【Objective】 To explore the diagnosis, treatment, prognosis and long-term follow-up of urogenital solitary fibrous tumor (SFT) and to differentiate the characteristics between benign and malignant SFT. 【Methods】 Clinical data of 20 patients with urogenital SFT treated in our hospital during Jan.2004 and Aug.2021 were respectively analyzed, including the general characteristics, clinical symptoms, imaging results, treatment methods, pathological results, and long-term follow-up results. 【Results】 Of the 20 cases, 9 cases had tumor in kidney, 7 in pelvic cavity, 3 in bladder and 1 in prostate.Six patients showed non-specific clinical symptoms, including lower extremity weakness, urodynia, dysuria, frequent urination with changes in stool habits, low back pain, and abdominal wall mass with abdominal pain, and the other 14 cases were asymptomatic.The median diameter of SFT was 5.2 cm (range:1.7-15.0 cm).All patients received surgical treatment, including robotic-assisted surgery in 8 cases, open surgery in 5 cases, laparoscopic surgery in 5 cases, and transurethral resection of tumor in 2 cases.CT plain scan showed high, low and mixed density soft tissue masses, and enhanced CT showed enhanced results.Pathology results revealed frequent nuclear divisions, morphological variations and necrosis in malignant SFT, which had higher expression of Ki-67 than benign SFT.The results of the modified Demicco prognostic risk stratification model showed that all malignant SFT cases were at intermediate risk. The DFS of the SFT radical tumor resection group was slightly longer than that of the simple tumor resection group but the difference was not statistically significant (P=0.203). 【Conclusion】 Markers such as CD34, Bcl2, STAT6 and CD99 are used to diagnose SFT, while Ki-67 and tumor necrosis are used to differentiate benign and malignant SFT.The modified Demicco prognostic risk stratification model plays an important role in predicting the prognosis of SFT.Surgical resection is the most common treatment with excellent prognosis.In addition, benign SFT has much better prognosis than malignant case.

Objective:To explore the effectiveness and safety of percutaneous radiofrequency ablation for renal tumors, guided by both ultrasound and CT, under local anesthesia.Methods:A retrospective analysis was conducted on the clinical data of 40 patients with renal tumors admitted to Nanjing Drum Tower Hospital between January 2018 and December 2022. This treatment involved ultrasound/CT dual-guided radiofrequency ablation under local anesthesia. The cohort included 33 males and 7 females, with an average age of (61.5±11.9) years old and a body mass index (BMI) of (24.79±3.37) kg/m 2. The tumors were located in the left kidney in 20 cases and the right kidney in 16 cases, with 4 cases involving bilateral renal tumors. There were 44 tumors in 40 patients, with the maximum tumor diameter ranging from 1.0 to 4.0 cm [mean (2.3 ± 0.7) cm]. Distribution by kidney pole was as follows: 15 cases at the upper pole, 21 at the middle pole, and 8 at the lower pole. Of the tumors, 23 were exophytic, 5 were endophytic, and 16 exhibited mixed features. There were 2 patients with multiple metastases before surgery(including 1 patient with bilateral renal tumor). Preoperative serum creatinine level was 68.0(56.5, 87.5)μmol/L, and the estimated glomerular filtration rate (eGFR) was 114.2 (79.6, 132.4) ml/(min·1.73 m 2). All patients underwent renal biopsy before or during radiofrequency ablation. Percutaneous radiofrequency ablation surgery was performed using ultrasound and CT dual guidance on all patients, ensuring complete tumor destruction during the procedure as confirmed by dual positioning. Patients with bilateral tumors underwent two separate surgeries, spaced one month apart. Postoperatively, closely monitor the patient's vital signs and conduct long-term follow-ups to record any recurrence and metastasis. Results:In this series, all 40 procedures (involving 44 renal units) were successfully completed under local anesthesia without any need for blood transfusion, conversion to open surgery, or perioperative deaths. The average radiofrequency ablation time was (9.5 ± 3.6) min. Tumor characteristics included predominantly exophytic growths (23 cases, 52.3%), with 31 cases (70.5%) located more than 7 mm from the collecting system and 28 cases (63.6%) positioned posteriorly. Thirteen cases (29.5%) were entirely outside the polar line. The average R. E.N.A.L. nephrometry score was 6.1±0.2. Pathological examination revealed 34 cases of clear cell carcinoma, 2 of papillary renal cell carcinoma, 4 of unclassified renal cell carcinoma, and 4 benign renal tumors. In this cohort, two patients with bilateral renal tumors exhibited benign tumors on one side, while two other patients had malignant tumors in both kidneys. All 40 malignant tumors identified in 38 cases were classified at stage cT 1a.Postoperative serum creatinine level was 71.5 (59.0, 94.3) μmol/L, showing no statistically significant change from preoperative levels ( P > 0.05). Similarly, the eGFR post-operation was 107.4 (79.7, 132.2) ml/(min·1.73 m 2), which also did not differ significantly from preoperative values ( P > 0.05). There were no postoperative complications of Clavien-Dindo grade ≥Ⅱ, except for one case of severe pain (score 7-10). The follow-up period ranged from 15 to 70 months. Among the 38 cases, 36 patients did not have distant metastasis before surgery. There were 2 patients (5.5%) with local recurrence within 60 months after surgery. Among them, one case relapsed 6 months after radiofrequency ablation and was treated with partial nephrectomy. The patient was followed up for 60 months after the second treatment, and no local recurrence occurred. Another patient relapsed 41 months after surgery and was treated with radiofrequency ablation again. The patient was followed up for 12 months after the second treatment, and no local recurrence occurred. Two patients with distant metastasis before surgery were treated with targeted therapy plus immunotherapy for 12 months after surgery. One case had local recurrence 8 months after surgery and was treated with partial nephrectomy. The patient was followed up for 60 months after partial nephrectomy and no local recurrence occurred. Another patient with bilateral renal tumors developed left kidney recurrence 34 months after radiofrequency ablation, and underwent left partial nephrectomy. The right kidney recurred 42 months after radiofrequency ablation and underwent radiofrequency ablation again. After the second right renal radiofrequency ablation, no local recurrence occurred during 12 months of follow-up. Conclusions:Ultrasound/CT dual-guided percutaneous radiofrequency ablation, performed under local anesthesia for treating renal tumors, has minimal impact on the patient's renal function. The procedure boasts a low complication rate, with no postoperative severe complications. Additionally, the postoperative tumor control is effective, making it a safe and minimally invasive surgical option.

Objective:A single-center analysis was performed to assess the significant clinical features and prognostic factors of TFE3-rearranged renal cell carcinoma (TFE3 rRCC).Methods:The clinical data of 85 confirmed cases of TFE3 rRCC patients at the Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2007 to February 2023 were analyzed retrospectively. Among these patients, there were 39 males and 46 females, with a median age of 32 (26, 45) years. All patients underwent preoperative CT scans, 21/85 cases (24.7%) of TFE3 rRCC exhibited the characteristic feature of "circular calcification" with plain CT imaging, and enhanced CT scan showed that the tumor enhancement during the arterial phase was lower than the adjacent renal cortex. Among the 85 patients in this cohort, the median tumor diameter was 4.8(3.2, 6.5). Thirty-two patients underwent partial nephrectomy (NSS), while 51 patients underwent radical nephrectomy (RN). Two patients with distant metastasis at the time of diagnosis received only sunitinib therapy. Forty-three patients received adjuvant treatment, including 14 patients who received targeted therapy. There were 29 patients in AJCC stage Ⅲ/Ⅳ, with 10 patients presenting with venous tumor thrombus and 14 patients with lymph node metastasis. Histopathology, TFE3 immunohistochemistry, and break-apart TFE3 FISH probe detection were performed on all 85 cases, while 52 patients underwent RT-PCR and/or DNA sequencing. By combining the clinical and pathological data, we summarized the diagnostic Methods for TFE3 rRCC, evaluated the impact of surgical approaches (RN and NSS) on the survival outcomes of cT 1a/b patients, and assessed the influence of genetic subtypes (ASPL, NONO, PRCC, SFPQ, and others) on the survival outcomes of all patients. Furthermore, we analyzed the risk factors for disease progression. Results:TFE3 rRCC exhibited variable histopathological features, and the presence of acinar-like structures with psammoma bodies may be a relatively typical characteristic. All 85 patients showed positive TFE3 immunohistochemical staining. In 6 cases of TFE3 rRCC, break-apart TFE3 FISH probe yielded negative results. However, final confirmation was achieved through genetic sequence, with 5 cases diagnosed as NONO-TFE3 subtype and 1 case as RBM10-TFE3 subtype. Among the 85 patients, 52 underwent RT-PCR and/or DNA sequencing, revealing a total of 8 TFE3 fusion subtypes, including 11 cases of ASPL-TFE3, 8 cases of PRCC-TFE3, 10 cases of NONO-TFE3, 15 cases of SFPQ-TFE3, 1 case of CLTC-TFE3, 2 cases of LUC7L3-TFE3, 4 cases of MED15-TFE3, and 1 case of RBM10-TFE3. The survival analysis results revealed that among the 12 patients with cT 1b stage tumors who underwent radical nephrectomy (RN), the progression-free survival (PFS) was 35 (14, 109) months, which was significantly better than the NSS group ( P=0.041). However, for the 14 patients with cT 1a stage tumors who underwent RN, there was no statistically significant difference in overall survival (OS) and PFS compared to the NSS group, with OS being 55(27, 134) months and PFS being 71(41, 134) months. Stratifying according to TFE3 fusion subtypes, it was found that patients with ASPL-TFE3 fusion had a significantly lower PFS compared to those with non-ASPL-TFE3 fusion subtypes ( P=0.029). Survival analysis revealed that tumor diameter, surgical approach, adjuvant therapy, AJCC staging, venous tumor thrombus, and lymph node metastasis were associated with OS and PFS( P<0.05). The results of the multivariate Cox regression analysis showed that AJCC stage Ⅲ/Ⅳ( HR=2.393, 95% CI 1.418-4.039, P=0.001) and venous tumor thrombus ( HR=3.543, 95% CI 1.159-10.827, P=0.026) were independent risk factors for progression-free survival (PFS). Conclusions:During the non-enhanced phase of CT scan, TFE3 rRCC tumors can exhibit a circular calcification. TFE3 immunohistochemistry is an important screening method for TFE3 rRCC.Break-apart TFE3 FISH probe detection is considered the diagnostic gold standard, and gene sequencing, if feasible, can provide the subtype diagnosis of TFE3 rRCC. For cT 1a stage TFE3 rRCC, partial nephrectomy (NSS) is a viable option, while caution should be taken in selecting NSS for cT1b stage patients. Patients with ASPL-TFE3 fusion subtype have a worse prognosis. AJCC stage Ⅲ/Ⅳ and venous tumor thrombus indicate poor prognosis in TFE3 rRCC.

Developmental dysplasia of the hip (DDH) is one of the most common orthopaedic diseases in children. Due to the complexity of risk factors, the molecular regulatory mechanism of its occurrence and development is still not clear. Understanding the molecular regulatory mechanism and morphological changes of DDH is of great significance for the exploration of the mechanism, the formulation of early screening, diagnosis and treatment strategies. Recently, with the development of development biology, molecular biology, preclinical medicine and clinical medicine, the risk factors and potential mechanism of DDH have been investigated deeply. Here, we reviewed the formation of anatomical structure during hip joint development, genes expression and signal pathways involved in endochondral ossification. Further, we analyzed the possible development stages, which might lead to the developmental instability. Previous studies have shown that the interaction between the femoral head and the acetabulum in the embryonic development of the hip joint determines the morphogenesis of the hip joint. The embryonic cartilage of the hip joint begins to develop at 5 to 12 weeks after fertilization, followed by the development of the primary and secondary ossification processes to form the hip joint with a complete structure. Transcription factors of SOX9 and RUNX2, which regulate chondrogenesis and osteogenesis during bone development, are mediated by HIF, WNT, FGF and PTHRP signal pathways. In addition, there are 28 potential pathogenic genes of DDH identified by clinical DDH case gene detection techniques, including whole genome sequencing and whole exon sequencing, which are of great significance for revealing the molecular mechanism of DDH occurrence. In addition, we summarized the current clinical screening methods, risk factors, diagnosis and treatment of DDH. Finally, we discussed the remaining challenges and possible future directions for DDH research and interventions, which may provide new ideas for the mechanism research, and clinical diagnosis and treatment strategies for DDH.

Objective To explore the effect of dexmedetomidine for the dosage of drug of pain pump of the patients postoperative.Methods From April 2013 to July 2015,86 patients with intestinal obstructionwhich come to our hospital for surgical treatment were divided into observation group and control group according to the lottery method,each had 43 cases.The patients of control group were given pain pump for pain treatment ; and the patients of observation group were given dexmedetomidine on the base of control group for treatment.The heart rate,systolic arterial pressure(SAP),arterial oxygen pressure(PaO2),analgesia satisfaction,visual analogue scale/score(VAS)pain score,sleep quality score,sufentanil dosage,the number of self-administration,adverse reactions,postoperative anal exhaust time.Results 36h and 72h,SAP,PaO2 in the observation group were significantly better than those in the control group after treatment(P<0.05); The total satisfaction of analgesia was significantly higher than that of control group(P<0.05); VAS pain score was significantly lower than the control group(P<0.05); The sleep quality score was significantly higher than that of the control group(P<0.05); The dosage of sufentanil and the times of administration were significantly lower than those of the control group(P<0.05); Anal exhaust time was significantly shorter than the control group(P<0.05); The incidence of adverse reactions was significantly lower than that of the control group(P<0.05).Conclusion By using dexmedetomidine on the base of pain pump can improve the analgesic effect postoperative,reduce the dosage of pain pump medication and the adverse reactions.

OBJECTIVETo initially explore the clinical effect of cool-tip radiofrequency ablation combined with enucleation for the giant hamartoma of kidney with narrow base and export-oriented way of growth.

METHODSThe clinical date of 15 patients including 6 male and 9 female with special hamartoma of kidney underwent cool-tip radiofrequency ablation assisted enucleation from July 2011 to October 2014 were reviewed.The median age was 49 years (ranging from 35 to 71 years). There were 6 cases with left renal tumor, 8 cases with right renal tumor and 1 case with solitary kidney tumor.All patients were confirmed by B ultrasound or CT scan, the mean diameter of hamartoma of kidney was 9.7 cm(8.5-12.7)cm, all tumors were located distant from the collecting system and presents with a special way of growth.The preoperative hemoglobin was (129±18)g/L, SCr was (92±41)μmol/L, glomerular filtration rate (GFR) was (32±12)ml·min(-1)·1.73 m(-2).

RESULTSCool-tip radiofrequency ablation assisted enucleation was technically successful in all patients.The mean operative duration was (115±31)minutes, and the average intraoperative bleeding was (72±21)ml with no blooding transfusion.The postoperative hospital stay was(7±2)days, and the postoperative hemoglobin was(129±18)g/L, SCr (92±41)μmol/L, GFR(30±15)ml·min(-1)·1.73 m(-2). No statistic change of hemoglobin and SCr or glomerular filtration rate after operations(all P>0.05). Postoperative pathology showed that all cases were hamartoma of kidney.During a mean follow-up period of 19.5 months, none of them had local tumor recurrence or chronic renal insufficiency.

CONCLUSIONSCool-tip radiofrequency ablation assisted enucleation is both safe and effective in the treatment of huge hamartoma of kidney with a narrow base and export-oriented way of growth. The short-term follow-up shows a satisfactory therapeutic effect.

Adult ; Aged ; Angiomyolipoma ; surgery ; Blood Transfusion ; Catheter Ablation ; methods ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms ; surgery ; Length of Stay ; Lipoma ; therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Period ; Treatment Outcome

Objective To analysis the modified Gleason scoring system for predicting the prognosis after radical prostatectomy.Methods A total of 242 patients who received radical prostatectomy from April,2006 to October 2011 were recruited.The patients who lost follow-up or had adjuvant radiation or hormonal therapy or had visceral or bone metastasis were excluded,the remaining 168 patients were evaluated in the present study.The patients' age ranged from 53 to 85 years old (mean age 69 years old).The mean PSA level was 13.31ng/ml (ranging from 4.59 to 36.12 ng/ml).According to the traditional Gleason scoring system,there were 50 patients in Gleason ≤ 6 group,86 patients in Gleason 7 group and 32 patients in Gleason≥8 group.Patients were divided in five groups according to the modified Gleason scoring system.There were 50 patients in Gleason ≤6 group,67 in Gleason 3 + 4 group,19 in Gleason 4 + 3 group,15 in Gleason 8 group and 17 in Gleason 9-10 group.The biochemical-free-survival curve was drawn by Kaplan-Meier method and the multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence.ROC curve analysis was used to determine the predicted value for 5-year BCR of modified and traditional Gleason scoring.Results Significant differences were noted between the modified Gleason scoring groups and traditional Gleason scoring groups in PSA value (P =0.005),pathological stage (P =0.002),extraprostatic extension (P =0.003),seminal vesicle invasion (P =0.004),lymph node involvement (P =0.049) and positive surgical margin (P =0.006).With a median follow-up of 68 months(ranging from 7 to 98 months),5-year BFS rates for men with Gleason grade ≤6,3 + 4,4 + 3,8 and 9-10 tumours on RP pathology were 84.0％ (42/50),76.1％ (51/67),57.9％(11/19),40.0％ (9/15),29.4％ (5/17),respectively.On multivariate analysis,the HR value of Gleason 3 + 4 group and Gleason 4 + 3 group were 1.736 and 2.075 (P ＜ 0.05).The area under the curve in modified and traditional Gleason scoring were 0.698 (95％ CI 0.609-0.788) and 0.674 (95％ CI O.584-0.764),respectively.Conclusions The modified Gleason scoring system is related to the prostate cancer grade and its survival rate.Therefore,it can predict prognosis accurately in patients with prostate cancer.It can potential to reduce overtreatment in patients with Gleason 3 +4 prostate cancer.

OBJECTIVETo improve the diagnosis and treatment of testicular torsion.

METHODSThe clinical features of 49 testicular torsion patients admitted to Department of Urology Nanjing Drum Tower Hospital from April 2008 to March 2014 were retrospectively analyzed, the average age was (21 ± 6) years (range 13-52 years).Forty-four cases underwent the color Doppler flow imaging of scrotum, demonstrated reduction of the testicular blood supply in 9 cases and loss of the testicular blood supply in 35 cases. Orchiectomy or orchiopexy was performed according to the testicular blood supply, the contralateral testis fixation was performed in all patients. A two-tailed Student's t-test was used to compare the data between two groups, Pearson correlation analysis was used to analyze the correlation of diurnal temperature and number of cases.

RESULTSAll the patients with testicular torsion were Tunica-reversed, 38 (77.5%) cases occurred from November to April. The monthly incidence of testicular torsion was positively correlated with diurnal temperature (r = 0.6434, P = 0.024). Forty-four cases underwent the color Doppler flow imaging, demonstrated the reduction or loss of the testicular blood supply, and these patients were confirmed to be testicular torsion by surgical exploration. The salvage rates of testis in patients with testicular torsion were 2/2, 5/15, 2/9 and 4.2% (1/24) in those seeking medical attention within 6, 12, 24 hours and over 24 hours after the onset of pain. All the patients were followed up for 3 to 75 months, and no one experienced recurrent torsion.

CONCLUSIONSThe incidence of testicular torsion is higher during the spring and winter, diurnal temperature change is associated with testicular torsion. The diagnostic rate of color Doppler flow imaging is high, which can be chosen as the primary method. Prompt recognition and treatment are necessary for testicular salvage.

Adolescent ; Adult ; Humans ; Incidence ; Male ; Middle Aged ; Orchiectomy ; Retrospective Studies ; Scrotum ; surgery ; Seasons ; Spermatic Cord Torsion ; diagnosis ; epidemiology ; Temperature ; Testis ; surgery ; Young Adult

OBJECTIVETo analyze the results of transperitoneal and retroperitoneal laparoscopic ureteroureterostomy procedure in the treatment of patients with retrocaval ureter.

METHODSFrom May 2004 to December 2012, 18 patients including 12 male and 6 female patients were operated for retrocaval ureter, the average age was (37 ± 10) years (range 17-55 years). Eight patients underwent transperitoneal laparoscopic ureteroureterostomy (transperitoneal laparoscopic group), and the other 10 patients' laparoscopic procedure were performed via retroperitoneal approach(retroperitoneal laparoscopic group). These patients' records were retrospectively analyzed for perioperative characteristics, complications and follow-up results. A two-tailed Student's t-test was used to compare perioperative data between the two groups.

RESULTSTechnical success was acquired in all 18 laparoscopic procedures. Mean operative time of transperitoneal and retroperitoneal laparoscopic group was (85 ± 20) minutes (60-130 minutes) and (98 ± 30) minutes (70-180 minutes) , respectively. There was no difference in operation time between the two groups (t = 1.03, P > 0.05). The blood loss was less than 50 ml in all the patients. Comparison of anal exhaust time between the two groups showed no statistic difference (t = 0.16, P > 0.05). No perioperative complication was observed. Intravenous pyelography or CT urography 3 months after the operation revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. There was no recurrence at a mean follow up of (40 ± 24) months (range 12-115 months).

CONCLUSIONBoth transperitoneal and retroperitoneal laparoscopic ureteroureterostomy are effective and minimally invasive surgical alternative for the management of retrocaval ureter.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrocaval Ureter ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To assess the contribution of transrectal realtime tissue elastography (TRTE) on the differential diagnosis of prostatic diseases. Methods A total of 88 prostatic disease patients with 95 lesions proved by pathology from May 2012 to January 2013 in the Afifliated Drum Tower Hospital of Medical College of Nanjing University were included. The elasticity grade and strain ratio were calculated by using TRTE. According to the gold standard of pathological results, the sensitivity, speciifcity, accuracy rate were calculated to evaluate the effectiveness of elasticity grade and strain ratio in distinguishing benign and malignant prostatic diseases;and the receiver operating characteristic (ROC) curves were made respectively. The accuracy of elasticity grade and strain ratio in diagnosing prostatic diseases was also compared using chi-square test. Results Forty-seven benign lesions were found in the 95 prostatic lesions and the other 48 lesions were malignant. The elasticity grades of the 95 prostatic lesions were as follows:GradeⅠ26, GradeⅡ19, GradeⅢ16, GradeⅣ21, and GradeⅤ13. Elasticity grade ≤Ⅱwas considered to be benign, while grade ≥Ⅲwas malignant. The sensitivity, speciifcity, accuracy rate of elasticity grade in diagnosis of prostatic malignant lesions was 79.17%(38/48), 74.47%(35/47) and 76.84%(73/95), respectively. According the ROC curve analysis, the cutoff point of strain ratio was 4.67, and Youden′s index was 0.622. The sensitivity, speciifcity, accuracy rate of strain ratio was 83.33%, 78.72%and 81.05%, respectively. The area under ROC curves of strain ratio was superior to that of elasticity grade. But the diagnosis accuracy of the two approaches was almost the same in statistics (χ2=0.51, P>0.05). Conclusions TRTE is valuable in the differential diagnosis of the prostatic benign and malignant lesions. Both strain ratio and elasticity grade are useful approaches, and have similar diagnostic accuracy.