Result of 10 Years of Experience in Echo-Guided Kidney Biopsy Punctures in the Nephrology Department of the Martigues Hospital Center, France

Introduction: Percutaneous renal biopsy (PRB) is an essential procedure for the diagnosis and therapeutic management of many primary or secondary nephropathies. Objectives: To identify the indications, to determine the profile of the diagnosed nephropathies and to evaluate the short-term complications related to the practice of echo-guided PRB at the Martigues hospital center. Methodology: This was a retrospective and descriptive study carried out on the records of patients who underwent echo-guided native kidney biopsy from January 1, 2010 to December 31, 2019 in the nephrology department of the Martigues Hospital. Results: The analysis of 123 cases of echo-guided PRB involved 76 men and 47 women with a sex ratio of 1.6. The mean age was 55.92 ± 17.80 with age extremes of 16 and 87 years. Glomerular syndromes were the main indication with 42 cases of nephrotic syndrome (34.1%), 15 cases of nephritic syndrome (12.2%), 11 cases of rapidly progressive glomerulonephritis syndrome (8.9%), and 6 cases of recurrent macroscopic hematuria syndrome (4.9%). The histological findings were 47 cases of primary glomerular lesions (38.3%), 32 cases of nephroangiosclerosis lesions (26%), 24 cases of secondary glomerulopathy (19.5%), 9 cases of interstitial nephritis (7.3%), 2 cases of myelomatous nephropathy (1.6%), and 9 cases (7.3%) of unclassified histological lesions. Twenty-two hypertensive patients (40.7%) had nephroangiosclerosis lesions (p = 0.001). The follow-up was simple in 119 patients (96.7%). Macroscopic hematuria was noted in 4 patients (3.3%). It was associated with a perirenal hematoma in 2 patients including 1 transfused case. Conclusion: Our data provide an important contribution to the understanding of the prevalence and clinical presentation of renal diseases in the nephrology department of the Martigues hospital center.

Relationship between Renalase Expression and Kidney Disease： an Observational Study in 72 Patients Undergoing Renal Biopsy

The relationship between the levels of renalase and changes in proteinuria, hypertension, renal function, renal tubular epithelial cell apoptosis and B-cell lymphoma-2 （Bcl-2） expression was investigated in patients （chronic nephritis, primary nephrotic syndrome or other kidney disease） that underwent renal biopsy. The study group comprised 72 patients undergoing renal biopsy. Patient profiles and renal function were collected. Concentrations of renalase and Bcl-2 were measured by immunohistochemistry. Tubular injury was detected by periodic acid Schiff staining （PAS） and renal tubular epithelial cell apoptosis was assessed by TUNEL assay. The expression of renalase was significantly lower in renal biopsy specimens than in normal kidney tissues. There was a positive linear relationship between renalase and some serum and cardiac indices; a negative correlation was found between age, eGFR, Ccr and 24-h urinary protein. Renal tubule injury index and tubular epithelial cell apoptosis index showed a negative linear correlation with renalase. The results showed that renalase probably increased the expression of Bel-2. By two independent samples t-test, renalase levels were significantly increased in the non-hypertension group than in the hypertension group. One-way ANOVA showed that renalase expression was higher in samples with Lee＇s grade Ⅲ than in those with Lee＇s grade V. The expression of renalase was significantly decreased in patients who underwent renal biopsy, and was also associated with blood and renal function. The research proved that renalase may reduce renal tubular injury and apoptosis of renal tubular epithelial cells through the mitochondrial apoptosis pathway, finally achieving the purpose of delaying the progress of renal failure.

Risk Factors of Complications after CT-guided Percutaneous Needle Biopsy of Lumps Near Pulmonary Hilum

The factors influencing the incidence of common complications（pneumothorax and pulmonary hemorrhage） of CT-guided percutaneous needle biopsy of lumps near pulmonary hilum were investigated. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum was performed on 48 patients. The complications of pneumothorax and pneumorrhagia as well as the contributing factors were analyzed statistically. The major complications associated with CT-guided needle biopsy included pneumothorax（13 cases, 27.1%） and pulmonary hemorrhage（14 cases, 20.24%）. ？2 test revealed that pneumothorax was associated with the lesion size and depth of needle penetration, and pulmonary hemorrhage with the depth of needle penetration and needle retention time with a significant P value. Pneumothorax was observed in 7 cases（17.5%） out of 40 cases with diameter of mass greater than 3 cm, and in 6 cases（60%） out of 10 cases with depth of needle penetration greater than 4 cm. Additionally, pulmonary hemorrhage was identified in 12 cases（41.4%） out of 29 cases with needle retention time longer than 15 min, and pulmonary hemorrhage in 7 cases（70%） out of 10 cases with depth of needle penetration greater than 4 cm. CT-guided percutaneous needle biopsy of lumps near pulmonary hilum is safe and effective. The key factors to prevent the complications include correct evaluation of lesion size, depth of needle penetration and the needle retention time before the operation. Key words： biopsy, CT-guided; hilum; pneumothorax; pulmonary hemorrhage

Three‑dimensional Modeling and Simulation of Muscle Tissue Puncture Process

Needle biopsy is an essential part of modern clinical medicine.The puncture accuracy and sampling success rate of puncture surgery can be effectively improved through virtual surgery.There are few three-dimensional puncture(3D)models,which have little significance for surgical guidance under complicated conditions and restrict the development of virtual surgery.In this paper,a 3D simulation of the muscle tissue puncture process is studied.Firstly,the mechanical properties of muscle tissue are measured.The Mooney-Rivlin(M-R)model is selected by considering the fitting accuracy and calculation speed.Subsequently,an accurate 3D dynamic puncture model is established.The failure criterion is used to define the breaking characteristics of the muscle,and the bilinear cohesion model defines the breaking process.Experiments with different puncture speeds are carried out through the built in vitro puncture platform.The experimental results are compared with the simulation results.The experimental and simulated reaction force curves are highly consistent,which verifies the accuracy of the model.Finally,the model under different parameters is studied.The simulation results of varying puncture depths and puncture speeds are analyzed.The 3D puncture model can provide more accurate model support for virtual surgery and help improve the success rate of puncture surgery.

Value of ultrasound guided biopsy combined with Xpert Mycobacterium tuberculosis/resistance to rifampin assay in the diagnosis of chest wall tuberculosis

BACKGROUND The thoracic wall lesions,particularly chest wall tuberculosis,and chest wall tumors and other pyogenic wall and actinomycetes infections,almost always present as a diagnostic challenge.AIM To explore the value of ultrasound-guided biopsy combined with the Xpert Mycobacterium tuberculosis/resistance to rifampin(MTB/RIF)assay to diagnose chest wall tuberculosis.METHODS We performed a retrospective study of patients with chest wall lesions from March 2018 to March 2021.All patients received the ultrasound-guided biopsy for pathology examination,acid-fast Bacillus staining,mycobacterial culture,and Xpert MTB/RIF analysis.The sensitivity,specificity,and area under the curve(AUC)were calculated for these diagnostic tests,either individually or combined.Rifampicin resistance results were compared between the mycobacterial culture and the Xpert MTB/RIF assay.RESULTS In 31 patients with the chest wall lesion biopsy,22 patients were diagnosed with chest wall tuberculosis.Of them,3,6,and 21 patients tested positive for mycobacterial culture,acid-fast stain,and Xpert MTB/RIF assay,respectively.The rifampicin resistance results of the 3 culture-positive patients were consistent with their Xpert MTB/RIF assay results.When considering the sensitivity,specificity,and AUC value,the Xpert MTB/RIF assay(95.5%,88.9%,and 0.92,respectively)was a better choice than the acid-fast Bacillus stain(27.3%,100.0%,and 0.64,respectively)and mycobacterial culture(13.6%,100.0%,0.57,respectively).No complications were reported during the procedure.CONCLUSION Ultrasound guided biopsy combined with Xpert MTB/RIF has high value in the diagnosis of chest wall tuberculosis,and can also detect rifampicin resistance.

Study on the Effect of Canceling Hard Bed on Patients after Renal Needle Biopsy

Objective: To investigate the effect of hard bed on postoperative complications and comfort level of patients after renal puncture biopsy. Methods: A total of 115 patients who underwent renal needle biopsy in the Department of Nephrology of The First Affiliated Hospital of Jinan University from May 2020 to February 2021 were selected, and 57 patients who received hard bed nursing after renal needle biopsy were set as the control group, the others were selected as the observation group. The incidence of postoperative bleeding at the puncture mouth, gross hematuria and dysuria, as well as the postoperative comfort level of 6 h and 18 h were compared between the two groups. Results: There was no significant difference in the incidence of postoperative bleeding, gross hematuria and dysuria between the two groups (P > 0.05), but the comfort scores at 6 h and 18 h in the observation group were higher than those in the control group (P < 0.05). Conclusion: There is no significant difference in the incidence of postoperative complications, such as bleeding at the puncture mouth, gross hematuria and dysuria, among patients with renal needle biopsy, whether to use hard bed nursing or not. Eliminate hard bed nursing can improve the comfort level of patients, reduce the occurrence of pressure ulcers, and relieve the negative psychological emotions of patients.

Pulmonary benign metastasizing leiomyoma: A case report and review of the literature

BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.

Influential factors and effect evaluation of the intra-operative puncture biopsy for pancreatic masses

Background It is a challenge for the surgeons to accurately diagnose the pancreatic masses preoperatively,which decides the choice of surgical managements and subsequently results in different survivor outcomes,operative complications,and mortality rates.The purposes of this study were to evaluate the diagnostic role that intra-operative puncture biopsy may play in pancreatic masses and to explore the relevant factors influencing the diagnosis.Methods A retrospective study was performed on 94 in-patients admitted to Peking University First Hospital for pancreatic masses during the period from June 1994 to December 2007.They all underwent intra-operative puncture biopsy during exploratory laparotomy.The sensitivity and specificity of intra-operative puncture biopsy were calculated and the relevant factors to the diagnosis of biopsy were selected for the statistical analysis.Results The overall sensitivity,specificity,positive predictive value,and negative predictive value of intra-operative puncture biopsy were 76.0%,94.7%,98.3% and 50.0%,respectively.The analysis of bivariate correlations showed that the size of the pancreatic masses （P=-0.000）,the number of puncture biopsies （P=0.000）,and the presence of pancreatic fibrosis （P=-0.012） had statistic significance for the diagnosis.But the multivariate analysis identified the size of the pancreatic masses （P=0.004） and the number of puncture biopsies （P=0.000） as independent predictive factors for intra-operative puncture biopsy.In addition,as the number of puncture biopsies increased,the sensitivity and specificity of diagnosis was improved （P=0.000）.The sensitivity and specificity of intra-operative puncture biopsy were found to be lower for the pancreatic masses less than 25 mm compared with the masses larger than 25 mm （P=0.000）.It was noted,however,that even if the masses were less than 25 mm,the sensitivity and specificity could be improved significantly as the number of puncture biopsies reached 3 to 6 （P=0.007）.Conclusions Intra-operative puncture biopsy is simple and accurate for qualitatively differentiating various types of pancreatic masses.Three to 4 biopsies could significantly improve the diagnostic effect for pancreatic masses,even if the masses are less than 25 mm in size.

Percutaneous Puncture Biopsy and Treatment Using Lo-cal Injection of Prednisolone for Solitary Esosinophilic Granuloma of the Skull.

The authors reported 8 cases of solitaty eosinophilic granuloma of the skull proved by percutaneous aspiration biopsy and treated with local prednisolone injection under fluoroscopic guidance and palpation with excellent results.