Objective To investigate the application of 3D printing technique in percutaneous nephrolithotomy (PCNL) of patients with complicated kidney stones. Methods From January 2015 to December 2017, 60 patients with complicated kidney stones were enrolled in the First Affiliated Hospital of Hebei North University for prospective study, and PCNL was proposed.All the patients were randomly divided into 3D print group (30 cases) and conventional image inspection group (30 cases, control group). Before operation, CT urography (CTU) was used in both groups.In 3D printing group, digital imaging and communications in medicine (DICOM) files of CT were extracted for 3D image postprocessing, and thermoplastic materials were used to print 3D model.In the 3D printing group, the digital imaging and communications in medicine (DICOM) files of CT were extracted for 3D image post-processing, and the 3D model was printed with thermoplastic materials.According to the comprehensive planning of 3D kidney model, a virtual safe and reliable percutaneous renal access was established for each patient, and PCNL was executed.The patients in the two groups were compared before, during and after operation.Preoperative: age, sex, body mass index, blood creatinine, stone size and CT value.During the operation: (1) the target renal calices location time; (2) the conformity between the preoperative planning and the actual operation; (3) the operation completion time.After operation: (1) stone removal rate; (2) hemoglobin reduction level; (3) postoperative recovery. Results All the 60 patients successfully completed the operation, 30 patients successfully printed out the 3D model, which can accurately express the relationship between the stone and the adjacent anatomical structure, the internal renal artery and the collecting system.Positioning time of 3D printing group in target renal calices((2.9 ± 1.5) min vs.(5.8 ± 1.7) min, P=0.023), coincidence between simulated and actual puncture calices((89.5 ± 3.5)% vs.(60.2 ± 5.7)%, P=0.005), postoperative stone removal rate ((89.9 ± 4.5)% vs.(75.9 ± 5.2)%, P=0.009), and hemoglobin levels((1.4 ± 0.5) g/L vs.(2.9 ± 1.4) g/L, P=0.032) were superior to the control group, and the difference was statistically significant.But there was no significant difference between the two groups (all P>0.05). Conclusion The 3D printed kidney model truly restores the anatomical details around the kidneys and stones, providing a stereoscopic and intuitive way to perform surgery, so it maybe has a significance guidance for percutaneous nephrolithotomy. Key words: Kidney stones; Percutaneous nephrolithotomy; Kidney model; Surgery simulation

Objective To study the correlation of serum monokine induced by IFN-γ(Mig)and interleukin9(IL-9) levels to HBV pre-C/BCP mutation and their influences on the response to interferon therapy in patients with HBeAg-positive chronic hepatitis B(CHB). Methods A total of 110 cases of HBeAg-positive CHB patients in the People′s Hospital of Jianyang City were retrospectively analyzed from February 2015 to February 2018, and all received pegylated-IFN-αtherapy.Before treatment, the gene fragment of HBV pre-C/BCP region was amplified and the patients were divided into two groups: wild type group (61 cases) and mutant group (49 cases). The difference of serum MIG, IL-9 and antiviral treatment effect between the two groups were compared. Results The serum IL-9 of mutant group before treatment ((10.8±1.9) ng/L)was significantly higher than that of wild group((8.3±1.7) ng/L) (P 1 lg 10 in mutation group before treatment was significantly higher than HBsAg decrease≤1 lg 10 ((129.2±37.9) ng/L vs.(91.5±25.7) ng/L)(P<0.05). The serum IL-9 in the mutant group were(8.8±1.9) ng/L and (8.9±1.6) ng/L at 12 and 24 weeks after treatment respectively, which were significantly lower than that before treatment (all P<0.05). Conclusion The high expression of IL-9 in serum of CHB and HBeAg positive patients before treatment is closely related to the variation of HBV pre-C/BCP region, and the expression of IL-9 is not related to the antiviral effect of interferon.The high expression of MIG in patients before treatment may be more beneficial to the antiviral effect of interferon in patients with HBV pre-C/BCP region variation. Key words: Chronic hepatitis B; Hepatitis B virus pre-C/BCP mutation; Pegylated-IFN-α; Interleukin 9; Monokine induced by IFN-γ

Coronary angiography is the core technology in the diagnosis and treatment of coronary heart disease. The left main coronary artery (LMCA), which supplies most of the left ventricular myocardium, is the key segment of the coronary network, but because of its special anatomical characteristics, it limits the value of coronary angiography in the diagnosis. Intravascular ultrasound, as an invasive tomographic technique, has been widely used in clinic to assist coronary angiography, and its value in diagnosis and treatment of left main artery disease has been recognized by most studies. Key words: Left main artery; Intravascular ultrasound; Percutaneous coronary intervention

Objective To explore the clinical effect of endoscopic assisted or microscopical transsphenoidal surgery in the treatment of different grades of invasive pituitary tumors and the measures to reduce complications. Methods From January 2016 to June 2019, 87 patients with pituitary tumor admitted to the neurosurgery of Tangshan People′s Hospital of Hebei Province were selected as the study objects for retrospective analysis. Among them, 42 patients were included in the endoscopic group and 45 patients were included in the endoscopic group. To compare the related indexes and clinical effects of two different surgical methods, and to analyze the treatment strategies to reduce the common postoperative complications. Results The amount of intraoperative bleeding, the time needed for operation and the hospital stay of patients in endoscopic group were significantly less or shorter than those in microscopical group(intraoperative bleeding volume: (66.19±9.55) ml and (79.78±11.68) ml; operation time: (93.93±9.53) min and (103.33±9.23) min; hospitalization time: (7.71±1.53) d and (10.16±1.33) d). The difference was statistically significant (T values were 5.92, 4.67, 7.94, all P< 0.01). There was no significant difference between the two groups (P= 0.577). There were 2 cases (4.8%) of cerebrospinal fluid leakage in endoscopic group and 12 cases (26.7%) in microscopical group. The difference between the two groups was statistically significant(χ2=5.67, P< 0.05). There were 7 cases (16.7%) of diabetes insipidus in endoscopic group and 22 cases (48.9%) in microscopical group. The difference between the two groups was statistically significant (χ2=5.19, P< 0.05). Conclusion The curative effect of endoscopic transsphenoidal resection of pituitary tumor is similar to that of microscopical resection of pituitary tumor. The patients recover quickly, have fewer complications, and have a short hospital stay. Key words: Neuroendoscopy; Microscope; Pituitary tumor; Complication

Objective To compare the advantages of nano carbon suspension mapping method and non dye method in the number of axillary lymph nodes detected during axillary lymph node dissection and axillary micro lymph nodes detected after neoadjuvant chemotherapy for breast cancer. Methods From January 1st, 2018 to July 1st, 2018, 66 breast cancer patients who were to undergo axillary lymph node dissection after new adjuvant treatment were selected for the prospective study.Using the method of random number table, the patients were randomly divided into two groups: the group of nano carbon mapping (33 cases) and the control group (33 cases). After 24 hours subcutaneous injection of nano carbon before operation, axillary lymph node dissection and direct axillary lymph node dissection without dye were used.The number of axillary lymph nodes and the number of micro axillary lymph nodes in the two groups were observed. Results The number of axillary lymph nodes and micro lymph nodes in the nano carbon mapping group were higher than those in the control group.The differences were statistically significant (the number of axillary lymph nodes were (19.3±6.2) vs (14.9±6.7), P=0.007; the number of micro-lymph nodes were 2.0(0.5, 3.0) vs 0(0, 1.0), Z=-4.328, P<0.001). Conclusion Nano carbon suspension mapping can increase the number of lymph nodes detected in axillary lymph node dissection after neoadjuvant chemotherapy for breast cancer, and also has advantages in the detection of some small axillary lymph nodes that are not easy to find. Key words: Breast cancer; Carbon nanoparticle suspension; Axillary lymph node dissection; Micro-lymph nodes; Neoadjuvant chemotherapy

Objective To investigate the detection of neutrophil gelatinase related lipid carrier protein (NGAL), alpha fetoprotein (AFP), leucine aminopeptidase (LAP), alpha L fucosidase (AFU) in primary liver cancer (PHC) individually and jointly The diagnostic value of cancer (PHC). Methods From January 2015 to December 2017, 124 patients with primary liver cancer from the third people′s Hospital of Yunnan Province were selected as PHC group, 53 patients with cirrhosis treated at the same time as benign group A, 37 patients with liver cyst as benign group B, and 64 healthy volunteers as healthy group. The serum AFU, LAP, NGAL and AFP of four groups of subjects were detected by rate method, immunoturbidimetric method and electrochemiluminescence method respectively. The diagnostic efficacy of PHC detected by different combinations of indicators was analyzed by receiver operating characteristic curve (ROC). Results There were significant differences in serum AFP, AFU, LAP levels and positive expression rates between PHC group, benign group A, group B and healthy group(F values were 56.832, 38.209, 23.415, respectively; χ2 values were 69.324, 72.568, 24.695, respectively; all P<0.05), and the serum AFP, AFU, LAP levels and positive expression rate were significantly higher in the PHC group than in the benign group A, group B and healthy group, the difference was statistically significant( all P<0.05); sensitivity of AFP+ AFU+ LAP combined detection(89.27% vs.72.17%, 73.52%, 76.31%, 81.35%, 80.69%, 86.87%), specificity(95.76% vs.81.58%, 82.79%, 84.16%, 86.95%, 94.23%, 93.29%) and the Yoden index (0.85 and 0.54, 0.56, 0.60, 0.68, 0.75, 0.80) are superior to their one indicator (LAP, AFU, AFP) and two indexes combined detection(LAP+ AFU, LAP+ AFP, AFU+ AFP). ROC curve analysis showed that the AUC(0.94) combined with AFP+ AFU+ LAP was greater than LAP+ AFU(0.78), LAP+ AFP(0.85) and AFU+ AFP(0.89). Conclusion Combined detection of AFP, AFU and LAP can effectively improve the diagnosis efficiency of PHC and reduce missed diagnosis. Key words: Primary hepatic cancer; Lipid carrier protein; Alpha fetoprotein; Leucine aminopeptidase; α-L-Fucosidase; Diagnosis