ObjectiveBased on two-dimensional transperineal pelvic floor ultrasound images obtained during the Valsalva maneuver，this study aims to develop a deep learning artificial intelligence model to assist in the clinical grading diagnosis of female stress urinary incontinence （SUI）.MethodsAll patients underwent transperineal pelvic floor ultrasound examination within one month of their initial visit. According to the International Consultation on Incontinence Questionnaire-Short Form （ICI-QSF），the SUI patients were divided into three groups: mild （S1），moderate （S2），and severe （S3）. Baseline information and ultrasound images of the patients were collected，and midsagittal plane images of the pelvic floor during the Valsalva maneuver were selected. After preprocessing，the regions of interest（ROI） were semi-automatically segmented using computer algorithms. A transfer learning approach was applied using a ResNet50 model pretrained on ImageNet. The data were randomly divided into a training set and a test set in an 8∶2 ratio，with five-fold cross-validation performed on the training set. After model training，performance was evaluated using a confusion matrix and the area under the receiver operating characteristic curve （AUC）. Finally，gradient-weighted class activation mapping （Grad-CAM） was used to generate heatmaps to visually demonstrate the areas of interest identified by the model.ResultsA total of 282 patients were included in the study，comprising 167 patients with SUI and 115 non-SUI patients（S0）. The model achieved an accuracy of 84.1% in the training set and 83.9% in the test set. The AUC values in the training set were as follows: non-SUI 0.89 （95%CI: 0.78-0.97），mild SUI 0.96 （95%CI: 0.90-1.00），moderate SUI 0.92 （95%CI: 0.81-1.00），and severe SUI 0.93 （95%CI: 0.84-0.98）. In the test set，the AUC values were non-SUI 0.88 （95%CI: 0.77-0.98），mild SUI 0.91 （995%CI: .80-0.99），moderate SUI 0.92 （95%CI: 0.80-1.00），and severe SUI 0.88 （95%CI: 0.75-0.98）.ConclusionThe grading diagnostic artificial intelligence model based on two-dimensional transperineal pelvic floor ultrasound images during the Valsalva maneuver shows potential to become an objective basis for the grading diagnosis of SUI patients.
Objective:To investigate the safety and efficacy of 3D laparoscopy combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi.Methods:The clinical data of 14 patients with renal pelvic ureteral junction obstruction and renal calyx stones who were admitted and operated in Guangdong Second Provincial General Hosptial from December 2019 to January 2022 were analyzed retrospectively. The size of kidney stones, number of stones, operation time, intraoperative blood loss, and one-stage stone removal rate and surgical effect were collected and analyzed. Results:All patients underwent transabdominal 3D laparoscopic nephroplasty. The ureteroscope was placed in the renal pelvis and calyces through the laparoscopic channel to find and remove calyx stone. The mean stone size was (0.89±0.32) cm, the number of stones was 2-6, the operation time was (138±18) min, the intraoperative blood loss was (12±5) ml, the primary stone clearance rate was 100%, The ureteral stent was removed 6-8 weeks after operation, and CT scan revealed hydronephrosis significant reduced or disappeared 3 month after operation, and there was no recurrence of renal calculus or aggravation of hydronephrosis.Conclusion:3D laparoscopy combined with rigid ureteroscopy is safe, effective, minimal invasive and has a high stone removal rate in the treatment of renal pelvic ureteral junction obstruction with calyx calculus, which is a good alternative therapy for partial UPJO with calyx calculi patients.
肾结石的发病率很高，是泌尿外科的常见疾病之一[1]。最常见的结石成分是以钙盐为基础[2]。肾结石的形成受遗传和环境因素的影响[3-4]。饮食习惯属于后者，饮食因素可导致尿成分异常等[5]，而较高的尿钙排泄是肾结石形成的重要危险因素[6]。因此，对钙盐结石者的营养建议包括增加液体、蔬菜和水果的摄入，平衡钙摄入，减少钠和动物蛋白的摄入等[7]。考虑到钙的吸收导致结石患者尿钙水平增加，理论上补充维生素D可能会增加钙的吸收和结石形成。虽然现有的关于膳食钙摄入的文献都支持钙饮食增加结石形成风险，但关于维生素D摄入和钙补充的数据不太一致[8-9]。因此，本研究旨在综述钙和维生素D与肾结石形成关系的研究现状及进展，为相关研究提供参考。
Objective:To analyze the expression and significance of orphan nuclear receptor HNF4α in renal clear cell carcinoma.Methods:The expression pattern of HNF4α in renal clear cell carcinoma and its related overall survival was analyzed by UALCAN. The expression of HNF4α mRNA in tumor, normal and metastatic tissues of renal clear cell carcinoma was analyzed by TNMplot. The prognostic significance of HNF4α in renal clear cell carcinoma was evaluated in Kaplan-Meier plotter online database. STRING analysis was used to analyze the HNF4α related protein-protein interaction networks.Results:HNF4α was significantly down regulated in renal clear cell carcinoma as compared to its normal control (P=0.002). The expression level of HNF4α was lower in metastatic renal clear cell carcinoma than that in primary tumor tissues (P<0.001). The expression level of HNF4α in stage 4 was significantly lower than that in stage 1 (P=0.007), and in grade 4 was significantly lower than that in grade 3 (P<0.001). The expression level of HNF4α was positively correlated with tumor prognosis (P=0.017). The overall survival rate of HNF4α-low expressed group was significantly lower than that of high expression group (P<0.001). There were 27 genes positively correlated with the expression of HNF4α with Pearson correlation coefficient greater than 0.5, including ERBB3, CUBN, HNF1A and CES2. There were interactions between HNF4α and HNF1A, EP300, LEF1, SMAD3, SMAD4, NCOA1, HIF1A, FOXO1 and PPARGC1A. The interaction network node is 11, and the PPI enrichment P value is 3.44e-08. Conclusions:HNF4α is significantly down regulated in renal clear cell carcinoma and negatively correlated with tumor prognosis. HNF4α and its related interaction factors may play important roles in the renal clear cell carcinoma. However, the role and mechanism of HNF4α in renal clear cell carcinoma need to be further studied.
Objective:To investigate the effect of different intrarenal pressures on perioperative complications in patients undergoing percutaneous nephrolithotomy (PCNL).Methods:The clinical data of 189 cases of complex kidney stones who underwent PCNL in General Hospital of the Southern Theater Command of the People's Liberation Army of China from August 2017 to December 2019 were retrospectively analyzed. According to the intraoperative pressure measurement in the renal pelvis, the patients were divided into instant high pressure group, transient high pressure group and sustained high pressure group. The operation time, flushing volume, extravasation of perfusate, primary stone clearance rate and other indicators of patients in each group were analyzed; postoperative conditions of patients were compared and analyzed: postoperative fever, incidence of septic shock, postoperative Hb, HCT, Na+ decrease degree, postoperative blood WBC, PCT elevation and so on.Results:There were significant differences in the extravasation of perfusate among the three groups, among which the instant high pressure group (8%) < transient high pressure group (18.4%) < sustained high pressure group (22.6%) (P< 0.05). The incidence of postoperative fever and septic shock, the degree of postoperative, HCT, Na+ decline, and the postoperative blood WBC and PCT elevations were statistically different among the three groups: instant high pressure group [20.69%, 2.30%, (0.09±0.01), (9.3±0.6), (2.6±0.2), (2.1±0.4)]< transient high pressure group [28.57%, 6.12%, (0.13±0.01), (12.3±0.9), (3.3±0.4), (5.2±1.7)]< sustained high pressure group [45.28%, 11.32%, (0.16±0.01), (13.8±0.9), (5.1±0.5), (9.8±1.8)] (P<0.05).Conclusion:Long-term maintenance of high pressure in the renal pelvis during percutaneous nephrolithotomy can significantly increase the incidence of perioperative complications.
