To investigate the relationship between S.T.O.N.E. nephrolithometry scoring system with stone clearance rate and postoperative complications, and to evaluate its ability to predict postoperative stone clearance rate and complications after percutaneous nephrolithotomy (PCNL).

The clinical data of 120 patients with renal calculus who underwent PCNL from July 2017 to December 2017 in our hospital were selected. The patient's general condition, stone characteristics, operation status and perioperative parameters were analyzed. Each patient was scored according to S.T.O.N.E nephrolithometry scoring system,the relationship between patient scores and stone clearance rate, postoperative complications, estimated blood loss, and postoperative hospital stay were analyzed.

The overall stone clearance rate was 85.5% (102/120), the complication rate was 6.7% (8/120), and the average S.T.O.N.E. score was (7.6±1.1). The mean S.T.O.N.E. score of the stone free group and the stone residual group was (7.5±1.1) and (8.3±1.1), respectively. The difference between the S.T.O.N.E. scores of the two groups was statistically significant (Z=-2.426,P=0.015). The stone score were correlated with stone clearance rate(OR=2.740,P<0.05) and with operative time(r=0.419,P<0.05), but not correlated with postoperative complications(r=0.050,P>0.05), estimated blood loss(r=0.100,P>0.05), total hospital stay(r=0.065,P>0.05) and postoperative hospital stay(r=0.050,P>0.05).

The stone clearance rate after PCNL is correlated with S.T.O.N.E. score, however, there was no significant correlation between S.T.O.N.E. score with the incidence of postoperative complications.

To evaluate the relationship between diffusion weighted imaging visual signal intensity and quantitative signal intensity of cell renal cell carcinoma (CCRCC) and histopathological differentiation of CCRCC.

This retrospective analysis included 91 patients with CCRCC confirmed by pathology. All patients were grouped according to the Fuhrman pathological grading system, from Ⅰto Ⅵ. Four grades were merged into three classifications consisting of 37 well-differentiated CCRCCs (Ⅰ and Ⅱ), 32 moderately-differentiated CCRCCs (Ⅲ) and 22 poorly-differentiated CCRCCs (Ⅳ). Magnetic resonance examinations of MR plain scan, LALA dynamic enhanced scan and DWI (1.5T, b value: 800 sec/mm²) were performed. The each visually signal intensity of CCRCC was evaluated and quantitative signal intensity of CCRCC was measured. The Kruskal-Wallis test was used to compare DWI visual signal intensity between the three different histopathological groups. ANOVA was used to compare SI values between the three different histopathological groups. Spearman correlation analysis was used to analyze the correlation between histopathological differentiation of CCRCC and DWI visual signal intensity and SI values. ROC analysis was performed to evaluate the diagnostic efficiency of SI values.

43.9% of CCRCC appeared as obviously hyperintense, 30.8% of CCRCC appeared as moderate hyperintense, and 25.3% of CCRCC appeared as isointense/slight hyperintense to the surrounding renal parenchyma. There was a significant difference between obviously hyperintense and isointense/slight hyperintense in histopathological differentiation (P<0.05). There was no significant difference between isointense/slight hyperintense and moderate hyperintense, and between moderate hyperintense and obviously hyperintense in histopathological differentiation (P>0.05).There was a moderate negative correlation between visually signal intensity and histopathological differentiation of CCRCC (r_s=-0.552; P<0.01). There was a significant difference in DWI signal intensity value among well- differentiated、moderately-differentiated and poorly-differentiated CCRCC (P<0.05). The SI value of moderately differentiated CCRCC was lower than that of poorly-differentiated CCRCC and there was significant difference between the SI value of moderately-differentiated and poorly-differentiated CCRCC. There was a significant negative correlation between SI value and histopathological differentiation of CCRCC (r=-0.711; P<0.01). The ROC curve showed the optimal cutoff point of SI value was 273.7 in diagnosing well-differentiated CCRCC. Taking 273.7 as the threshold value, sensitivity and specificity of differential diagnosis was 67.6% and 98.2%, respectively. The ROC curve showed the optimal cutoff point of SI value was 378.9 in diagnosing poorly-differentiated CCRCC. Taking 378.9 as the threshold value, sensitivity and specificity of differential diagnosis was 91.3% and 59.1%, respectively.

CCRCC tended to show a higher visual signal intensity and quantitative signal intensity on DWI with decreasing histopathologicaldifferentiation (P<0.05). DWI had some practical value in predicting histopathogical differentiation of CCRCC using signal intensity and quantitative signal intensity.

To evaluate R.E.N.A.L. nephrometry score for transperitoneal laparoscopic partial nephrectomy (TLPN).

Between July 2010 and October 2016, 67 cases (52 males and 15 females) underwent TLPN. Mean age was (56±13) years, mean tumor size was (2.5 ± 0.8) cm in diameter, 32 cases (48%) on the left side and 35 cases (52%) on the right side. R.E.N.A.L. nephrometry score were evaluated in tumor size, warm ischemia time, intraoperative blood loss, operation time, preoperative and postoperative creatinine and hospitalization days.

Sixty-seven patients were successfully completed TLPN, no conversion to open surgery and deaths. Mean R.E.N.A.L.score was (6.3± 1.7). 37 cases(55%), 24 cases(36%) and 6 cases(9%) were enrolled in low, moderate and high score group, respectively. There were significant differences between patients of different R.E.N.A.L.score groups in tumor size (F=5.230, P=0.008). There was no difference in warm ischemia time, intraoperative blood loss, operation time, preoperative and postoperative creatinine and hospitalization days (P>0.05).

In patients with T1a kidney tumor undergoing TLPN, the value of R.E.N.A.L. nephrometry score is limited in clinical application.

To found a score system to estimate operation difficulty and surgical complexity of adrenal tumors.

A retrospective single-center analysis was made in 466 patierts with adrenal tumors who underwent retroperitoneal laparoscopic surgery by the same surgeon. The adrenal tumor score system (ATS) was based on the quantization of the following independent variables: size of the tumors, boundary with surrounding organs, boundary with abdominal great vessels, endocrine function and body mass index, which were associated with operation time and the amount of bleeding after screening, and a clinical validation was performed for the score system.

By univariate and multivariate Logistic regression analysis in 466 cases of adrenal tumor, size of the tumors, boundary with surrounding organs, boundary with abdominal great vessels, endocrine function and body mass index were all associated with operation time and the amount of bleeding (P<0.01). A correlation existed between ATS and operation time, blood loss during operation (P<0.01). And there were significant differences among high, moderate and low complexity groups.

ATS system covering all the major factors that influence operation difficulty and surgical complexity of adrenal tumors, has important clinical value of surgical treatment.