15.34%,respectively. CE,absCE,MDCE and MDACE were 0.06%,1.42%,0.03% and 1.21%,respectively. The measured values were in indirect relationship with predicated values(r=0.986,P