Ultrasonography-guided Percutaneous Nephrolithotomy with Chinese One-shot Tract Dilation Technique Based on Stimulated Diuresis:A Report of 67 Cases

The safety and effectiveness of a novel Chinese one-shot dilation technique based on stimulated diuresis for percutaneous nephrolithotomy（PCNL） were investigated.After the feasibility of the Chinese one-shot dilation based on stimulated diuresis was verified by an animal study,this technique was applied in the clinical practice.A total of 67 patients in our department underwent the modified PCNL from July 2014 to June 2015.After the renal infundibulum was distended by stimulated diuresis,the kidney was punctured under the ultrasonographic guidance via the fornix of the target calyx.The working channel was dilated using a special designed pencil-shaped fascial dilator.The successful access rate,nephrostomy tract creation time,pre-and postoperative hemoglobin values and serum creatinine concentrations,stone-free rate and complications were recorded and analyzed.The renal infundibulum was successfully distended in all of the patients by the diuresis treatment.Under the ultrasonographic guidance,the successful access rate was 100% and the mean tract creation time was 2.0 min（range：1.5–5.0 min）.The stone-free rate right after surgery was 91.0%.Although the postoperative hemoglobin was significantly reduced（P〈0.01）,transfusion was not clinically necessary.There was no significant difference in serum creatinine concentrations before and after operation（P〉0.05）.No severe complication occurred during or after the PCNL.It was suggested that this Chinese one-shot dilation technique based on stimulated diuresis is an efficient and safe innovation for PCNL,and is even helpful for those patients with non-dilated pelvicaliceal systems.

A new path planning method for bevel-tip flexible needle insertion in 3D space with multiple targets and obstacles

In this paper,a new bevel-tip flexible needle path planning method based on the bee-foraging learning particle swarm optimization(BFL-PSO)algorithm and the needle retraction strategy in 3D space is proposed to improve the puncture accuracy and shorten the puncture distance in the case of multiple puncture targets.First,the movement of the needle after penetrating the human body is analyzed,and the objective function which includes puncture path error,puncture path length,and collision function is established.Then,the BFL-PSO algorithm and the needle retraction strategy are analyzed.Finally,medical images of the tissue to be punctured are obtained by medical imaging instruments,i.e.,magnetic resonance(MR),and the 3D model of the punctured environment is constructed by 3D Slicer to obtain the environment information on targets and obstacles,and the path of flexible needle is carried out based on the BFL-PSO optimization algorithm and the needle retraction strategy.The simulation results show that,compared with other path planning methods in the related literature,the new path planning method proposed in this paper has higher path planning accuracy,shorter puncture distance,and good adaptability to multi-target path planning problems.

Identification of KIF20A as a tumor biomarker and forwarder of clear cell renal cell carcinoma

To the Editor:Renal cell carcinoma(RCC)is one of the top 10 major cancer types in adults.Current research shows that clear cell renal cell carcinoma(ccRCC)remains a deadly tumor disease and is associated with most cancerrelated deaths.[1]Timely diagnosis is extremely important for the treatment of tumor patients.Adjusting the treatment plan based on the results of clinical diagnostic markers has a positive effect on patient prognosis.There is still a high risk of local recurrence or distant metastasis after nephrectomy.Tyrosine kinase inhibitor(TKI)has shown encouraging efficacy in advanced ccRCC patients.[2]Unfortunately,TKI resistance still develops and can lead to poor progression in cancer.[3]Thus,there is an urgent need to explore more effective prognostic biomarkers and to identify novel drug targets for ccRCC therapies.