Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.

Objective:To investigate the diagnostic performance of MRI Liver Imaging Reporting and Data System version 2018 in high-risk hepatocellular carcinoma (HCC) patients with intrahepatic parenchymal substantial lesions ≤3.0 cm.Methods:A retrospective analysis was conducted in hospitals between September 2014 to April 2020. 131 pathologically confirmed non-HCC cases with lesions ≤3.0 cm in diameter were randomly matched with 131 cases with lesions ≤3.0 cm in diameter and divided into benign (56 cases), other hepatic malignant tumor (OM, 75 cases), and HCC group (131 cases) in a 1:1 ratio. MRI features of the lesions were analyzed and classified according to LI-RADS v2018 criteria (tie-break rule was applied to lesions with both HCC and LR-M features). Taking the pathological results as the gold standard, the sensitivity and specificity of the LI-RADS v2018 classification criteria and the more stringent LR-5 criteria (with three main signs of HCC at the same time) were calculated for HCC, OM or benign lesions diagnosis. Mann -Whitney U test was used to compare the classification results. Results:The number of cases classified as LR-M, LR-1, LR-2, LR-3, LR-4, and LR-5 in HCC group after applying the tie-break rule were 14, 0, 0, 12, 28, and 77, respectively. There were 40, 0, 0, 4, 17, 14 and 8, 5, 1, 26, 13, 3 cases in benign and OM group, respectively. There were 41 (41/77), 4 (4/14) and 1 (1/3) lesion case in the HCC, OM and benign group, respectively, that met the more stringent LR-5 criteria. The sensitivity of LR-4 combined with LR-5 (LR-4/5) criteria, LR-5 criteria and more stringent LR-5 criteria for HCC diagnosis were 80.2% (105/131), 58.8% (77/131) and 31.3% (41/131), respectively, and the specificity were 64.1% (84/131), 87.0% (114/131) and 96.2% (126/131), respectively. The sensitivity and specificity of LR-M were 53.3% (40/75) and 88.2% (165/187), respectively. The sensitivity and specificity using LR-1 combined with LR-2 (LR-1/2) criteria for the diagnosis of benign liver lesions were 10.7% (6/56) and 100% (206/206), respectively.Conclusions:LR-1/2, LR-5, and LR-M criteria have high diagnostic specificity for intrahepatic lesions with a diameter of ≤3.0 cm. Lesions classified as LR-3 are more likely to be benign. The specificity of LR-4/5 criteria is low, while the more stringent LR-5 criteria has a high specificity for HCC diagnosis.

Objective To analyze clinical characteristics and short-term efficacy of endoscopic hemostasis in acute duodenal hemorrhage. Methods A retrospective study was conducted for the patients who received endoscopy in the PUMC Hospital due to upper gastrointestinal bleeding and were confirmed to be on account of duodenal lesions for bleeding from January 2011 to December 2018.Clinical information of patients was collected,including demographics,comorbidities,and medication use.Endoscopic information included the origin of bleeding,the number and location of lesions,Forrest classes and size of ulcers,and endoscopic therapeutic methods.Factors that could be relative to the failure of endoscopic hemostasis or short-term recurrence of hemorrhage in these patients were analyzed. Results Among all the patients with duodenal hemorrhage,79.7%(102/128)were due to ulcers,14.1%(18/128)to tumors,3.9%(5/128)to vascular malformation,and 2.3%(3/128)to diverticulum.Fifty-three(41.4%)patients received endoscopic hemostasis,and six patients(4.7%)received surgery or interventional embolization after the endoscopic test.Among the patients receiving endoscopic hemostasis,5.7%(3/53),66.0%(35/53),and 28.3%(15/53)received injection therapy,mechanical therapy,and dual endoscopic therapy,respectively,and 94.3% of them were cured.However,10(18.9%)of them experienced recurrence of hemorrhage and 3 patients died during hospitalization.Only one patient suffered from perforation after the second endoscopic treatment.Lesions located on the posterior wall of bulb appeared to be a risk factor for the failure of endoscopic hemostasis(OR=31.333,95% CI=2.172-452.072,P=0.021).The lesion diameter≥1 cm was a risk factor of rebleeding after endoscopic therapy(OR=7.000,95% CI=1.381-35.478,P=0.023).Conclusions Peptic ulcers were always blamed and diverticulum could also be a common reason for duodenal hemorrhage,which was different from the etiological constitution of acute upper gastrointestinal hemorrhage.Lesions locating on the posterior wall of the duodenum had a higher potential to fail the endoscopic hemostasis.The lesion diameter≥1 cm was a predictive factor for short-term recurrence.Forrest classes of ulcers at duodenum did not significantly affect the endoscopic therapeutic efficacy or prognosis.
Duodenal Ulcer/therapy* ; Embolization, Therapeutic ; Endoscopy ; Gastrointestinal Hemorrhage/etiology* ; Hemostasis, Endoscopic ; Humans ; Recurrence ; Retrospective Studies

Objective:To analyze the traditional Chinese medicine（TCM） syndromes of 46 patients with coronavirus disease-2019 (COVID-19) by cluster analysis method. Method:The 46 COVID-19 patients with TCM symptoms, signs, tongue and pulse were analyzed by frequency analysis and clustering analysis, and the TCM syndrome types of COVID-19 patients were classified and summarized by combining clinical expertise, and the evolution law was analyzed by combining the median days of the syndrome collection. Result:The major signs and symptoms of the 46 patients with COVID-19: fever (frequency of 39, accounted for 84.8%), poor appetite (frequency of 44, 95.7%), fatigue (frequency of 42, 91.3%), wheezing breath (frequency of 35, 76.1%), dry mouth (frequency of 21, 45.7%), lung condition short (frequency of 20, 43.5%), defecate pond (frequency of 15, 32.6%), red tongue (frequency 30, accounting for 65.2%), yellowish moss (frequency 27, accounting for 58.7%), and slimy pulse (frequency 30, accounting for 62.5%). TCM syndromes were divided into seven types, i.e. dampness and heat syndrome (13 cases), dampness and toxin syndrome (10 cases), heat stasis syndrome (7 cases), dampness and heat syndrome (5 cases), cold dampness internal invasion syndrome (4 cases), dampness poison blood stasis syndrome (2 cases).According to the time of onset, there were cold and dampness syndrome (median days 6.5 days), dampness was heavier than heat syndrome (10 days), dampness and heat syndrome (10 days), dampness and heat syndrome (11.5 days), heat stagnation of liver and gallbladder syndrome (13 days), dampness and blood stasis syndrome (15 days), and Yin injury syndrome (16 days). Conclusion:Among the 46 cases of COVID -19, damp-heat syndrome was the most common, followed by heat stagnation of liver and gallbladder syndrome, Yin injury and gas consumption syndrome, cold and damp internal invasion syndrome, and dampness and blood stasis syndrome. The pathogenesis of the disease evolved into heat and poison, and later appeared to consume Qi Yin performance.