Objective:This study aimed to compare the detection efficacy of transrectal ultrasound-guided transrectal cognitive fusion targeted+ systematic prostate biopsy and transperineal cognitive fusion targeted + systematic biopsy in patients with suspected prostate cancer (PCa). In addition, the relative clinical characteristics of PCa were evaluated.Methods:A total of 385 patients with suspected prostate cancer in the affiliated hospital of Qingdao University from May 2019 to November 2019 were retrospectively analyzed. All patients met the prostate biopsy criterion, who underwent transrectal(n=275)and transperineal(n=110)prostate biopsy respectively. There were no significant differences of mean age [(70.7±7.3)years vs.(69.2±8.4) years], PSA [(55.12±116.96)ng/ml vs. (63.41±315.34)ng/ml], prostate volume [(55.96±35.26)ml vs. (64.35±55.99)ml] between two groups. According to preoperative prostate magnetic resonance imaging combined with intraoperative ultrasound, 2-4 needles targeted puncture of suspected lesion were performed, followed by 12 needle systematic prostate biopsy. The detection rate of prostate cancer between two biopsy ways were compared. The related factors of PCa including age, prostate volume and PSA level were collected for univariable and multivariable logistic analysis. The cancer detection rate was compared and logistic regression was used to assess the impact of patient characteristics on PCa detection.Results:For all patients, the detection rate with cancer between transrectal group and transperineal group were 121/275(40.0%) and 67/110(60.9%), respectively. The transperineal group detected a higher rate of PCa ( P=0.003)and more clinically significant prostate cancers (csPCa) (54.6% vs.36.7%, P=0.001) than that of the transrectal group, there were significant differences between two groups ( P<0.05). Univariate and multivariate logistic regression analysis revealed that PSA( OR=1.025, P=0.001) and prostate volume( OR=0.984, P=0.001)were two independent factors for the detection rate of prostate cancer between two biopsy ways( P<0.05). The effect of age on the detection rate of PCa in the transperieal group was significantly lower than that of the transrectal group( OR=0.037, P=0.238 vs. OR=0.053, P=0.002). Conclusion:The transperieal biopsy could find more PCa than the transrectal biopsy. PSA level and prostate volume could affect the detection rate of cancer between two prostate biopsy ways.

Objective:To explore the feasibility and safety of long-distance urological nephrotomy with the support of 5G communication technology by using the domestic robot.Methods:Clinical data of the patients with remote robot-assisted laparoscopic nephrectomy, which were completed from March to April 2021 by the Affiliated Hospital of Qingdao University (as the host hospital where the main operating system located) were retrospectively analyzed. There were 3 patients, including 2 males and 1 female.The average age was 61 (49-73) years, and the average body mass index was 23.73 (20.00-27.76) kg/m 2. One patient had a ASA classification of grade 2, and the other 2 patients had grade 3. All patients met the surgical criteria for non-functional nephrectomy. The chief surgeon who performing the telesurgery was located at the Affiliated Hospital of Qingdao University. The surgeon remotely controlled the bedside operating system (slave system) in 3 local hospitals located in other cities in Shandong Province (network communication distances of 82.5, 141 and 229 km, respectively) by manipulating the master system located in Qingdao. Images and operating instructions during surgery were transmitted using 5G wireless communication technology. Intraoperative network conditions, robot operation, and patient perioperative data were summarized. Results:All 3 tele-nephrectomies were successfully completed. The average network signal latency time was 27.3 (23-30) ms, with no packet loss, and the average total latency time was 177.3(173-180) ms. The mean resection time was 79.3 (52-111) min, and the average intraoperative blood loss was 31.1 (15.6-41.9) ml. There were no network related adverse events occurred during the operation, and the robot-related adverse events occured 3 times, all three of which were characterized by inconsistent master and slave movements of the manipulator arm and the bedside robotic arm. None of these adverse events affected the successful performance of the telesurgery. The mean postoperative exhaust time was 60.5 (38.5-78.0) h. The mean postoperative VAS score at 24 hours was 3.7 (3-4). The Clavien-Dindo classification were all grade I. No significant abnormality was found on the 30th day after surgery, and the patients recovered well at the follow-up until 6 months postoperatively.Conclusions:It is safe and feasible to perform remote robot-assisted laparoscopic nephrectomy based on 5G communication technology with no serious adverse events or surgical complications.However, the conclusion needs to be further verified by large sample and multi-center prospective study.

Mucinous tubular and spindle cell carcinoma of the kidney is a rare subtype of renal carcinoma. In July 2019, one case of mucinous tubular and spindle cell carcinoma of the kidney was admitted to our hospital, The laparoscopic partial nephrectomy was performed, and there was no recurrence or metastasis during the follow-up period of 13 months. The disease has no obvious clinical manifestations and its diagnosis depends on pathological and immunohistochemical features. Surgical treatment is the main treatment for this disease, and most patients have a good prognosis.Howerer, the possibility of progression remains in the late stage of the disease.

Objective:To evaluate the biocompatibility of collagen suture (CS) and collagen biofilm (CB) preliminarily.Methods:The pyrogenic contaminants test was used to analyze the pyrogen in CS and CB. The skin stimulation and intradermal stimulation tests were used to evaluate the stimulation effects of CS and CB to the skin. The hemolytic test was used to evaluate the hemolytic effect of CS and CB. The muscle implantation experiment was used to evaluate the stimulation and toxicity of CS and CB.Results:The results of pyrogenic contaminants test show that the temperature increment of rabbits in each group is lower than 0.6 ℃, and the total temperature increment is lower than 1.4 ℃ indicating that the two materials meet the requirements of pyrogenic examination and the pyrogenic contaminants test is qualified. The results of skin stimulation test and intradermal stimulation test of collagen suture and collagen biofilms were negative indicating that the two materials have no skin irritation. The hemolysis rates of collagen suture and collagen biofilm were 2.943% and 4.127% respectively (all P<0.05) indicating that the two materials will not cause hemolysis. The muscle was tolerated well and the tissue response was not serious after two biomaterials were embedded, which was reduced over time gradually. Conclusions:Both the collagen suture and collagen biofilm have good biocompatibility.

Objective:To study the role of indocyanine green(ICG)fluorescence imaging in laparoscopic partial splenectomy (LPS).Methods:The data of 4 patients who underwent ICG fluorescence imaging technology for LPS at Beijing Luhe Hospital Affiliated to Capital Medical University from May 2017 to May 2020 were retrospectively analyzed. There were 3 females and 1 male, aged 46, 41, 27 and 12 years respectively. The extents of spleen preservation were compared between ICG fluorescence imaging with ordinary white light during operation. The residual splenic remnants were tested with fluorescence imaging after splenectomy, which showed fluorescence fading indicating good vascular perfusion.Results:ICG fluorescence imaging was performed on 4 patients. The operation time ranged from 180.0 to 250.0 min, and the intraoperative blood loss ranged from 40.0 to 200.0 ml. The postoperative hospital stay ranged from 4 to 14 days. There were no serious complications. Postoperative histopathology showed: splenic cyst ( n=1), splenic hemangioma ( n=2), and splenic laceration ( n=1). Conclusions:ICG fluorescence imaging technology had a significant role to play in partial splenectomy. This study showed this technique to improve safety of laparoscopic partial splenectomy.

In the past ten years, the research and application of microbiome has continued to increase. The microbiome has gradually become the research focus in the fields of life science, environmental science, and medicine. Meanwhile, many countries and organizations around the world are launching their own microbiome projects and conducting a multi-faceted layout, striving to gain a strategic position in this promising field. In addition, whether it is scientific research or industrial applications, there has been a climax of research and a wave of investment and financing, accordingly, products and services related to the microbiome are constantly emerging. However, due to the rapid development of microbiome sequencing and analysis related technologies and methods, the research and application from various countries have not yet unified on the standards of technology, programs, and data. Domestic industry participants also have insufficient understanding of the microbiome. New methods, technologies, and theories have not yet been fully accepted and used. In addition, some of the existing standards and guidelines are too general with poor practicality. This not only causes obstacles in the integration of scientific research data and waste of resources, but also gives related companies unfair competition opportunity. More importantly, China still lacks national standards related to the microbiome, and the national microbiome project is still in the process of preparation. In this context, the experts and practitioners of the microbiome worked together and developed the consensus of experts. It can not only guide domestic scientific research and industrial institutions to regulate the production, learning and research of the microbiome, the application can also provide reference technical basis for the relevant national functional departments, protect the scale and standardized corporate company's interests, strengthen industry self-discipline, avoid unregulated enterprises from disrupting the market, and ultimately promote the benign development of microbiome-related industries.
China ; Consensus ; Humans ; Industry ; Microbiota

Objective:To explore the clinical effects of ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation in the treatment of recurrent urethral stricture.Methods:The clinical data of 62 patients with recurrent urethral stricture in the Third People′s Hospital of Datong from October 2016 to September 2018 were retrospectively analyzed.The patients were divided into two groups according to the treatment method.The control group( n=28) underwent ureteroscopic holmium laser urethrotomy, and the combined group( n=34) underwent ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation.The urodynamic parameters[maximum urinary flow rate(Qmax), residual urine volume(RUV), Abrams-Griffiths(AG)value], lower urinary tract symptoms[International Prostate Symptom Score(IPSS)], erectile function[International Index of Erectile Function-5(IIEF-5)] and sexual life quality[Sexual Life Quality Questionnaire(SLQQ)] were compared between the two groups before surgery and at 6 months after surgery.The perioperative basic indicators and incidence rate of complications and recurrence rate of urethral stricture within 6 months after surgery were analyzed in the two groups. Results:At 6 months after surgery, the Qmax, scores of IIEF-5 and SLQQ in the control group were (19.18±4.67)mL/s, (15.23±3.94)points and (55.69±16.97)points, respectively, which in the combined group were (22.41±4.82)mL/s, (17.54±3.72)points and (64.31±15.80)points, respectively, and the indicators in the two groups were significantly increased compared with before surgery, and the indicators in the combined group were significantly higher than those in the control group( t=2.406, 2.135, 2.208, all P<0.05). The RUV, AG value and IPSS score in the control group were (11.75±3.24)mL, (36.09±7.86) and (13.80±4.18)points, respectively, which in the combined group were (9.46±2.89)mL, (30.58±7.27) and (11.34±3.65)points, respectively, and the indicators in the two groups were significantly decreased compared with before surgery, the indicators in combined group were significantly lower than those in control group( t=2.637, 2.573, 2.216, all P<0.05). The operative time, intraoperative blood loss, gross hematuria duration, hospital stay and catheter indwelling time in the combined group were (35.10±10.26)min, (12.15±2.06)mL, (18.61±5.19)h, (4.72±1.25)d and (14.46±3.20)d, respectively, which were significantly shorter or lower than those in the control group [(44.12±11.95)min, (13.64±2.80)mL, (22.62±5.76)h, (5.81±1.43)d and (27.93±4.48)d] ( t=2.863, 2.143, 2.586, 2.869, 3.151, all P<0.05). Within 6 months after surgery, the incidences of local hematoma, rectal injury and recurrence rate of urethral stricture in the combined group were 2.94%(1/34), 0.00%(0/34) and 5.88%(2/34), respectively, which were significantly lower than those in the control group [25.00%(7/28), 21.43%(6/28) and 28.57%(8/28)] (χ 2=4.830, 5.801, 4.286, all P<0.05). Conclusion:Ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation can effectively improve the lower urinary tract symptoms in patients with recurrent urethral stricture.And it has few complications and low recurrence rate, and can improve sexual life quality of patients.

Objective:To explore the application value of virtual reality technology in thoracoscopic anatomical segmentectomy.Methods:Eighty-four patients with early stage non-small cell lung cancer admitted to the First Hospital of Jiaxing from December 2017 to December 2018 were enrolled in the study.They were divided into observation group and control group according to the random digital table method, with 42 cases in each group.The observation group used virtual reality technology to construct a three-dimensional digital model, and performed preoperative evaluation and simulated surgical drills and intraoperative navigation on the three-dimensional digital model, based on the preoperative evaluation and simulated surgical drill results, combined with the specific actual situation during the operation, developed and implemented individualized thoracoscopic anatomical segmentectomy.Thoracoscopy anatomical segmentectomy was routinely performed in the control group.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization, cost and incidence of postoperative complications were compared between the two groups.Results:The operation of both two groups was successfully completed, and no intraoperative thoracic surgery was performed during the operation.There was no perioperative death.The operation time, intraoperative blood loss, intraoperative lymph node dissection number, intraoperative lymph node dissection, postoperative hospital stay, postoperative thoracic closed drainage tube, total postoperative drainage, total hospitalization cost and the incidence of postoperative complications in the observation group were (100.98±26.51)min, (67.98±32.96)mL, (7.79±1.32), (11.98±4.69), (4.60±1.43)d, (2.86±0.81)d, (437.14±193.86)mL, (3.76±0.31)million, 9.52%(4/42), respectively, which in the control group were (114.88±24.26)min, (104.52±52.37)mL, (6.45±0.3), (8.31±1.94), (6.50±2.55)d, (4.00±2.25)d, (667.26±415.01)mL, (4.20±0.65)million, 26.19%(11/42), respectively, the differences between the two groups were statistically significant ( t=-2.208, -3.328, 5.916, 4.678, -4.221, -3.993, -3.265, -3.968, χ 2=3.977, all P<0.05). No local recurrence or distant metastasis was found during the follow-up period. Conclusion:Virtual reality technology can provide preoperative evaluation and simulated surgical exercises and intraoperative navigation for thoracoscopic anatomical segmentectomy, which can reduce the difficulty of surgery and improve the accuracy and safety of the operation.

Objective:To explore the clinical effects of computer navigation-assisted surgery in the precise resection of pelvic chondrosarcoma.Methods:A retrospective analysis of 54 patients who had computer-assisted surgery from Dec 2007 to Dec 2018, including 27 males and 27 females, was conducted. The average age was 34.00±1.41 years (range 23-72 years). There were 47 cases with primary tumors and 7 with recurrence cases. The tumors in 15 cases located in the ilium (region I), 35 in the acetabulum (region II), 1 in the pubic (region III), and 3 in the sacroiliac joint (region IV). A total of 45 cases (83.3%) underwent needle biopsy, and 4 cases (7.4%) had incision biopsy. Among 5 cases who did not have biopsy, two of them was diagnosed of malignant change of multiple osteochondromas, two cases were diagnosed of recurrent pelvic chondrosarcoma and one with pelvic malignant tumor by imaging examinations. Pathological grade was presented as following, 36 cases in grade I, 15 in grade II, and 3 in grade III. All operations were performed on the bases of preoperative design with computer navigation-assisted surgical technology. A total of 49 cases (90.7%) had limb salvage operations and 5 cases had amputations. The surgical margins were confirmed by gross appearance and the maximum diameter profile of the tumor. Univariate analysis was performed to compare recurrence rate of different preoperative tumor status, gender, tumor stage, biopsy method, tumor location, operation method and surgical margins.Results:There were 39 cases underwent extensive resection, 13 cases with marginal resection and 2 cases with intracapsular resection. In 52 cases (96.3%), the surgery was performed according to the preoperative plan of surgical resection margin. However, two cases (3.7%) was not performed based on the preoperative plan. All patients were followed-up for 84.00±93.34 months (range 12-150 months). During the follow-up, a total of 45 cases (83.3%) survived and 9 cases died from lung metastasis. Eight cases (14.8%, 8/54) had local recurrence of whom 7 (14.3%) were limb salvage cases and 1 (20.0%, 1/5) had amputation. There was significantly different in local recurrence rate (χ 2=17.022, P=0.001). The risk of recurrence of marginal resection was 8.222 times than that of extensive resection [95% CI (1.297, 52.140)]. According to the Musculoskeletal Tumor Society (MSTS) limb function evaluation system score, postoperative limb function recovery rate was 90.00%±4.71% (range 60.00%-100%). There were 13 cases (24.1%) had postoperative complications, including 7 cases (13.0%) of infection, 2 cases (3.7%) of operative area and deep vein thrombosis of lower extremity, and 4 cases (7.4%) of skin necrosis and delayed healing. Among 49 limb salvage patients, two of them had secondary amputation due to tumor recurrence, five had hemipelvectomy due to neurovascular tumor invasion. The final limb salvage rate was 77.8% (42/54). Conclusion:Computer navigation-assisted precise pelvic tumor resection is technically feasible. It could decrease recurrence rate and promote limb function recovery by improving the reliability of oncology evaluation and the accuracy of tumor resection with superior safety.

Objective To investigate the relationship between preoperative albumin-to-alkaline phosphatase ratio and overall survival (OS) after radical cystectomy of bladder cancer.Methods The clinical date of patients with bladder cancer who underwent radical cystectomy and urinary diversion and confirmed by pathology from Jan 2007 to Dec 2015 were analyzed retrospectively,with 140 cases undergoing laparoscopic surgery and 26 cases undergoing open surgery.There were 148 males and 18 females,aged was 33-85 years,with an ayerage ageof (65.1 ± 9.4) years.There were 55 cases of cutaneous ureterostomy,96 cases of Brick diversior with ileum,and 15 cases of ileal neobladder.The AAPR range 0.03-1.67,with an average 0.62 ± 0.23,and body mass index (BMI) was 16.79-32.65 kg/m2,with an average of (24.00 ± 3.32) kg/m2.There were 33 cases with hydronephrosis and 133 no hydronephrosis,31 cases with hypertension and 135 cases no hypertension,and 14 cases with diabetes and 152 cases no diabetes.Four cases were classified as grade0,65 cases as grade 1,86 cases as grade 2,and 11 cases as grade 3.Based on the preoperative AAPR(0.62 ±0.23),they were divided into three groups,with 55 cases in the low AAPR (0.42 ± 0.09) group,55 cases in the middle AAPR (0.58 ± 0.05) group,and 56 cases in the high AAPR (0.86 ± 0.21)group.Cox proportional hazards regression methodology were used to evaluate the relationship between preoperative AAPR and overall survival.Survival analysis was conducted using the Kaplan-Meier method and compared with the log-rank test.Results 166 patients were followed up for 1-144 months,with a median of 63 months,and 71 cases died and 95 survived.The median serum AAPR level in all cases was 0.59 (range 0.03-1.67).Results of univariate Cox regression model revealed that AAPR(HR =0.09,95％ CI 0.022-0.391,P =0.001),high AAPR (HR=0.40,95％CI0.216-0.742,P=0.003),age (HR =2.42,95％ CI 1.294-4.531,P =0.006),tumor size (HR =2.11,95％ CI 1.112-4.014,P =0.023),pT3 stage (HR=8.93,95％CI3.173-25.114,P＜0.001),pT4 stnge(HR =10.39,95％ CI 3.110-34.707,P ＜0.001),pN1 stage(HR =2.80,95％ CI 1.422-5.531,P =0.003),pN3 stage (HR =17.06,95％ CI2.192-132.863,P =0.007),pathological grade (HR =0.30,95％ CI 0.113-0.817,P =0.019),hydronephrosis (HR =2.36,95 ％ CI 1.406-3.939,P =0.001),adjuvant chemotherapy (HR =2.66,95％ CI 1.674-4.247,P ＜ 0.001)were associated with OS.Compared with patients in the lowest of AAPR,the risk for death in the highest AAPR group decreased about 59％ (HR =0.406,95％ CI 0.200-0.822,P =0.012)after adjustment for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy in multiple Cox regression models.Each unit increase in the AAPR was associated with about 80％ decreased risk of death (HR =0.199,95％ CI 0.051-0.779,P =0.020) after adjusting for the confounding variables.After adjusting for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy,the curve fitting results showed that with the increase of AAPR,the risk of death decreased and the overall survival prolonged.Consistent with the linear trend test results,the relationship between AAPR and OS is linear.Conclusions AAPR was associated with overall survival of patients who underwent radical cystectomy of bladder cancer.