Objective To evaluate the application value of artificial intelligence mixed reality(AI-MR)technology in the planning of ultrasound-guided percutaneous nephrolithotomy(PCNL)for special types of complex upper urinary stones.Methods The prospective single-center,single-arm clinical study involved 15 patients with complex upper urinary stones undergoing ultrasound-guided PCNL during Aug.2022 and May 2023,including 9 male and 6 female,3 cases of pelvic ectopic kidney stones,5 cases of horseshoe kidney stones,3 cases of renal stones combined with spinal deformity,and 4 cases of transplant kidney stones.Based on preoperative computed tomography urography(CTU)data,digital three-dimensional reconstruction was performed,and AI-MR was used to project surgery-related three-dimensional images in real space to obtain"perspective"information of the surgical area.This facilitated preoperative design and planning,including target calyx,number of channels,and auxiliary measures.The compliance of target calyx and number of channels,stone clearance rate,total operation time,time required to establish the percutaneous renal channel,decrease in hemoglobin level,surgical complications,and postoperative hospital stay were analyzed.Results All 15 patients underwent preoperative planning using AI-MR and successfully completed one-stage ultrasound-guided PCNL.Based on the preoperative planning,we utilized S-PCNL alone or combined with Needle-perc or antegrade/retrograde FURS/RIRS.Among all patients,4 underwent single-channel S-PCNL,3 multi-channel S-PCNL,and 8 S-PCNL combined with Needle-perc or FURS.The compliance of target calyx and number of channels was 86.7％,the one-stage stone clearance rate was 80.0％,the average time for establishing the channel was(2.3±0.3)minutes,the average total operation time was(61.5±12.2)minutes,the mean decrease in hemoglobin level was(9.6±1.2)g/L,and the average postoperative hospital stay was(4.6±0.5)days.There were no Clavien-Dindo grade ≥ Ⅱ complications,such as blood transfusion,organ injury,or urosepsis.Conclusion Before surgery,AI-MR can be used to quantitatively analyze imaging data for patients with special types of complex upper urinary stones,which can achieve three-dimensional fluoroscopy effects,formulate surgical plans,optimize puncture paths,effectively avoid the risk of damage to surrounding organs,reduce complications,shorten treatment cycle and improve the first-stage stone clearance rate.

Percutaneous nephrolithotomy(PCNL) has always been the first-line minimally invasive treatment for staghorn kidney stones, with high surgical efficiency and first-stage stone free rate. However, due to the complexity of stones and the difficulty of surgery, serious complications such as postoperative bleeding, infection, and renal function damage often occur. Needle-perc assisted endoscopic surgery(NAES) surgery, also known as needle-perc assisted endoscopic surgery, is an innovative model based on needle-perc proposed by our center. The S+ N mode is standard tract PCNL combined with needle-perc, which not only improves the efficiency and stone free rate, but also reduces the number of tracts, effectively protecting renal function and reducing complications. This article reports a case of complete staghorn kidney stones that were completely removed by NAES surgery in one stage, with no complications after surgery and the patient recovering quickly and being discharged from the hospital.

Objective:To summarize the clinical characteristics and therapeutic efficacy of central nervous system (CNS) aspergillosis.Methods:The clinical manifestations, laboratory examination, neuroimaging features, treatment and prognosis of 37 cases of CNS aspergillosis diagnosed and treated in the First Medical Center of People′s Liberation Army General Hospital from January 2000 to January 2021 were retrospectively analyzed. According to the correlation between intracranial lesions and paranasal sinus lesions, they were divided into two groups: rhino-cerebral aspergillosis (RA, n=21) group and cerebral aspergillosis (CA, n=16) group. Results:Only 16.2% (6/37) of CNS aspergillosis patients had a clear background of immunosuppression, but 35.1% (13/37) were complicated with diabetes. The most common clinical manifestations were headache (73.0%, 27/37), cranial nerve involvement (59.5%, 22/37) and fever (37.8%, 14/37). Cerebrospinal fluid characteristics included increased pressure (53.8%, 14/26), increased white blood cell count (46.7%, 14/30), decreased glucose (30.0%, 9/30), increased protein (70.0%, 21/30), and high positive results of the metagenomic next-generation sequencing (mNGS) of pathogenic microorganism (7/10). Cranial magnetic resonance imaging showed that commonly involved sites were sinus, orbital apex, posterior orbit, cavernous sinus (43.2%, 16/37) and cerebral lobes (27.0%, 10/37). Treatment options included antifungal drugs alone (64.9%, 24/37), combination of drugs and surgery (27.0%, 10/37) and surgery alone (8.1%, 3/37). Compared with the CA group, RA group had fewer males [47.6% (10/21) vs 14/16, χ2=6.34, P=0.012] and older age [(54.2±19.4) years vs (38.4±18.4) years, t=2.50, P=0.017], and was more prone to headache [85.7% (18/21) vs 9/16, χ2=4.00, P=0.046) and cranial nerve involvement [81.0% (17/21) vs 5/16, χ 2=9.31, P=0.006]. The misdiagnosis rate of these patients in the early stage was 73.0% (27/37). A total of 29 patients (85.3%, 29/34) were treated with voriconazole successively, and the course of treatment was 3.0 (0.5, 10.4) months. Compared with salvage therapy, the mortality of primary therapy was lower (4/17 vs 9/12, χ2=7.54, P=0.006). All patients were followed up to December 2021, and 17 patients died, with a mortality rate of 45.9% (17/37). Conclusions:CNS aspergillosis may have no definite immunosuppressive background. Some of CNS aspergillosis patients are complicated with diabetes, and the clinical manifestations of the disease lack specificity, with high misdiagnosis rate in the early stage, no inflammatory changes in cerebrospinal fluid, and high positive rate of mNGS for pathogenic microorganism. Early and long-term application of voriconazole can significantly reduce the mortality rate.

Objective:To investigate the efficacy of transurethral resection of the prostate (TURP) versus plasmakinetic resection of the prostate (PKRP) in the treatment of patients with giant benign prostatic hyperplasia and their effects on erectile function. Methods:A total of 100 patients with GBPH who received treatment in the General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd., from February 2017 to January 2020 were included in this study. They were randomly assigned to undergo either PKRP (PKRP group, n = 50) or TURP (TURP group, n = 50). Perioperative indicators were recorded. Urodynamic indicators and serum indicators pre- and post-operation were compared between the two groups. Erectile function and quality of life were compared between the two groups. The incidences of postoperative complications such as erectile dysfunction, urinary incontinence and urethral stricture were calculated. Results:Operative time, hospital stay, catheter indwelling time, and intraoperative blood loss in the PKRP group were significantly shorter and less than those in the TURP group ( t = 14.35, 8.74, 6.20, 8.34, all P < 0.001). There were no significant differences in residual urine volume and maximum urine flow rate measured before surgery between the two groups ( t = 0.59, 0.73, both P > 0.05). After surgery, residual urine volume decreased and maximum urine flow rate increased in each group. Residual urine volume was significantly lower and maximum urine flow rate was significantly higher in the PKRP group compared with the TURP group ( t = 19.85, 11.67, both P < 0.001). Before surgery, there were no significant differences in serum prostate-specific antigen and free prostate-specific antigen between the two groups ( t = 0.43, 0.33, both P > 0.05). After surgery, both serum prostate-specific antigen and free prostate-specific antigen decreased in each group, and both serum prostate-specific antigen and free prostate-specific antigen were significantly lower in the PKRP group than those in the TURP group ( t = 16.01, 5.09, both P < 0.001). Before surgery, there were no significant differences in quality of life (QOL) score and International Index of Erectile Function (IIEF) score between the two groups ( t = 0.62, 0.63, both P > 0.05). After surgery, IIEF score was increased and QOL score was decreased in each group. After surgery, IIEF score in the PKRP group was significantly higher than that in the TURP group [(25.06 ± 3.61) points vs. (21.52 ± 3.05) points, t = 5.29, P < 0.001], and QOL score in the PKRP group was significantly lower than that in the TURP group [(1.05 ± 0.18) points vs. (1.58 ± 0.29) points, t = 5.29, 10.98, both P < 0.001]. The incidence of complications in the PKRP group was significantly lower than that in the TURP group ( χ2 = 5.98, P < 0.05). Conclusion:This study investigated the effects of TURP versus PKRP on giant benign prostatic hyperplasia from the aspects including erectile function, QOL, and perioperative indicators. This study is of certain innovation. Findings from this study confirm that both PKRP and TURP can improve erectile function, serum indicators, and urodynamic indicators in patients with giant benign prostatic hyperplasia. PKRP is preferred because it is less invasive, results in better improvements in erectile function, serum indicators, and urodynamic indicators, and has fewer complications than TURP.

【Objective】 To determine the reference range of thromboelastogram(TEG) and establish a TEG feature for local population by measuring TEG parameters in healthy adults in Shenzhen comparing the difference between gender and age, and analyzing the reference data provided by reagent manufacturer. 【Methods】 A total of 916 healthy adults, aged between 19 to 59, who did their regular health checks in our hospital from September 2020 to August 2021 were selected. The TEG(from Lepu Medical Technology Co., Ltd.) was performed, and the clot reaction time(R), clot formation time(K), coagulation angle(α-Angle), maximum amplitude(MA), coagulation index(CI), fibrinolysis index LY30 and the estimated percent lysis (EPL) were analyzed. 【Results】 The reference ranges of TEG parameters, including R, K, α-Angle, MA, CI, LY30 and EPL, of 916 healthy adults from Shenzhen were 3.25~8.19 min, 0.66~3.18min, 47.70~76.56deg, 50.05~72.91mm, -4.3~3.4, 0~2.2% and 0~3%, respectively. The value of α-Angle, CI, K, LY30, MA and R didn’t all meet the given range provided by the manufacturer; some were exceeding and some inferior to. A total of 227 out of 916 individuals presented abnormal results, relative to the references, in at least one parameter, and 78 were diagnosed of abnormal coagulation based on the given reference range, with a specificity of 75.2%. 【Conclusion】 The reference range of TEG parameters of Shenzhen locals is significantly different from that provided by manufacturers. And it is imperative for local TEG laboratories to establish their own reference ranges according to age and gender groups based on local population characteristics.

Objective:To evaluate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of complex lumbar disc herniation (LDH).Methods:A retrospective analysis of clinical data of 122 patients with LDH who underwent PELD from October 2015 to June 2019 in department of orthopedics, Beijing Chui Yang Liu Hospital was performed. There were 71 males and 51 females. According to whether lumbar disc herniation was a simple non migrated type, the patients were divided into control group ( n=85) and complex group ( n=37). The age, length of stay, operative approach, operation time, the bleeding volume, operative segments, perioperative complications, and excellent and good rate of 3 months after operation were recorded. Follow-up visit was performed by regular outpatient visit for 3 to 36 months. Before and after surgery, 3 days, 1 month, and 3 months after surgery, the Oswestry disability index (ODI) and modified MacNab criteria were used to evaluate the effect of surgery. The measurement data were expressed as mean±standard deviation ( Mean± SD), and the comparison between groups was performed by ANOVA analysis, the count data were expressed as percentage (%), and the comparison between groups was performed by χ2 test or Fisher test, the rank grouping data were performed by Mann-Whitney U non-parametric test. Results:The age of patients in complex group [(63.0±15.9) years] was older than that in control group [(48.7±16.3 years] ( t=2.289, P=0.030), and the length of stay in complex group [(13.0±6.9) d] was longer than that in control group [(8.2±4.3) d] ( t=2.384, P=0.024). There were no significant differences of the operative approach between the two groups ( χ2=0.420, P=0.517). Compared with the control group [(59.0±25.0) min, (16.3±10.9) mL], the operation time of the complex group [(87.0±29.2) min] was longer ( t=2.737, P=0.011), and the bleeding volume [(63.5±52.5) mL] was more ( t=3.925, P=0.001). There were no significant differences of the operative segments between the two groups ( χ2=0.356, P=0.837). The incidence of operation related complications in the complex group (13.5%, 5/37) was significantly higher than that in the control group (2.4%, 2/85) ( χ2=5.937, P=0.026). There were no significant differences in the excellent and good rate between the two groups at 3 months after operation ( U = 1 398.000, P=0.106). The preoperative ODI score of the complex group [(86.6±8.8) scores] was significantly higher than that in the control group [(76.1±7.7) scores]( t=3.359, P=0.002). The ODI score of the two groups decreased significantly. There were significant differences ( t=18.683, P=0.001) between the preoperative [(76.1±7.7) scores] and 3 d postoperative [(36.6±7.5) scores] in the control group. There were significant differences ( t=7.365, P=0.001) between the 3 d postoperative [(36.6±7.5) scores] and 1 month postoperative [(15.0±10.8) scores] in the control group. There were significant differences ( t=4.524, P=0.001) between the 1 month postoperative [(15.0±10.8) scores] and 3 month postoperative [(10.4±12.7) scores] in the control group. There were significant differences ( t=9.923, P=0.001) between the preoperative [(86.6±8.8) scores] and 3d postoperative [(40.1±11.0) scores] in the complex group. There were significant differences ( t=3.619, P=0.006) between the 3d postoperative [(40.1±11.0) scores] and 1 month postoperative [(18.2±15.1) scores] in the complex group. There were significant differences ( t=5.966, P=0.001) between the 1 month postoperative [(18.2±15.1) scores] and 3 month postoperative [(12.7±14.5) scores] in the complex group. Conclusions:PELD technology can treat complex LDH. Compared with simple non migrated LDH, although the operation time is longer, the amount of intraoperative bleeding is more and the incidence of postoperative complications is higher, there is no difference in ODI scores, excellent and good rate. The clinical effect is similar to that of simple non migrated LDH.

Objective:To evaluate the clinical effect of percutaneous coablation nucleoplasty (PCNP) in the treatment of discogenic low back pain (DLBP).Methods:From March 2015 to March 2019, the clinical data of 97 single segment DLBP patients with PCNP admitted to orthopaedic department of Beijing Chui Yang Liu hospital were analyzed retrospectively. They were divided into PCNP group ( n=43) and control group ( n=54). The sex proportion, age, medical history, length of hospital stay, follow-up time, operation time, responsibility segment, Pfirrmann classification and complications were recorded. 1 month, 3 months and 6 months after the operation, the routine outpatient reexamination and follow-up were conducted for 6-36 months. The therapeutic effect was evaluated by numeric rating scale (NRS) and Roland-Morris Disability Questionnaire (RMDQ) before, 1 month, 3 months and 6 months after the operation. Measurement data were presented by Mean± SD, t test was used for comparison between groups, and analysis of variance of repeated measurement data was used for comparison of NRS score and RMDQ score before and after treatment. The counting data were expressed by percentage, χ2 test or Fisher precision test was used for comparison between groups, and Mann-Whitney rank sum test was used for comparison between groups of follow-up time and hierarchical grouping data. Statistical software SPSS 20.0 was used to process the data, P< 0.05 was statistically significant. Results:The average operation time of PCNP patients was (36.3±13.2) min (15 to 65 min), and no complications occurred. After treatment, the NRS score and RMDQ score of the two groups decreased significantly( F组内=26.000, P=0.001; F组内=26.000, P=0.001), and the NRS score and RMDQ score of the PCNP group decreased more significantly( F组间=5.666, P=0.024; F组间=4.261, P=0.048), and the NRS score and RMDQ score of the PCNP group decreased more significantly with time ( F交互=26.000, P=0.028; F交互=26.000, P=0.010). Conclusion:PCNP with DLBP patients showed satisfied clinical results in pain relief and improve dysfunction. PCNP is a safe, minimally invasive and effective treatment method, which has a long therapeutic effect and is superior to conservative treatment.

OBJECTIVE: To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain. METHODS: We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment. RESULTS: The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation ( CONCLUSIONS As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.
Humans ; Injections, Epidural ; Low Back Pain/drug therapy* ; Lumbar Vertebrae ; Radiculopathy/drug therapy* ; Retrospective Studies ; Treatment Outcome

Objective To evaluate the effect of diabetes on the effect of percutaneous transforaminal discectomy (TPED) for patients with lumbar disc herniation (LDH).Methods Retrospective analysis 69 LDH patients treated with TPED from January 2014 to June 2017 in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University.There were 32 males and 37 females with an age of (58.2±14.8) years and body mass mdex (BMI) (22.4 t 4.0) kg/m2.According to whether they had diabetes or not,they were divided into control group (53 cases) and diabetes mellitus (DM) group (16 cases).Agex,BMI,course of disease,operative segment,MRI grade of Pfirrmann lumbar disc herniation,operative time,blood loss,hospitalization time and perioperative complications were compared between the two groups.Outpatient follow-up was conducted for 6 months.The follow-up included Oswestry dysfunction index (ODI) and modified MacNab criteria.ODI score,modified MacNab criteria and postoperative complications were compared between the two groups.Independent sample t test was used to compare the measurement data between groups,and repeated measurement data analysis of variance was used to compare ODI scores.x2 test or Fisher exact test were used to compare the counting data between groups;Kruskal-Wallis rank sum test was used to compare the graded grouped data between groups.Results The average age,the BMI,the course of the disease,the time of follow-up,the distribution of the lumbar disc herniation and the severity of the lumbar disc were not significantly different between the two groups.The time of hospitalization in DM group was significantly longer than that in the control group (t =2.095,P =0.045).The operation time of DM group was slightly longer (t =1.369,P =0.182),and the amount of bleeding was slightly more (t=1.833,P =0.077).In DM group,the incidence of operative complications (18.8％) and the recurrence rate (6.3％) was higher,while the incidence of operative related complications (3.8％) and the recurrence probability (1.9％) was lower in the control group,but there was no statistical difference (P =0.233 and 0.393).In DM group,the improvement of ODI score after operation was not as good as that in the control group (F =10.475,P =0.003),especially in 3 months and 6 months after operation,the ODI score was higher than that in the control group (P =0.043 and 0.048).After 6 months of follow-up,the overall good rate was 92.8％ according to the modified MacNab criteria,and there were significant differences between the two groups (U =311.00,P =0.033).Conclusions TPED is a safe and effective treatment for LDH,which can significantly improve the quality of life after LDH,but has a limited effect on the postoperative effect.In the actual clinical work,in order to obtain better effect of TPED operation,we should pay attention to the control of

Objective To find out if there is any difference in intercondylar fossa width and notch width index (NWI) between tibial intercondylar eminence avulsion fracture and anterior cruciate ligament (ACL) injury.Methods A retrospective study was conducted of the patients who had sought medical attention at Department of Sports Medicine and Adult Reconstructive Surgery,Drum Tower Hospital from June 2014 to May 2018.There were 10 patients with tibial intercondylar eminence avulsion fracture (4 males and 6 females with an average age of 32.7 ± 9.2 years),13 patients with ACL injury (8 males and 5 females with an average age of 31.8 ± 10.9 years) and 22 patients with simple meniscus injury as controls (13 males and 9 females with an average age of 30.9 ± 10.6 years).They all had MRI examination of the knee before surgery.The width of intercondylar fossa and the width and height of bilateral femoral condyles were measured on high resolution images of MRI axial view.NWI was calculated.The 3 groups were compared in intercondylar fossa width and NWI.Results The 3 groups of patients were comparable because there were no significant differences in gender,age,height,weight or BMI between them (P ＞ 0.05).The intercondylar fossa width in the ACL injury group (17.4 ± 3.5 mm) was significantly smaller than that in the avulsion fracture group (20.8 ± 1.1 mm) or in the control group (20.2 ±2.6 mm) (P ＜ 0.05),but no significant difference was detected between the avulsion fracture group and the control group (P ＞ 0.05).NWI in the avulsion fracture group (0.301 ±0.011) was similar to that in the control group (0.280 ±0.039) (P ＞ 0.05) but significantly higher than that in the ACL injury group (0.25 ± 0.05) (P ＜ 0.05).NWI in the ACL injury group was significantly lower than that in the control group (P ＜ 0.05).Conclusions Intercondylar notch stenosis may be a risk factor for ACL injury but may not be associated with tibial intercondylar eminence avulsion fracture.The difference in pathogenesis between tibial intercondylar eminence avulsion fracture and ACL injury may be associated with their difference in NWI.