Objective To analyze the characteristics and malignancy of red-patch like lesion(RPL)during cystoscopy,and to explore the significance of RPL biopsy.Methods Clinical data of patients who had RPL detected in our hospital during Jan.2019 and Jun.2023 were retrospectively analyzed,including gender,age,cause of examination,presence of scars,complications and biopsy pathology.The patients were divided into the benign and malignant groups,and their clinical and RPL characteristics were analyzed.Results A total of 521 cases of RPL were enrolled including 416(79.8％)benign cases,and 105(20.2％)malignant cases.The averae age of the malignant group was higher than the benign group's[(66.8±12.2)years vs.(62.8±12.9)years,P=0.005].The malignant detection rate of RPL in postoperative follow-up patients,those with hematuria and those with lower urinary tract symptoms was 23.7％(92/389),19.6％(9/46),4.7％(4/86),respectively.According to direct observation and experience,the detection rate of pathological malignancy in the three groups of patients with high suspicion of RPL malignancy,mild suspicion of RPL malignancy and high probability of benign was 56.9％(37/65),37.0％(30/81)and 10.1％(38/375),respectively.Conclusion Once RPL is detected during cystoscopy,active biopsy should be performed.For elderly male patients undergoing postoperative follow-up,RPL biopsy is particularly important,especially when the lesion is located on or near the scar surface.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To investigate the clinical effect of fascial sling of flexor-pronator teres origin and anterior subcutaneous transposition of ulnar nerve in the treatment of severe cubital tunnel syndrome.Methods:30 patients with severe cubital tunnel syndrome were prospectively enrolled, who underwent surgical treatment at the Affiliated Hospital of Binzhou Medical University from December 2021 to February 2022. Randomized drawing divided the patients into two groups: the fascial sling group and the anterior subcutaneous transposition group with 15 cases on each group. In the fascial sling group, there were 11 males and 4 females, with an average age of 59 years (range 51-73 years), who underwent fascial suspension after ulnar nerve decompression. In the anterior subcutaneous transposition group, there were 10 males and 5 females, with an average age of 56 years (range 41-72 years), who underwent where the ulnar nerve was subcutaneous transposition after ulnar nerve decompression. The dynamic two-point discrimination and grip strength of the little finger on the affected limb were measured at 6, 12, and 24 months postoperatively. The postoperative improvement between the two groups were compared. Functional assessment and patient satisfaction surveys were conducted and compared at 24 months.Results:Neither groups had incision-related complications. The surgical duration for the fascial sling group was longer than that for the anterior subcutaneous transposition group (46.80±1.86 min and 43.87±2.00 min) with significant difference ( t=4.166, P<0.001). Blood loss during surgery in the fascial sling group was greater than that in the anterior subcutaneous transposition group (3.53±0.52 ml and 2.53±0.52 ml) with significant difference ( t=5.303, P<0.001). No significant difference was found in the improvement of dynamic two-point discrimination of the little finger in the affected limb at 6, 12, and 24 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (5.87±1.41 mm, 4.27±1.16 mm, 3.13±1.06 mm and 5.73±1.98 mm, 4.40±1.45mm, 3.20±1.15 mm), ( t=0.213, P=0.833; t=-0.277, P=0.784; t=-0.165, P=0.870). There was no significant difference in grip strength improvement in the affected limb at 6 and 12 months postoperatively between the fascial sling group and the anterior subcutaneous transposition group (24.62±4.94 kg, 25.88±4.72 kg and 21.94±3.76 kg, 23.62±4.00kg), ( t=1.448, P=0.159; t=1.404, P=0.171). At 24 months postoperatively, the fascial sling group showed better grip strength improvement compared to the anterior subcutaneous transposition group (27.58±4.92 kg and 23.62±4.00 kg) with significant difference ( t=2.425, P=0.033). The functional assessment revealed that the fascial sling group included 4 excellent, 8 good, and 3 acceptable cases, while the anterior subcutaneous transposition group had 3 excellent, 8 good, and 4 acceptable cases. One case in the fascial sling group was unsatisfied with the improvement in function. Four cases in the anterior subcutaneous transposition group were unsatisfied with functional improvement due to significant discomfort in the surgical area. Conclusion:The fascial sling technique of the flexor-pronator muscle origin yielded better clinical results on postoperative grip strength improvement and patient satisfaction compared to the anterior subcutaneous transposition.

Objective:To investigate the clinical value of improved perforator area CTA three-dimensional reconstruction in design and harvest of anterolateral thigh perforator flap(ALTPF) and deep inferior epigastric artery perforator flap(DIEPF).Methods:Repairs of defects of oral and maxillofacial tumour resection with ALTPF for 8 patients and defects of breast tumour resection with DIEPF for 2 patients were performed from September 2021 to January 2022 in the Department of Hand and Microsurgery of Affiliated Hospital of Binzhou Medical College. According to the improved scanning parameters and drug administration protocol, patients underwent CTA scans of both thighs or abbomen before operation. The data of CTA were sent to GE AW 4.7 work station to produce three-dimensional reconstruction of perforator area and angiosome. The source artery and perforator were observed dynamically from the angiosome in the perforator area, and the specific data were measured. The perforator location was marked by HHD, and then according to the measurement data of CTA three-dimensional reconstruction marked the location, course of perforator and the course of source artery on the body surface. The data of source arteries and perforators explored during the operation were compared with preoperative three-dimensional reconstruction. The perforator locations of CTA were compared with the HHD. The harvest time and survival condition of flap were compared with the previous patients who only had the perforator location markers from HHD. The sizes of ALTPFs and DIEPFs were 4.0 cm×4.0 cm-15.0 cm×6.0 cm and 19.0 cm×7.5 cm-25.0 cm×10.0 cm, respectively. The survival of flaps and the healing of wound were observed in the postoperative follow-up in terms of appearance, texture, function of recipient site and the shape and function of the donor site.Results:Eight ALTPFs and 2 DIEPFs all survived without any adverse event. Both recipient and donor sites healed well without any complication. Seven femoral septocutaneous perforators, 2 musculocutaneous perforators and abdominal 3 perforators coursed directly, 2 tortuously perforators were seen from three-dimensional reconstruction. The types and origins of perforators explored during operation were basically consistent with three-dimensional reconstruction. The accuracy of CTA[(0.36±0.11) cm] was higher than HHD[(0.54±0.19) cm] for perforators location( t=-3.160, P<0.05). Compared with the previous group[(74.60±30.53) min], this group[(52.80±24.57) min] had a shorter time to cut out the flap of similar area( t=-9.179, P<0.05). In the previous group, one flap transfer was failed due to the thinner caliber of perforator and source artery. All the flaps survived with satisfactory outline and softness with good blood supply after 2-6 months of follow-up. The oral and maxillofacial functions were normal. The reconstructed breasts were symmetrical with the healthy side, and the shape was satisfactory. Only linear scars remained in the donor sites without dysfunction. Conclusion:The improved CTA three-dimensional reconstruction of perforator area can help to determine the detailed location, course and distribution of the perforators at the superficial fascia layer. It provides a reliable bases in the design and harvest of perforator flaps during operation, reduces the perioperative risks and has certain clinical values.

Inflammatory bowel disease (IBD) mainly includes Crohn′s disease (CD) and ulcerative colitis (UC) . The imaging diagnosis of CD is difficult because of its complex disease and varied imaging manifestations. Standardizations of imaging techniques and reports are helpful to improve the imaging diagnosis level of CD. This article aims to provide guideline for the imaging technique selection, scanning scheme formulation, imaging features interpretation and imaging report writing of CD in China.

Inflammatory bowel disease (IBD) mainly includes Crohn′s disease (CD) and ulcerative colitis (UC) . The imaging diagnosis of CD is difficult because of its complex disease and varied imaging manifestations. Standardizations of imaging techniques and reports are helpful to improve the imaging diagnosis level of CD. This article aims to provide guideline for the imaging technique selection, scanning scheme formulation, imaging features interpretation and imaging report writing of CD in China.

Objective:It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer.Methods:The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools.Results:A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77, P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion:The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.

Objective:It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer.Methods:The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools.Results:A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77, P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion:The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.

OBJECTIVETo investigate the value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy (NAT) for locally advanced rectal cancer.

METHODSInclusion criteria: (1) rectal cancer proven by biopsy; (2) locally advanced rectal cancer (T3-4 or positive lymph nodes) with distance from lower edge of tumor to anal verge within 12 cm diagnosed by MRI before NAT; (3) acceptance of NAT treatment regulations and completion of NAT; (4) completion of routine MRI scan and CUBE scan before and after 2-course NAT chemotherapy (including new neoadjuvant chemotherapy and chemoradiotherapy); (5) completion of surgery 6-8 weeks after NAT; (6) exclusion of any previous NAT due to rectal malignant tumor or other tumors; (7) exclusion of poor image quality of preoperative routine MRI insufficient for rectal cancer staging or of CUBE image insufficient for tumor volume measurement. Fifty patients with advanced local rectal cancer were recruited in our hospital from February 2014 to January 2016. All the patients underwent MRI before and after 2-course neoadjuvent therapy. Tumor volume on CUBE were measured and the volume changes were calculated: volume difference= pre-treatment volume-post-treatment volume, volume change rate= (pre-treatment volume-post-treatment volume)/ pre-treatment volume. All the patients were categorized into sensitive and non-sensitive group according to postsurgical pathology. Comparisons were made between both groups before and after therapy. ROC curve was used to evaluate the value of CUBE-associated parameters in predicting the efficacy of rectal cancer.

RESULTSAmong enrolled 50 patients with rectal cancer, 31 were male and 19 were female, with mean age of 49.1 years (range 21 to 70 years). T-staging by MRI before NAT was T2N1-2 in 1 case, T3 in 43 cases, T4 in 6 cases. The number of patients after NAT from tumor regression grading (TRG) 0 to TRG3 was 14, 13, 18, 5, respectively. The sensitive group and insensitive group were 45 cases and 5 cases. Mean tumor volume before and after preoperative 2-course NAT was 18.70 (4.14 to 91.77) cmand 9.26 (1.02 to 52.58) cm, respectively, whose difference was significant (U=-5.826, P<0.001). Both measure values of overall tumor volume before and after preoperative NAT between sensitive group and insensitive group did not show significant differences(all P>0.05). While sensitivity group had significantly higher volume difference and change rate compared to insensitive group [ (11.90±10.01) cmvs. (0.65±3.93) cm, P=0.005; 0.45±0.28 vs. 0.09±0.36, P=0.010]. ROC curve revealed that the optimal cutoff value of accurate identification of patients with NAT sensitive was 1.96 cmfor volume difference with sensitivity 86.7% and specificity 80%, and 0.06 for volume change rate with sensitivity 93.3% and specificity 60%.

CONCLUSIONMRI CUBE can predict the efficacy of NAT for early rectal cancer patients accurately and sensitively through the detection of tumor volume change before and after NAT.

OBJECTIVETo evaluate the influences of inferior mesenteric artery (IMA) types and Riolan artery arcade absence on the incidence of anastomotic leakage(AL) after laparoscopic resection of rectal cancer.

METHODSClinical data of 116 local advanced rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2014 were analyzed retrospectively. IMA and Riolan artery arcade were examined by preoperative computed tomography angiography (CTA) reconstruction. The influences of IMA type, Riolan artery arcade absence and ligation site (high or low) on AL were analyzed by Logistic regression.

RESULTSThe proportion of IMA types(I(-IIII() was 57.8%(67/116), 10.3%(12/116), 31.0%(36/116) and 0.9%(1/116), respectively. Riolan artery arcade absence was found in 60.3%(70/116). Eight (6.9%) patients suffered from AL. IMA type III( had significantly higher AL incidence as compared to other IMA types [19.4%(7/36) vs. 1.2%(1/80), P=0.001]. Meanwhile, patients with Riolan artery arcade absence also had significantly higher AL incidence[11.4%(8/70) vs. 0.0%(0/46), P=0.030]. However, the difference in AL incidence between high and Low IMA ligation was not statistically significant [8.0%(7/87) vs. 3.4%(1/29), P=0.531]. Seven of these 8 AL patients were found in IMA type III( with Riolan artery arcade absence and high ligation. Multivariate analysis showed that IMA type III( (P=0.001) and Riolan artery arcade absence (P=0.002) were independent risk factors of AL.

CONCLUSIONSIMA type III( with Riolan artery arcade absence increases AL incidence significantly in laparoscopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the colorectal cancer patients with IMA type III( and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be recommended.

Adult ; Anastomotic Leak ; Arteries ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Incidence ; Laparoscopy ; Ligation ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Mesenteric Artery, Inferior ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies