Objective:To explore the predictive value of a regression model based on diffusion kurtosis imaging (DKI) parameters for prediction of the recurrence risk in patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER-2)-negative early invasive breast cancer.Methods:A retrospective cross-sectional study was designed. The clinicopathological (age, histological grade, Ki-67 level, etc.) and imaging data of 50 patients (50 lesions) with ER-positive, HER-2 negative early invasive breast cancer who underwent treatment at Wuxi People′s Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients were female, aged 29 to 81 years, and underwent pre-operation conventional MRI and DKI examinations. The volume of breast fibroglandular tissue (FGT), background parenchymal enhancement (BPE), and internal enhancement features were recorded; the peak enhancement (PH), peak enhancement rate, time to peak, mean kurtosis (MK), and mean diffusivity (MD) were calculated. Based on the 21-gene recurrence risk scores, patients were divided into low recurrence risk group and medium-high recurrence risk group. Independent sample t test, Mann-Whitney U test, χ2 test were used to compare the differences of various indicators between the two groups. Two logistic models were constructed with age, PH, MD, and MK as independent variables (Pre1), and with Ki-67, age, PH, MD, and MK as independent variables (Pre2), respectively. The efficacy of the models in predicting low recurrence risk in patients was assessed using receiver operating characteristic curve and area under the curve (AUC). Results:There were 25 cases in the low recurrence risk group and 25 cases in the medium-high recurrence risk group. The differences in age, FGT, PH, MD, MK, and Ki-67 between the low recurrence risk group and the medium-high recurrence risk group were statistically significant (all P<0.05), while other indexes showed no statistically significant differences (all P>0.05). The AUC of Pre1 in predicting low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.87, with a sensitivity of 0.76 and specificity of 0.88. The AUC of Pre2 for predicting the low recurrence risk of ER-positive, HER-2 negative early invasive breast cancer was 0.92, with a sensitivity of 0.84, and specificity of 0.92. Conclusions:A multi-parameter model based on DKI can effectively predict the recurrence risk of ER-positive and HER-2 negative breast cancer. The model with combination of Ki-67 can further improve the predictive efficacy, and help effectively identify patients at low recurrence risk.

Objective:To review and analyze the clinical diagnosis and treatment of renal Ewing's sar-coma with venous tumor embolus,to follow up the survival and prognosis of the patients,and to provide help for the diagnosis and treatment of the disease.Methods:Clinical data(including general data,sur-gical data and postoperative pathological data)of patients diagnosed with renal Ewing's sarcoma with ve-nous tumor embolus in Peking University Third Hospital from June 2016 to June 2022 were collected,and the prognosis of the patients was followed up to analyze the influence of diagnosis and treatment process on the prognosis of the disease.Results:There were 6 patients,including 1 male and 5 females.There were 4 cases of left renal tumor and 2 cases of right renal tumor.The median age at diagnosis was 28 years(16-52 years).The imaging findings were all exogenous tumors with internal necrotic tissue and hemorrhage.The mean maximum tumor diameter was 12.6 cm,and the mean tumor thrombus length was 7.8 cm.Four patients underwent open surgery and 2 patients underwent laparoscopic surgery.The post-operative pathological results were renal Ewing sarcoma.Immunohistochemical results showed 3 cases of CD99(+),2 cases of FLI-1(+),and 1 case of CD99,FLI-1(-).3 patients received chemothera-py(cyclophosphamide,doxorubicin,vincristine/ifosfamide,etoposide),1 case received chemotherapy combined with radiotherapy,and 2 cases received no adjuvant therapy.The mean overall survival(OS)of the 6 patients was 37 months,and the mean OS of the 4 patients(47 months)who received chemo-therapy was significantly higher than that of the 2 patients(16 months)who did not receive chemotherapy(P=0.031).Conclusion:Renal Ewing's sarcoma with venous tumor embolus is rare in clinic,and it is common in young female patients.The operation is difficult and the prognosis is poor.Surgical resection,adjuvant radiotherapy and chemotherapy can improve the overall survival rate of the patients.

Objective:To investigate the postoperative renal function and oncologic outcomes of cystic renal cell carcinoma with partial nephrectomy,and to compared the single-center data on surgical out-comes with the Surveillance,Epidemiology,and End Results(SEER)database.Methods:This was a retrospective study that included the patients with cystic renal cell carcinoma who underwent partial ne-phrectomy in the Department of Urology,Peking University Third Hospital(PUTH)from 2010 to 2023.The clinical data and depicting baseline characteristics were collected.Renal dynamic imaging and the Chinese Coefficients for Chronic Kidney Disease Epidemiology Collaboration(C-CKD-EPI)formulae were used to calculate the estimated glomerular filtration rate(eGFR).The renal function curves over time were then plotted,and the patients were followed-up to record their survival status.Cases of cystic renal cell carcinoma in the SEER database between 2000 and 2020 were included,propensity score matching(PSM)was performed to balance the differences between SEER cohort and PUTH cohort,and the cancer-specific survival(CSS)curves for both groups were plotted and statistical differences were calcu-lated by the Kaplan-Meier method.Results:A total of 38 and 385 patients were included in the PUTH cohort and SEER cohort,respectively,and 31 and 72 patients were screened in each cohort after PSM.Of the baseline characteristics,only tumor size(P=0.042)was found to differ statistically between the two groups.There was no statistically significant difference between the two cohorts in terms of CSS after PSM(P=0.556).The median follow-up time in the SEER cohort was 112.5(65,152)months and a 10-year survival rate of 97.2％,while the PUTH cohort had a median follow-up of 57.0(20,1 172)months and a 10-year survival rate of 100.0％.There was no statistically significant difference between eGFR determined by preoperative renal dynamic imaging and the results of the C-CKD-EPI formulae based on creatinine estimation(P=0.073).There was a statistically significant difference in eGFR among the preoperative,short-term postoperative,and long-term postoperative(P＜0.001),which was characterized by the presence of a decline in renal function in the short-term postoperative period and the recovery of renal function in the long-term period.Conclusion:Partial nephrectomy for cystic renal cell carcinoma is safe and feasible with favorable renal function and oncologic outcomes.

Objective:To assess whether urinary incontinence after holmium laser enucleation of the prostate (HoLEP) is associated with membranous urethral length(MUL)on preoperative magnetic resonance imaging.Methods:The data of 96 patients who underwent HoLEP from January 2019 to April 2021 in Peking University Third Hospital were retrospectively analyzed. For all patients, the average age was (70.0±7.7) years old, the average body mass index was (23.9±2.9)kg/m 2, median pre-biopsy PSA was 3.79(2.48, 6.03)ng/ml, the average prostatic volume was (60.5±35.0)ml. 22 patients(22.9%) suffered with diabetes mellitus, and 17 patients(17.7%)had at least one time urinary retention. MUL was measured on MRI as the vertical distance from prostatic apex to the entry of the urethra into the penile bulb. All patients' median MUL was 13(11, 17)mm. The recovery of continence was followed up 2 weeks after HoLEP. The difference of age, body mass index, preoperative PSA, diabetes mellitus, urinary retention, prostate volume and MUL between urinary continence and incontinence group 2 weeks after HoLEP operation. The variables with P<0.1 were included in multivariable logistic regression to analyze the independent risk factors of urinary incontinence after HoLEP were compared. Results:All operations were successfully completed. The continence returned to normal in 72 cases (75.0%) and urinary incontinence existed in 24 cases (25.0%) in 2 weeks after surgery. There were 27 cases (37.5%) in continence group and 16 cases (66.7%) in incontinence group for those aged≥70 years. 21 cases (29.2%) in continence group and 13 cases (54.2%) in incontinence group had prostate volume ≥ 60 ml. There were 30 cases (41.7%) in continence group and 20 cases (83.3%) in incontinence group with MUL<13 mm. χ 2 test showed that age ( P=0.013), prostate volume ( P=0.027) and MUL ( P<0.001) were related to the incontinence after surgery. The age, prostate volume and MUL were included in the multivariate logistic regression analysis. Multiple logistic regression showed that MUL<13 mm( P<0.001) was independent predictor for incontinence after HoLEP. Conclusions:The incidence of urinary incontinence was high 2 weeks after HoLEP. Short MUL, which is less than 13 mm, is significantly associated with delayed recovery of urinary continence after HoLEP.

Objective:To identify the relationship between positive surgical margin after laparoscopic radical prostatectomy and intravesical prostatic protrusion length on preoperative magnetic resonance imaging.Methods:We retrospectively analyzed 110 patients with pathologic confirmed prostate carcinoma who underwent laparoscopic radical prostatectomy in our hospital. For all 110 patients, the average age was (70.4±7.8) years old, median pre-biopsy PSA was 12.23 ng/ml(range 0.78-110 ng/ml). There were 27 cases, 35 cases and 48 cases for biopsy Gleason score 6, 7 and ≥8. There were 73 patients with clinical stage T 1 and T 2, 37 patients with clinical stage T 3.The median prostatic volume was 38.16ml(range 11.83-163.36ml). MRI examination was performed in 1 week before the biopsy. Intravesical prostatic protrusion length (IPPL) was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. All patients who underwent MRI preoperatively median IPPL was 3 mm(range 0-27 mm). There were 72 patients with IPPL<5 mm and 38 patients with IPPL≥5 mm respectively. All patients received extra-peritoneal laparoscopic radical prostatectomy. Parameters describing the surgical margin status and the location of positive surgical margin was recorded. The χ 2 tested the statistical significance in proportions differences. The multivariable logistic regression was used to assess risk factors for positive surgical margin and positive base surgical margin(PBSM). Results:Positive surgical margin rate was 38.1% for all patients, 25 patients(22.7%) had PBSM.χ 2 test showed that clinical stage ( P<0.001) and IPPL ( P=0.038) were related to the postoperative positive surgical margin. The clinical stage, Gleason score and IPPL were included in the multivariate logistic regression analysis. Multiple logistic regression showed that T 3 stage( P<0.001) was independent predictor for positive surgical margin. χ 2 test showed that clinical stage( P<0.001) and IPPL( P=0.001) were related to the postoperative PBSM. The clinical stage, Gleason score and IPPL were included in the multivariate logistic regression analysis. T 3 stage( P<0.001)and IPPL≥5 mm ( P=0.009) were independent predictors for PBSM according to multivariable logistic regression. Conclusions:For prostate cancer patients who received laparoscopic radical prostatectomy, clinical stage T 3was an independent risk factor for postoperative positive surgical margin. IPPL≥5 mm on preoperative magnetic resonance imaging and clinical stage T 3 were independent risk factors for PBSM.

Objective To study the urodynamic characters of pelvic lipomatosis(PL) and its clinic significance.Methods From Sep.2013 to Feb.2016,7 patients,including 6 males and one female,were diagnosed as PL by image examinations and related lower urinary tract syndrome.Their mean age was 46 years,ranged from 30 to 52 years.All the patients(study group) have normal renal function.However,4 patients were noticed bilateral hydronephrosis.Other patients with similar LUTS but were confirmed as normal by image and urodynamic examinations were concluded in control group,which was paired designed to match the study group in visiting time,gender,age,and number of patients.The uroflowmetry and pressure/flow cystometry were performed in all patients.The urodynamic data of two groups including maximum flow rate (Qmax),time to maximum flow,post-voiding residual (PVR),first sensation capacity,first desire to void capacity,cystometric capacity,intravesical pressure at terminal of filling phase,compliance,detrusor pressure at maximum flow,detrusor opening pressure,bladder outlet obstruction index (BOOI) and bladder contractility index (BCI),were retrospectively analyized.Results There were no significant different between study aud control groups respect to Qmax [(18.71 ± 10.31) ml/min vs.(13.29 ± 6.55) ml/min],time to maximum flow [(6.71 ±2.50)s vs.(7.43±2.76)s],PVR [(28.14±27.81)ml vs.(3.14± 3.48) ml],first sensation capacity[(138.86 ± 77.01) ml vs.(142.29 ± 89.84) ml],first desire to void capacity [(203.71 ± 131.09) ml vs.(216.57 ± 72.20) ml],cystometric capacity [(271.0 ± 151.95) ml vs.(323.29± 92.87)ml],i ntravesical pressure at terminal of filling phase [(30.29 ± 16.45)cmH2O vs.(18.71 ± 9.57) cmH2 O],and compliance [(90.53 ± 126.46) cmH2O/ml vs.(129.57 ± 136.25) cmH2O/ml].The study group was significant higher than control group in terms of pressure at maximum flow [(69.57 ±25.06) cmH2O vs.(33.14 ± 11.63) cmH2O,P =0.004],opening pressure [(42.57 ± 22.16)cmH2O vs.(18.00±13.18) cmH2O,P=0.027],BOOI [(34.00±15.92)vs.(16.50±5.96),P=0.030] and BCI [(133.17 ± 27.37) vs.(87.67 ± 20.16),P =0.008],respectively.Moreover,the BCI of PL patients with hydronephrosis were significant higher compare with PL patients without hydronephrosis [(155.67 ±14.98) vs.(110.67 ± 1 1.37),P =0.014].Conclusions The urodynamic characters of PL were increased pressure at maximum flow and opening pressure,which implied obstruction.

Objective To investigate the safety and feasibility of radical nephrectomy and Mayo 0-Ⅳ venous thrombectomy.Methods The clinical data of 52 patients with Mayo 0-Ⅳ tumor thrombus from February 2015 to January 2017 were analyzed retrospectively.Of the 52 patients,42 were male and 10 were female.The average age was (59.8 ± 13.6) years old (2.5 to 84.0 years).The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 12 cases,type Ⅰ thrombus in 11 cases,type Ⅱ thrombus in 15 cases,type Ⅲ thrombus in 9 cases,type Ⅳ thrombus in 5 cases (Mayo Medical Center classification).Imaging suggested the right renal tumor in 36 cases and left tumor in 16 cases.The average tumor size was (8.5 ±2.0) cm(2.0-21.1 cm).There were 2 cases of ASA Ⅰ,40 cases of ASA Ⅱ and 10 cases of ASA Ⅲ according to the American Society of Anesthesiologists (ASA).In laparoscopic radical nephrectomy and Mayo 0 venous thrombectomy,we clamped the vena cava vessel wall nearby the renal vein entrance.The vena cava blood flow was blocked partially.Then we cut the vessel wall arcuately.Mayo Ⅰ tumor thrombus requires the use of a non traumatic auricle clamp to control blood flow by the block of vena cava above thrombus,vena cava below the renal vein level,and the contralateral renal vein.Right kidney tumors with Mayo Ⅱ could be completed by retroperitoneal surgery.At the time of vascular occlusion,the distal inferior vena cava,the left renal vein and the proximal inferior vena cava were interrupted sequentially.For left renal tumors with Mayo Ⅱ,the retroperitoneal approach combined with transperitoneal approach was used.The technique of "milking" can shrink the tumor thrombus and reduced the difficulty of the operation.For Mayo Ⅲ tumor thrombus just at the hepatic vein level,we cut off 3-5 hepatic short veins,and separated inferior vena cava long enough to provide surgical field.For Mayo Ⅲ tumor thrombus much higher than the hepatic vein level,we used open surgeries to free the liver and porta hepatis.We first blocked the distal inferior vena cava,followed by the left renal vein,the hepatic artery and portal vein,at last the proximal inferior vena cava.Mayo Ⅳ tumor thrombus often required a median incision to open the chest and establish an extracorporeal circulation.Results All the 52 surgeries were completed successfully without intraoperative and perioperative mortality.Open radical nephrectomy and inferior vena cava thrombectomy was underwent in 22 cases.Pure laparoscopic surgery was under went in 30 case.Two cases were converted to open surgery.The average surgery time was(333.7 ±80.1)min(136-694 min).The average blood loss volume was (1339.0 ± 508.1) ml(20-10 000ml).During the operation,the amount of suspended red blood cells transfusion was(761.5 ± 394.8)ml(0-10 400ml).28 cases underwent regional lymph node dissection,and postoperative pathological diagnosis showed lymph metastasis in 4 cases.24 cases underwent ipsilateral adrenalectomy,and 2 cases showed tumor invasion of adrenal gland.7 cases with right tumors underwent inferior vena cava wall resection because of invasion by tumor thrombus.The average postoperative hospitalization of all 52 cases was (9.7 ± 4.7) d.Among 27 patients,early postoperative complications occurred in 18 cases (34.6％).There were 1 case of Clavien Ⅰ,12 cases of Clavien Ⅱ,1 case of Clavien Ⅲ a,2 cases of Clavien Ⅳ a and 2 cases of Clavien Ⅴ according to modified Clavien classifications.44 cases (84.6％) were followed up for 1 to 22 months with a median of 8 months.Postoperative recurrence occurred in 3 cases,and distant metastasis occurred in 9 cases.9 cases (20.5％) had tumor specific death.Conclusions Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo 0-Ⅳ tumor thrombus,but the wide extension of vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation,rich operative experience and skills can improve the safety of operation.

BACKGROUND:Large-scale expansion of undifferentiated and multipotential adipose-derived stem cells using serum-free culture system is a difficult issue to be resolved. OBJECTIVE:To establish an in vitro culture system combined with the extracellular matrix in order to investigate the efficiency, effectiveness and security of extracellular matrix on expanding adipose-derived stem cells. METHODS:In vitro isolated adipose-derived stem cells were seeded in traditional two-dimensional plastic plates and extracellular matrix-coated plates supplemented with serum-free medium respectively. After in vitro expansion, total cellnumber, expression of cellsurface markers, cellsenescence degree and multipotent differentiation ability (adipogenic, osteoblastic and chondrogenic differentiation) of adipose-derived stem cells cultured under both conditions were detected and compared. Moreover, the clinical safety of adipose-derived stem cells expanded in extracellular matrix-coated plates was investigated. RESULTS AND CONCLUSION:Total cellnumber of passage 5 adipose-derived stem cells cultured in extracellular matrix-coated plates was 10 times more than that in traditional two-dimensional plastic plates. Flow-cytometric analysis showed that adipose-derived stem cells cultured with extracellular matrix expressed stem cellsurface markers. cellular senescence examination showed that almost al of passage 15 adipose-derived stem cells cultured with extracellular matrix showed no aging, while most passage 5 adipose-derived stem cells cultured by the two-dimensional system aged and lost their proliferation ability. Multidirectional induction of adipose-derived stem cells showed that passage 15 adipose-derived stem cells cultured with extracellular matrix could stil differentiate into adipocytes, osteoblasts and chondrocytes as passage 5 adipose-derived stem cells did, which performed much better than the induced differentiations of passage 5 adipose-derived stem cells cultured by the two-dimensional system. Karyotype analysis and in vivo invasion experiment insured the clinical safety of adipose-derived stem cells expanded with extracellular matrix. Al above results suggest a safe and more efficient expansion system of extracellular matrix for clinical application using the serum-free culture system combined with extracellular matrix.

ABSTRACT:Objective To investigate the countermeasures and reasons of pouch related complications of permanency cardiac pacemaker implantation.Methods Clinical materials of 129 permanent cardiac pacemaker patients were retrospectively analyzed and reasons of pouch related complications were analyzed.Results 129 patients were implanted heart pacemakers.Pouch relat-ed complications occurred in 12 cases (9.3%),and pouch hematoma occurred in 5 cases (3.9%), pouch infection in 3 cases (2.3%)and pain of pouch area in 4 cases (7.1%).Most patients were able to find inducing factors and these factors were removed through strengthening the nursing edu-cation and proper communication.Conclusion Preoperative evaluation,strengthening intraopera-tive and postoperative nursing,health education and discharge guidance can reduce pouch related complications.

ABSTRACT:Objective To investigate the countermeasures and reasons of pouch related complications of permanency cardiac pacemaker implantation.Methods Clinical materials of 129 permanent cardiac pacemaker patients were retrospectively analyzed and reasons of pouch related complications were analyzed.Results 129 patients were implanted heart pacemakers.Pouch relat-ed complications occurred in 12 cases (9.3%),and pouch hematoma occurred in 5 cases (3.9%), pouch infection in 3 cases (2.3%)and pain of pouch area in 4 cases (7.1%).Most patients were able to find inducing factors and these factors were removed through strengthening the nursing edu-cation and proper communication.Conclusion Preoperative evaluation,strengthening intraopera-tive and postoperative nursing,health education and discharge guidance can reduce pouch related complications.