1.Simultaneous determination of the contents of 7 components in the Embelia laeta (L.) Mez with HPLC
Yi ZHANG ; Sha HAN ; Maochun HUANG ; Mushui XIE ; Huanxin ZHONG ; Zhiqiang GONG
International Journal of Traditional Chinese Medicine 2025;47(12):1739-1743
Objective:To establish an HPLC method to simultaneously determine the contents of 7 components, including Cardol triene, Cardol diene, (8'Z,11'Z,14'Z)-5-(Heptadeca-8',11',14'-trienyl)benzene-1,3-diol, Alkylresorcinol B, 5-(8'Z,11'Z-heptadecadienyl)-1,3-benzenediol, Adipostatin A, and 5-(11'Z-heptadecenyl)-resorcinol in Embelia laeta (L.) Mez. Methods:Chromatographic column was Arcus EP-C18(4.6 mm×250 mm, 5 μm); mobile phase was methanol-water (90∶10); column temperature was 25 ℃; flow rate was 1 ml/min; detection wavelength was 220 nm; the injection volume was 10 μl.Results:The 7 compounds in Embelia laeta (L.) Mez showed good linear relationships, which sample recovery rate ranges from 97.69%- 100.62%. The average contents of the 7 components from 9 origins were 3.099 9, 6.246 3, 9.942 8, 4.093 7, 2.180 3, 0.960 2, 1.855 9 mg/g. Conclusion:The established HPLC method for simultaneous determination of the contents of 7 components in Embelia laeta (L.) Mez is feasible, which can provide references for further development and utilization of Embelia laeta (L.) Mez.
2.Continuous radiofrequency versus high-voltage,long-duration pulsed radiofrequency of ganglia impar for the treatment of perineal pain in patients with rectal cancer:a clinical study
Bo ZHONG ; Taomei ZHANG ; Zhiqiang WANG ; Ping TAO ; Huaiming WANG ; Aimin ZHANG
Journal of Interventional Radiology 2025;34(2):154-159
Objective To evaluate the efficacy and safety of DSA-guided continuous radiofrequency ablation(CRF)and high-voltage,long-duration pulsed radiofrequency(HL-PRF)of ganglia impar in treating perineal pain in patients with rectal cancer.Methods This study is a single-center,randomized,active-controlled,double-blind trial that included 57 rectal cancer patients with perineal pain.At a 1∶1 ratio,the patients were randomly divided into CRF group(n=28)and HL-PRF group(n=29).The primary outcome indicators were the pain numerical rating scale(NRS)scores determined at the preoperative(T0),postoperative 24 h(T1),one week(T2),one month(T3),3 months(T4)and 6 months(T5)time-points.The secondary outcome indicators included the sitting time at T0,T1,T2,T3,T4 and T5 time-points,the 9-item patient health questionnaire(PHQ-9)score,the pittsburgh sleep quality index(PSQI)score,the postoperative oral morphine dosage,and the incidence of perineal numbness.Results Compared with the value at T0 time-point,in both groups the NRS score,PHQ-9 score and PSQI score at T1-T5 time-points were significantly decreased,while the sitting time become remarkably increased(all P<0.05).No statistically significant differences in postoperative oral morphine dosage and incidence of perineal numbness existed between the two groups(both P>0.05).There were no statistically significant differences in NRS score,PHQ-9 score and PSQI score,sitting time and oral morphine dosage at T1,T2,T3 time-points between CRF group and HL-PRF group(all P>0.05),while at T4 and T5 time-points the NRS score,PHQ-9 score and PSQI score in HL-PRF group were significantly higher than those in CRF group(all P<0.05),and the sitting time in HL-PRF group was strikingly lower than that in CRF group(P<0.05).Conclusion Both CRF and HL-PRF of ganglion impar can alleviate perineal pain in patients with advanced rectal cancer and improve the quality of life of patients.CRF is superior to HL-PRF in the long-term efficacy.
3.Predictive value of caliceal pelvic height-to-infundibular length ratio for stone-free rate in lower calyx stone treatment with flexible ureteroscopic lithotripsy
Shiwei HUANG ; Sheng ZHONG ; Guangming YIN ; Long WANG ; Zhiqiang JIANG ; Kai HUANG ; Jing TAN
Chinese Journal of Urology 2025;46(8):600-606
Objective:This study aims to explore the predictive value of the ratio of caliceal pelvic height to infundibular length(CPH/IL)for the stone-free rate(SFR)in the treatment of lower calyx stones using flexible ureteroscopic lithotripsy(FURL)combined with a distally bendable negative pressure suction sheath.Methods:A retrospective analysis was conducted on the clinical data and anatomical parameters of 312 patients with lower calyx stones or combined lower calyx stones admitted to the Third Xiangya Hospital of Central South University from September 2022 to December 2023,all of whom were treated with FURL combined with a distally bendable negative pressure suction sheath. Stone clearance was defined as no residual stones or residual stones with a diameter of ≤3 mm without any symptoms. Patients were divided into the clearance group(265 cases,84.90%)and the non-clearance group(47 cases,15.10%). There were no significant differences in gender(male/female:173/92 cases vs. 29/18 cases),age[(44.69 ± 13.14)years vs.(42.60 ± 10.93)years],degree of hydronephrosis(no hydronephrosis/mild hydronephrosis/moderate to severe hydronephrosis:122/85/58 cases vs. 21/12/14 cases),side of lower calyx stones(left/right:157/108 cases vs. 31/16 cases),maximum diameter of stones(MDS)[(19.23 ± 6.41)mm vs.(17.77 ± 6.18)mm],and CT value of stones[(993.46 ± 249.12)Hu vs.(1013.43 ± 300.90)Hu]between the two groups( P > 0.05),indicating comparability between groups. There was no significant difference in the distance from the midpoint of the lower lip of the renal pelvis to the ureter at the lowest plane of the lower calyx(K-A line)between the clearance and non-clearance groups[(26.16 ± 5.18)mm vs.(25.70 ± 8.66)mm, P > 0.05]. However,significant differences were observed in the infundibulopelvic angle(IPA)[(53.97 ± 15.72)° vs.(37.43 ± 15.39)°],infundibular length(IL)[(27.26 ± 5.11)mm vs.(33.04 ± 7.38)mm],infundibular width(IW)[(8.27 ± 2.82)mm vs.(7.09 ± 3.20)mm],caliceal pelvic height(CPH)[(19.96 ± 4.63)mm vs.(30.32 ± 7.56)mm],ureter-lower calyx distance(ULD)[(23.00 ± 5.59)mm vs.(18.78 ± 6.31)mm],CPH/IL ratio[(0.73 ± 0.11)vs.(0.92 ± 0.09)],and curvature of the lower calyx of the renal pelvis[(0.06 ± 0.01)mm -1 vs.(0.08 ± 0.03)mm -1]between the two groups( P <0.05). Univariate and logistic multivariate regression analyses were used to identify the independent risk factors affecting the postoperative SFR of FURL-treated lower calyx stones and to assess the value of CPH/IL for SFR in the treatment of lower calyx stones using FURL combined with a distally bendable negative pressure suction sheath. A logistic multivariate regression model and a corresponding nomogram were constructed,and the predictive ability of the model for SFR was evaluated using the receiver operating characteristic(ROC)curve. The calibration curve and the Hosmer -Lemeshow test were used to assess the consistency and accuracy of the model. The clinical utility of the model was evaluated using decision curve analysis(DCA). Results:Univariate analysis revealed that seven anatomical parameters differed significantly between the clearance and non-clearance groups(all P < 0.05):infundibulopelvic angle(IPA, OR = 0.27,95% CI 0.17-0.42, P < 0.01),infundibular length(IL, OR = 2.52,95% CI 1.83-3.47, P < 0.01),infundibular width(IW, OR = 0.64,95% CI 0.45-0.90, P = 0.011),caliceal pelvic height(CPH, OR = 5.78,95% CI 3.67-9.10, P < 0.01),ureter-lower calyx distance(ULD, OR = 0.43,95% CI 0.30-0.63, P < 0.01),CPH/IL ratio( OR = 13.62,95% CI 6.86-27.03, P < 0.01),and curvature of the lower calyx of the renal pelvis( O = 3.15,95% CI 2.08-4.78, P < 0.01). Multivariate logistic regression further identified CPH/IL( OR = 9.87,95% CI 4.92-19.79, P < 0.01),IPA( OR = 0.41,95% CI 0.23-0.71, P = 0.001),and ULD( OR = 0.50,95% CI 0.29-0.87, P = 0.014)as independent risk factors influencing the stone-free rate after flexible ureteroscopic lithotripsy combined with a distally bendable negative-pressure suction sheath. The area under the ROC curve(AUC)of the univariate regression model showed that for IPA,the AUC was 0.788(95% CI 0.711-0.864);for IL,it was 0.731(95% CI 0.643-0.819);for ULD,it was 0.677(95% CI 0.586-0.767);for CPH,it was 0.867(95% CI 0.804-0.929);for IW,it was 0.628(95% CI 0.535-0.721);for CPH/IL,it was 0.906(95% CI 0.850-0.961)with an optimal cutoff value of 0.882,corresponding to a sensitivity of 83.02% and a specificity of 92.08%;and for curvature of the lower calyx of the renal pelvis,it was 0.744(95% CI 0.662-0.827). The AUC of the multivariate regression model was 0.929(95% CI 0.884-0.974)with an optimal cutoff value of 0.364,corresponding to a sensitivity of 82.98% and a specificity of 95.09%. Calibration curves demonstrated close agreement between the predicted and actual stone-free rates after FURL(C-index = 0.921). The Hosmer-Lemeshow goodness-of-fit test indicated no significant discrepancy between predicted and observed probabilities( P = 0.135,>0.05). Decision-curve analysis further revealed that basing clinical decisions on the model ,s predicted probability yields a higher net clinical benefit than either withholding FURL for all patients or treating all patients regardless of risk,and it also outperforms strategies guided by any single independent predictor alone. Conclusions:IPA,IL,IW,CPH,ULD,CPH/IL ratio,and curvature of the lower calyx of the renal pelvis can all predict the postoperative SFR of FURL combined with a distally bendable negative pressure suction sheath for the treatment of lower calyx stones to varying degrees. Among them,CPH/IL has the highest predictive value. When CPH/IL >0.88,it may be difficult to use FURL to treat lower calyx stones.
4.Changes and clinical application value of AMH,INHB,and INHA levels in boys with cryptorchidism
Longqing ZHONG ; Wenbo WU ; Zhiqiang LIU ; Ximei YANG ; Jiangwei KE
International Journal of Laboratory Medicine 2025;46(10):1185-1189
Objective To investigate the changes of anti-Müllerian hormone(AMH),inhibin-B(INHB)and inhibin-A(INHA)levels in boys with cryptorchidism,analyze their clinical application value,and provide labo-ratory data for the diagnosis and treatment of cryptorchidism.Methods A total of 1 310 boys with cryp-torchidism who were hospitalized or visited the outpatient department in the hospital from July 2020 to July 2023 were included in the case group.Another 50 boys who underwent physical examination at the hospital and had no abnormalities in reproductive system development such as testicles were selected as the control group.Venous blood was collected from all the research subjects in a fasting state and placed into biochemical tubes.After centrifuging the serum,the changes in the levels of anti-Müllerian hormone(AMH),Inhibin B(INHB),and Inhibin A(INHA)in the two groups were detected by the chemiluminescence method.The differences between the two groups were analyzed,and the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of AMH,INHB,and INHA for cryptorchidism.Results The AMH lev-els in boys with cryptorchidism were significantly higher than those in the control group(P<0.01),while the INHB and INHA levels were significantly lower than those in the control group(P<0.01).ROC curve analy-sis showed that the area under the curve(AUC)of AMH was 0.65(95%CI:0.56-0.74,P<0.01).When the Youden index was 26.85%and the cut off value was 37.19 ng/mL,it had relatively good sensitivity(88.85%)but relatively low specificity(38.00%).The AUC of INHB was 0.63(95%CI:0.57-0.70,P<0.01).When the Youden index was 24.17%and the cut off value was 77.17 pg/mL,it had relatively poor sensitivity(38.17%)but relatively good specificity(86.00%).Both AMH and INHB have certain clinical val-ue in the differential diagnosis of boys with cryptorchidism.The AUC of INHA was 0.81(95%CI:0.79-0.84,P<0.01).When the Youden index was 75.86%and the cut off value was 5.165 pg/mL,it had a rela-tively good sensitivity(77.86%)and specificity(98.00%).Conclusion The changes in the levels of serum AMH and INHB have certain diagnostic value for boys with cryptorchidism,while INHA has a good diagnos-tic value and can be used as an auxiliary diagnostic indicator for boys with cryptorchidism.
5.Efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms: a multicenter retrospective study
Xiaowen ZHANG ; Jing LI ; Xifeng LI ; Chuanzhi DUAN ; Aihua LIU ; Huaizhang SHI ; Haowen XU ; Nan MA ; Zhiqiang YAO ; Feng FAN ; Chao LIU ; Jinyi LI ; Hailong ZHONG ; Mengyan FAN ; Jiaxin WAN ; Rijin LIN ; Huixiang LIU ; Jiamei ZHANG ; Xin ZHANG ; Sheng GUAN
Chinese Journal of Neuromedicine 2025;24(1):16-22
Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.
6.Neuroform Atlas stent-assisted coil embolization for middle cerebral artery bifurcation aneurysms: a multicenter retrospective study
Mengyan FAN ; Jing LI ; Chuanzhi DUAN ; Huaizhang SHI ; Aihua LIU ; Xiaochuan SUN ; Feng FAN ; Jinyi LI ; Chao LIU ; Haowen XU ; Linyu WANG ; Zhiqiang YAO ; Hailong ZHONG ; Xiaowen ZHANG ; Rijin LIN ; Jiaxin WAN ; Nan ZHANG ; Huixiang LIU ; Jiamei ZHANG ; Sheng GUAN
Chinese Journal of Neuromedicine 2025;24(2):141-146
Objective:To evaluate the efficacy and safety of Neuroform Atlas stent-assisted coil embolization in patients with middle cerebral artery bifurcation aneurysms.Methods:A retrospective analysis was performed; the clinical data of 46 patients with middle cerebral artery bifurcation aneurysms accepted Neuroform Atlas stent-assisted coil embolization in First Affiliated Hospital of Zhengzhou University, Beijing Tiantan Hospital Affiliated to Capital Medical University, First Affiliated Hospital of Harbin Medical University, Zhujiang Hospital of Southern Medical University and First Affiliated Hospital of Chongqing Medical University from January 2022 to March 2024 were collected. There were 28 ruptured aneurysms (60.87%) and 18 unruptured aneurysms (39.13%). Follow-up was performed for more than 3 months; Raymond-Roy grading was used to evaluate the aneurysm embolization immediately after embolization and during follow-up; perioperative hemorrhagic or ischemic complications were recorded; modified Rankin Scale (mRS) was used to evaluate the prognosis of the patients at discharge and during follow-up (mRS score≤2: good prognosis, and mRS score>2: poor prognosis).Results:Coil embolization was successful in all 46 patients. DSA immediately after embolization showed that 41 patients (89.13%) had completely occluded aneurysms (Raymond-Roy grading I), 2 patients (4.35%) had residual aneurysm neck (Raymond-Roy grading Ⅱ) and 3 patients (6.52%) had partially occluded aneurysms (Raymond-Roy grading Ⅲ). Perioperative complications occurred in 5 patients, including 2 with postoperative cerebral infarction, 1 with hydrocephalus, 1 with postoperative pneumonia leading to respiratory failure, and 1 with stent thrombosis during embolization. Both at discharge and 3 months after embolization, 43 patients (93.48%) had good prognosis and 3 patients (6.52%) had poor prognosis. No obvious ischemic complications (such as stent restenosis) or hemorrhagic complications (such as re-rupture of the aneurysms) were found in all patients. Thirty patients (65.22%) had imaging follow-up for 6-12 months: 26 (86.67%) had Raymond-Roy grading I, 3 (10.00%) had Raymond-Roy grading II, and 1 (3.33%) had Raymond-Roy grading III.Conclusion:Neuroform Atlas stent-assisted coil embolization has good short-term efficacy and high safety in middle cerebral artery bifurcation aneurysms, but long-term follow-up observation is still needed to verify its efficacy.
7.Intelligent Identification Model of Traditional Chinese Medicine Pieces Based on Improved YOLOv3 Algorithm
Shuang GAO ; Zhiqiang ZHOU ; Siyu ZHONG ; Xianzhang HUANG
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(2):364-374
Objective To improve the accuracy of intelligent detection and evaluation of traditional Chinese medicine(TCM)pieces and solve the problems of leakage,misdetection,inaccurate localization and low confidence in the study of TCM pieces identification,YOLOv3 algorithm which has good detection effect for high overlap and small targets was improved.Methods An RGB image database containing 148 commonly used TCM pieces was established.Based on the YOLOv3 algorithm model,the anchor box size was improved by K-means clustering algorithm.The CIoU loss function was introduced for bounding box regression to improve the localization accuracy and confidence of bounding boxes.The traditional non-maximum suppression was improved to DIoUNMS to reduce the problems of missed detection and false detection of dense targets with high overlap by YOLOv3 algorithm.Results 148 kinds of TCM pieces were tested with the improved algorithm,and the average detection accuracy of 98.47%was achieved,which is 1.83%better than the original YOLOv3 algorithm.It realizes better detection effect for TCM pieces in complex situations such as dense,high overlapping,etc.Problems such as leakage,misdetection,imprecise positioning and low confidence level have been alleviated to a certain extent.Conclusion The improved algorithm effectively improves the recognition accuracy and generalization ability of TCM pieces,providing a new reference for the realization of automated intelligent detection of TCM pieces.
8.Intelligent Identification Model of Traditional Chinese Medicine Pieces Based on Improved YOLOv3 Algorithm
Shuang GAO ; Zhiqiang ZHOU ; Siyu ZHONG ; Xianzhang HUANG
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(2):364-374
Objective To improve the accuracy of intelligent detection and evaluation of traditional Chinese medicine(TCM)pieces and solve the problems of leakage,misdetection,inaccurate localization and low confidence in the study of TCM pieces identification,YOLOv3 algorithm which has good detection effect for high overlap and small targets was improved.Methods An RGB image database containing 148 commonly used TCM pieces was established.Based on the YOLOv3 algorithm model,the anchor box size was improved by K-means clustering algorithm.The CIoU loss function was introduced for bounding box regression to improve the localization accuracy and confidence of bounding boxes.The traditional non-maximum suppression was improved to DIoUNMS to reduce the problems of missed detection and false detection of dense targets with high overlap by YOLOv3 algorithm.Results 148 kinds of TCM pieces were tested with the improved algorithm,and the average detection accuracy of 98.47%was achieved,which is 1.83%better than the original YOLOv3 algorithm.It realizes better detection effect for TCM pieces in complex situations such as dense,high overlapping,etc.Problems such as leakage,misdetection,imprecise positioning and low confidence level have been alleviated to a certain extent.Conclusion The improved algorithm effectively improves the recognition accuracy and generalization ability of TCM pieces,providing a new reference for the realization of automated intelligent detection of TCM pieces.
9.Predictive value of caliceal pelvic height-to-infundibular length ratio for stone-free rate in lower calyx stone treatment with flexible ureteroscopic lithotripsy
Shiwei HUANG ; Sheng ZHONG ; Guangming YIN ; Long WANG ; Zhiqiang JIANG ; Kai HUANG ; Jing TAN
Chinese Journal of Urology 2025;46(8):600-606
Objective:This study aims to explore the predictive value of the ratio of caliceal pelvic height to infundibular length(CPH/IL)for the stone-free rate(SFR)in the treatment of lower calyx stones using flexible ureteroscopic lithotripsy(FURL)combined with a distally bendable negative pressure suction sheath.Methods:A retrospective analysis was conducted on the clinical data and anatomical parameters of 312 patients with lower calyx stones or combined lower calyx stones admitted to the Third Xiangya Hospital of Central South University from September 2022 to December 2023,all of whom were treated with FURL combined with a distally bendable negative pressure suction sheath. Stone clearance was defined as no residual stones or residual stones with a diameter of ≤3 mm without any symptoms. Patients were divided into the clearance group(265 cases,84.90%)and the non-clearance group(47 cases,15.10%). There were no significant differences in gender(male/female:173/92 cases vs. 29/18 cases),age[(44.69 ± 13.14)years vs.(42.60 ± 10.93)years],degree of hydronephrosis(no hydronephrosis/mild hydronephrosis/moderate to severe hydronephrosis:122/85/58 cases vs. 21/12/14 cases),side of lower calyx stones(left/right:157/108 cases vs. 31/16 cases),maximum diameter of stones(MDS)[(19.23 ± 6.41)mm vs.(17.77 ± 6.18)mm],and CT value of stones[(993.46 ± 249.12)Hu vs.(1013.43 ± 300.90)Hu]between the two groups( P > 0.05),indicating comparability between groups. There was no significant difference in the distance from the midpoint of the lower lip of the renal pelvis to the ureter at the lowest plane of the lower calyx(K-A line)between the clearance and non-clearance groups[(26.16 ± 5.18)mm vs.(25.70 ± 8.66)mm, P > 0.05]. However,significant differences were observed in the infundibulopelvic angle(IPA)[(53.97 ± 15.72)° vs.(37.43 ± 15.39)°],infundibular length(IL)[(27.26 ± 5.11)mm vs.(33.04 ± 7.38)mm],infundibular width(IW)[(8.27 ± 2.82)mm vs.(7.09 ± 3.20)mm],caliceal pelvic height(CPH)[(19.96 ± 4.63)mm vs.(30.32 ± 7.56)mm],ureter-lower calyx distance(ULD)[(23.00 ± 5.59)mm vs.(18.78 ± 6.31)mm],CPH/IL ratio[(0.73 ± 0.11)vs.(0.92 ± 0.09)],and curvature of the lower calyx of the renal pelvis[(0.06 ± 0.01)mm -1 vs.(0.08 ± 0.03)mm -1]between the two groups( P <0.05). Univariate and logistic multivariate regression analyses were used to identify the independent risk factors affecting the postoperative SFR of FURL-treated lower calyx stones and to assess the value of CPH/IL for SFR in the treatment of lower calyx stones using FURL combined with a distally bendable negative pressure suction sheath. A logistic multivariate regression model and a corresponding nomogram were constructed,and the predictive ability of the model for SFR was evaluated using the receiver operating characteristic(ROC)curve. The calibration curve and the Hosmer -Lemeshow test were used to assess the consistency and accuracy of the model. The clinical utility of the model was evaluated using decision curve analysis(DCA). Results:Univariate analysis revealed that seven anatomical parameters differed significantly between the clearance and non-clearance groups(all P < 0.05):infundibulopelvic angle(IPA, OR = 0.27,95% CI 0.17-0.42, P < 0.01),infundibular length(IL, OR = 2.52,95% CI 1.83-3.47, P < 0.01),infundibular width(IW, OR = 0.64,95% CI 0.45-0.90, P = 0.011),caliceal pelvic height(CPH, OR = 5.78,95% CI 3.67-9.10, P < 0.01),ureter-lower calyx distance(ULD, OR = 0.43,95% CI 0.30-0.63, P < 0.01),CPH/IL ratio( OR = 13.62,95% CI 6.86-27.03, P < 0.01),and curvature of the lower calyx of the renal pelvis( O = 3.15,95% CI 2.08-4.78, P < 0.01). Multivariate logistic regression further identified CPH/IL( OR = 9.87,95% CI 4.92-19.79, P < 0.01),IPA( OR = 0.41,95% CI 0.23-0.71, P = 0.001),and ULD( OR = 0.50,95% CI 0.29-0.87, P = 0.014)as independent risk factors influencing the stone-free rate after flexible ureteroscopic lithotripsy combined with a distally bendable negative-pressure suction sheath. The area under the ROC curve(AUC)of the univariate regression model showed that for IPA,the AUC was 0.788(95% CI 0.711-0.864);for IL,it was 0.731(95% CI 0.643-0.819);for ULD,it was 0.677(95% CI 0.586-0.767);for CPH,it was 0.867(95% CI 0.804-0.929);for IW,it was 0.628(95% CI 0.535-0.721);for CPH/IL,it was 0.906(95% CI 0.850-0.961)with an optimal cutoff value of 0.882,corresponding to a sensitivity of 83.02% and a specificity of 92.08%;and for curvature of the lower calyx of the renal pelvis,it was 0.744(95% CI 0.662-0.827). The AUC of the multivariate regression model was 0.929(95% CI 0.884-0.974)with an optimal cutoff value of 0.364,corresponding to a sensitivity of 82.98% and a specificity of 95.09%. Calibration curves demonstrated close agreement between the predicted and actual stone-free rates after FURL(C-index = 0.921). The Hosmer-Lemeshow goodness-of-fit test indicated no significant discrepancy between predicted and observed probabilities( P = 0.135,>0.05). Decision-curve analysis further revealed that basing clinical decisions on the model ,s predicted probability yields a higher net clinical benefit than either withholding FURL for all patients or treating all patients regardless of risk,and it also outperforms strategies guided by any single independent predictor alone. Conclusions:IPA,IL,IW,CPH,ULD,CPH/IL ratio,and curvature of the lower calyx of the renal pelvis can all predict the postoperative SFR of FURL combined with a distally bendable negative pressure suction sheath for the treatment of lower calyx stones to varying degrees. Among them,CPH/IL has the highest predictive value. When CPH/IL >0.88,it may be difficult to use FURL to treat lower calyx stones.
10.Efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms: a multicenter retrospective study
Xiaowen ZHANG ; Jing LI ; Xifeng LI ; Chuanzhi DUAN ; Aihua LIU ; Huaizhang SHI ; Haowen XU ; Nan MA ; Zhiqiang YAO ; Feng FAN ; Chao LIU ; Jinyi LI ; Hailong ZHONG ; Mengyan FAN ; Jiaxin WAN ; Rijin LIN ; Huixiang LIU ; Jiamei ZHANG ; Xin ZHANG ; Sheng GUAN
Chinese Journal of Neuromedicine 2025;24(1):16-22
Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Result Analysis
Print
Save
E-mail