Objective To explore the feasibility and safety of robot-assisted partial right nephrectomy using a combined retroperitoneal and transperitoneal approach in the treatment of horseshoe kidney with renal tumor.Methods Clinical and follow-up data of a patient with horseshoe kidney with renal tumor were retrospectively analyzed.Before operation,the diagnosis was confirmed with renal CT scanning and enhancement with angiography to show the blood supply.After that,the patient underwent robot-assisted partial right nephrectomy for horseshoe kidney by robot-assisted partial right nephrectomy using a combined retroperitoneal and transperitoneal approach.After operation,the patient was followed up.Results The operation went smooth with an operation time of 270 min.The intraoperative warm ischemia time was 30 min,intraoperative bleeding was approximately 300 mL,and no intraoperative or postoperative complications occurred.After 2 months of follow-up,the patient recovered well,and no chest and abdominal lymph node enlargement and lung metastasis were observed.Conclusion Robot-assisted partial nephrectomy of horseshoe kidney using a combined retroperitoneal and transperitoneal approach is a safe and feasible minimally invasive treatment option.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

A total of 4 patients with renal cancer were admitted to our hospital from October 2006 to September 2015 in a familial renal cancer family. Among the 4 patients, 1 patient showed unilateral multiple clear cell carcinoma, 1 patient showed bilateral multiple clear cell carcinoma, and 2 patients showed bilateral multiple chromophobe cell carcinoma. No mutation of VHL or FLCN gene was found in all patients by genetic analysis.

Objective To explore the potential value of applying three-dimensional visualization technology in the robot-assisted laparoscopic nephron sparing partial nephrectomy.Methods From January to December 2018,98 patients with renal carcinoma undergoing robot-assisted laparoscopic nephron sparing surgery were retrospectively analyzed.Forty-one patients in the experimental group accomplished kidney CT examination and three-dimensional reconstruction before surgery,and fifty-seven patients in the control group only completed kidney CT examination.There were 20 males and 21 females in the experimental group with the age of (51.39 ± 14.80) years and body mass index (BMI) of (23.54 ± 3.08) kg/m2.The median tumor diameter was 3.40 cm (range 1.90-8.30 cm) and the mean R.E.N.A.L.score was (5.83 ± 1.51) in the experimental group including 11 cases of transperitoneal,17 cases of retroperitoneal and 13 cases of combined transperitoneal and retroperitoneal access.There were 35 males and 22 females in the control group with the age of (52.84 ± 12.28) years and BMI of (24.01 ±3.30)kg/m2.The median tumor diameter was 3.35 cm (range 1.40-7.0 cm) and the mean R.E.N.A.L.score was (6.17 ± 1.77) in the control group including 15 cases of transperitoneal,31 cases of retroperitoneal and 11 cases of combined transperitoneal and retroperitoneal access.There was no statistical difference between two groups in term of age,gender,BMI score,R.E.N.A.L.score,tumor size,tumor location and operative approach.Results Ninety-eight cases of operation were successfully completed without causing vascular and ureteral injury.The warm ischemia time in the experimental group was significantly shorter than that of the control group [median 15.0 (7.0-26.0) min vs.20.0 (10.0-28.0) min,P--0.02],while no statistical difference was observed in term of operation time [median 130.0 (65.0-340.0) min vs.139.0 (67.0-250.0) min,P =0.22].There was no significant difference between the two groups in the decrease of hemoglobin within 24 hours after operation [median 20.0 (4.0-39.0) g/L vs.15.5 (2.0-40.0) g/L,P =0.56] and the average length of hospital stay after operation [median 6.0(4.0-14.0) d vs.6.0(5.0-14.0) d,P =0.86].The trend of creatinine declining was not statistically significant between the two groups at both 24 hours [median:2.0 (-10.0-28.0) μmol/L vs.7.5 (-17.0-51.0) μ mol/L,P =0.24] and 6 months after operation [median:2.0 (-12.0-57.0) μ mol/L vs.4.5 (-3.0-24.0) μmol/L,P =0.39].Conclusions Preoperative three-dimensional reconstruction is helpful to shorten the warm ischemia time,but it did not show short-term and long-term protection for renal function.

Objective:To establish an LC-MS/MS and HPLC assay for the determination of linezolid in human plasma to be used for the therapeutic drug monitoring ( TDM) and pharmacokinetic study. Methods:Acetontrile containing furazolidone ( internal stand-ard) as the protein precipitation agent was added to100 μl human plasma, and then vibrated and centrifuged for the precipitation of plasma protein. ① The supernatant was eluted on an Eclipse XDB-C18 (100mm × 2. 1mm,3. 5μm) column with acetontrile and water (80 :20) as the mobile phase at the flow rate of 0. 3 ml·min-1. The electrospray ionization (ESI) source was applied and operated in the positive ion mode. The multiple reaction monitoring (MRM) modes with the transition of m/z338. 1→296. 2 (linezolid) and m/z226.1→122.0 (furazolidone) were used for the quantification. ② The supernatant was eluted on an Eclipse Eclipse XDB -C18(250 mm × 4. 6 mm, 5μm) column with acetontrile and 0. 1% formic acid (20 :80) as the mobile phase at the flow rate of 1. 0 ml·min-1 and detected at 254 nm. The established assays were used for the determination of linezolid in the plasma samples after the administra-tion. Results:Linezolid was linear within the range of 0. 05-30 μg·ml-1 for LC-MS/MS, and 0. 25-30 μg·ml-1 for HPLC ( r2 >0. 999). The extraction recovery and the matrix effect respectively was 82. 1%-91. 3% and 74. 0%-82. 3%. The relative recovery of LC-MS/MS and HPLC was 91. 2%-106. 4% and 100. 1%-111. 6%, respectively. The intra-and inter-day RSDs were both lower than 20%. There was a good correlation between LC-MS/MS and HPLC. The trough concentration of 12 patients was (1. 77 ± 1. 23) g· ml-1 and the plasma concentration of 5 patients 2h after linezolid adminstration was (13. 36 ± 2. 63) g·ml-1 , respectively. Conclu-sion:The established assays are simple, rapid, specific, sensitive and accurate, which are suitable for the TDM and pharmacokinetic study of linezolid.

Objective:To establish an LC-MS/MS and HPLC assay for the determination of linezolid in human plasma to be used for the therapeutic drug monitoring ( TDM) and pharmacokinetic study. Methods:Acetontrile containing furazolidone ( internal stand-ard) as the protein precipitation agent was added to100 μl human plasma, and then vibrated and centrifuged for the precipitation of plasma protein. ① The supernatant was eluted on an Eclipse XDB-C18 (100mm × 2. 1mm,3. 5μm) column with acetontrile and water (80 :20) as the mobile phase at the flow rate of 0. 3 ml·min-1. The electrospray ionization (ESI) source was applied and operated in the positive ion mode. The multiple reaction monitoring (MRM) modes with the transition of m/z338. 1→296. 2 (linezolid) and m/z226.1→122.0 (furazolidone) were used for the quantification. ② The supernatant was eluted on an Eclipse Eclipse XDB -C18(250 mm × 4. 6 mm, 5μm) column with acetontrile and 0. 1% formic acid (20 :80) as the mobile phase at the flow rate of 1. 0 ml·min-1 and detected at 254 nm. The established assays were used for the determination of linezolid in the plasma samples after the administra-tion. Results:Linezolid was linear within the range of 0. 05-30 μg·ml-1 for LC-MS/MS, and 0. 25-30 μg·ml-1 for HPLC ( r2 >0. 999). The extraction recovery and the matrix effect respectively was 82. 1%-91. 3% and 74. 0%-82. 3%. The relative recovery of LC-MS/MS and HPLC was 91. 2%-106. 4% and 100. 1%-111. 6%, respectively. The intra-and inter-day RSDs were both lower than 20%. There was a good correlation between LC-MS/MS and HPLC. The trough concentration of 12 patients was (1. 77 ± 1. 23) g· ml-1 and the plasma concentration of 5 patients 2h after linezolid adminstration was (13. 36 ± 2. 63) g·ml-1 , respectively. Conclu-sion:The established assays are simple, rapid, specific, sensitive and accurate, which are suitable for the TDM and pharmacokinetic study of linezolid.

Objective To explore the predictive ability of magnetic resonance spectroscopy (MRS) in overall survival (OS) and progression-free survival (PFS) of patients with glioblastoma multiforme (GBM) before,during,and 2 months after radiotherapy with concomitant/adjuvant temozolomide (TMZ).Methods GBM patients,admitted to our hospital from January 2011 to January 2016 and confirmed by pathology,were chosen in our study;all patients underwent postoperative three-dimensional conformal radiotherapy with concomitant/adjuvant TMZ.And 3D-MRS was performed before,during,and 2 months after radiotherapy,the levels of N-acetyl-aspartic acid (NAA),choline (Cho) and creatine (Cr),and ratios of Cho/NAA,Cho/Cr and NAA/Cr in the GBM/edge of surgery side and the normal brain tissues were observed.The survival curve,median overall survival (mOS) and median progression free survival (mPFS) of patients with standardized Cho decreased＜30％ and patients with standardized Cho decreased＞30％ 2 months after radiotherapy were compared.Results Twenty-one patients finished the scheduled MRS for 3 times.Until the end of our study,16 patients died and 5 survived.Standardized Cho gradually decreased before,during,and 2 months after radiotherapy (2.08±0.22,1.45 ±0.21 and 1.16±0.18),with significant differences (P＜0.05).Standardized Cho after radiotherapy was significantly decreased as compared with that before radiotherapy (P＜0.05).Ratios of Cho/NAA and Cho/Cr in the GBM/edge of surgery side were significantly higher than those in the normal brain tissues (P＜0.05),and ratio of NAA/Cr in the GBM/edge of surgery side was significantly lower than that in the normal brain tissues (P＜0.05).Ratio of Cho/NAA gradually decreased before,during,and 2 months after radiotherapy,with significant differences (P＜0.05).As compared with patients with standardized Cho decreased＜30％ 2 months after radiotherapy,patients with standardized Cho decreased＞30％ 2 months after radiotherapy had significantly decreased rates of OS and PFS,and statistically shorter mPFS and mOS (4.5 vs.13.5,10.9 vs.25.3,P＜0.05).Conclusion The changes of standardized Cho 2 months after radiotherapy have high prognostic significance for PFS and OS.

Objective To investigate the risk factors and the influence of intravenous thrombolysis of acute cerebral infarction with cerebral microbleeds(CMBs)by SWI.Methods 1 64 patients with acute cerebral infarction were enrolled in this study.All pa-tients were scanned with routine MRI and SWI.According to the presence of CMBs on SWI,the patients were classified into two groups:CMBs group(73 cases)and non-CMBs group(91 cases).Past history was recorded and risk factors of CMBs were explored. 76 cases patients(including 35 cases of CMBs group and 41 cases of non-CMBs group)were treated by intravenous thrombolysis and rescanned with routine MRI and SWI to compare the changes in the number of CMBs and hemorrhage transformation 24 hours after thrombolysis.Results The difference age,hypertension,lacunar infarction and leukoaraiosis between the two groups were significant (P <0.05).The difference of CMBs and hemorrhagic transformation between the two groups treated by thrombolysis were not sig-nificant(P >0.05).Conclusion Acute cerebral infarction with CMBs are influenced by age,hypertension,lacunar infarction and leu-koaraiosis.Thrombolysis in acute cerebral infarction with CMBs can not augment the incidence of hemorrhagic transformation.

OBJECTIVE:To improve the working efficiency of the drug delivery system. METHODS:The kinds of drugs in delivery system and manual dispensing window were adjusted through comparing the number of prescriptions and drug box dis-pensed by the system and manual window in our hospital before adjustment (Jun. 2014),combining with analysis of EIQ(En-try-item-quantity)-ABC. The improvement effect was evaluated through analyzing related index after adjustment(Aug. 2014). RE-SULTS:The data before adjustment showed the workload of the delivery system was lower than that of manual delivery in term of the number of drug box (P=0.000),and they were similar in term of the number of prescription (P=0.122). The drug delivery system was significantly better than manual delivery in terms of two indexes after resetting the type of drugs in the system(P=0.000). CONCLUSIONS:Optimized delivery system can effectively improve the working efficiency.

Objective To evaluate the effect of combination therapy of tolterodine and tamsulosin in improving symptoms in patients with indwelling double-J ureteral stents.Methods A total of 96 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease,which were prospectively randomized ( random numbers table) into two groups.The tamsulosin group ( n =48) was administered tamsulosin 0.2 mg once daily,the combination group (n =48) was administcred tamsulosin 0.2 mg once daily and tolterodine 2 mg twice daily.All the patients completed a validated Ureteral Stent Symptom Questionnaire (USSQ),the Overactive Bladder Symptom Score (OABSS),the International Prostate Symptom Score (IPSS) one day before he placement and 4 weeks after stent placement of stent.Results The mean urinary symptom index score (25.4 ± 4.0 vs 15.3 ± 2.9,P ＜ 0.0001 ),the mean pain index score (15.0 ±2.6 vs10.3 ±2.1,P ＜0.0001),the mean general health index score (15.4 ±2.2 vs 11.0±1.5,P＜0.0001),the work performance index score (13.0±2.2vs9.7±1.9,P＜0.0001),the sex index score (3.6 ± 1.1 vs 2.2 ± 0.9,P ＜0.0001 ) improved significantly in combination group than those in tamsulosin group.There was a statistically significant difference between tamsulosin group and combination group in the IPSS score ( 12.8 ± 2.0 vs 9.2 ± 1.7,P ＜ 0.0001 ) and OABSS score ( 6.7 ± 1.4 vs 4.2 ± 1.4,P ＜ 0.0001 ) at the 4 weekfollow-up.Conclusions Indwelling ureteral stents have a significant impact on health related quality of life.It is effective for improving symptoms in patients with indwelling double-J ureteral stents by combination therapy with tolterodine and tamsulosin.