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Objective:To study the learning curve in laparoscopic left lateral hepatic sectionectomy.Methods:The clinical data of 62 consecutive patients who underwent left lateral hepatic sectionectomy by a single operator from February 2015 to May 2022 in General Hospital of Northern Theater Command were retrospectively analyzed. There were 22 males and 40 females, with mean ±s.d. of (50.7±11.7) years. The learning curve was depicted and evaluated by using the cumulative summation test. The general information, operation and postoperative indicators of the growth level group and the master level group were compared.Results:The average operation time of the 62 consecutive subjects was (172.9±70.1) minutes. Intraoperative blood loss was 100 (50, 200) ml. Two patients were converted to open hepatectomy. Clavien-Dindo grade I postoperative complications occurred in 20 patients (32.3%), with grade Ⅱ in 1 patient (1.6%) and grade Ⅲb in another patient (1.6%). The learning curve reached its highest point on the 20th patient by using the cumulative summation test. The study subjects were then assigned into the growth level group (patient 1-20) and the master level group (patient 21-62). The master level group had a significantly wider spread of patient age [(52.9±11.0) years vs (46.1±11.9) years], decreased operation time [(146.8±55.6) min vs (227.9±66.7) min], shortened drainage tube removal time [4(3, 5) d vs 6(4, 7) d] and decreased postoperative hospital stay [5(5, 7) d vs 6.5(4, 9) d] (all P<0.05) when compared with the growth level group. Conclusion:Left lateral hepatic sectionectomy was safe and feasible, and a single operator went through a learning curve of 20 patients before he/she could master the operation more proficiently.
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Objective:To explore the clinical application of magnetic foreign body extractor in metal foreign body of upper digestive tract children.Methods:The clinical data of 115 children with metallic foreign bodies in the upper digestive tract who were admitted to the Department of Pediatrics, the Second Affiliated Hospital of Air Force Medical University, from January 2017 to September 2022, were selected as subjects.All the metallic foreign bodies were removed by a self-made metallic foreign body extractor in the department.The clinical characteristics of the metallic foreign bodies in the upper digestive tract were comprehensively analyzed by using descriptive analysis methods, summarize the age, gender, metallic foreign body type, number of the metallic foreign bodies, incarcerated location, retention time, clinical symptoms and complications.Results:A total of 115 children with metallic foreign bodies in the upper digestive tract were included in the analysis, involving 51 males and 64 females, with a mean age of (3.63±2.28) years.The majority was children aged 0-3 years (68/115, 59.1%). Coins (86 cases, 74.8%) were the major foreign bodies in metal foreign body of upper digestive tract, followed by button batteries (11 cases, 9.6%), magnetic balls (8 cases, 7.0%), and others (10 cases, 8.6%). The main clinical symptoms were nausea, vomiting, abdominal pain, chest pain, and foreign body sensation, and button battery ingestion and magnetic balls were easy to produce complications.The primary retention sites of metallic foreign bodies were the gastric fundus (75 cases, 65.2%), followed by upper esophageal segment (38 cases, 33.0%) and lower esophageal segment(2 cases, 1.7%).Conclusions:In children′s metal foreign body of upper digestive tract, coins are the most common foreign bodies that are easily retained in the stomach fundus.Button batteries are prone to cause severe complications and should be removed timely.The self-made metallic foreign body extractor in our department can remove coins, batteries, magnetic balls, nails, chains, party emblems and other metallic foreign bodies.It can shorten the operation time, improve the removal efficiency, and featured by active search, strong adsorption, no mucosal damage and removal with the endoscope, which can be widely used in the clinical treatment of metallic foreign bodies.
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Objective:To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy and establish the risk graph model of pancreatic fistula.Methods:The clinical data of 147 patients undergoing pancreaticoduodenectomy from Jan. 2018 to Jan. 2021 in Department of Hepatobiliary Surgery of Northern Theater Command General Hospital were retrospectively analyzed. The independent risk factors for postoperative pancreatic fistula were determined by univariate and multivariate analysis, and the linear graph model for predicting individual pancreatic fistula was drawn. The area under the subject operating characteristic curve was used to evaluate the model differentiation, the calibration curve was used to evaluate the model calibration, and finally the clinical application value of the model was evaluated by the clinical decision curve (DCA) .Results:The incidence of pancreatic fistula was 38.1%, including grade B pancreatic fistula in 49 cases and Grade C pancreatic fistula in 7 cases. Univariate analysis showed that operation method, body mass index (BMI), pancreatic texture, pancreatic duct diameter and lesion location were the related factors for postoperative pancreatic fistula. Multivariate analysis showed that BMI>25 kg/m 2, pancreatic soft texture, pancreatic duct diameter ≤3 mm and non-pancreatic diseases were independent risk factors for postoperative pancreatic fistula. According to the results of multiple factors, a prediction model of the nomogram was drawn, and the area under the subject operating characteristic curve of the model was calculated as AUC=0.792 (95% CI: 0.718-0.867). The calibration curve was drawn through internal verification of re-sampling, and the fitting curve swung around the 45° reference line, showing a high calibration degree; Clinical decision curve (DCA) analysis showed that the threshold probability was between 15% and 75% for maximum net benefit. It had good clinical application value. Conclusions:BMI>25 kg/m 2, soft pancreas, pancreatic duct diameter ≤3 mm and non-pancreatic diseases are independent risk factors for pancreatic fistula after pancreaticoduodenectomy. The established line graph model has good predictive efficiency and can effectively predict the occurrence of postoperative pancreatic fistula.
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Objective:To quantitatively evaluate the risk of recurrence in patients with secondary hyperparathyroidism after parathyroidectomy. Methods:The clinical data of 168 patients who underwent parathyroidectomy（PTX） from June 2017 to May 2019 were collected. The prediction model was constructed by using Akaike information criterion（AIC） to screen factors. A total of 158 patients treated with PTX from June 2019 to September 2021 were included in the validation set to conduct external validation of the model in three aspects of differentiation, consistency and clinical utility. Results:The prediction model we constructed includes different dialysis methods, ectopic parathyroid gland, the iPTH level at one day and one month after surgery, the number of excisional parathyroid and postoperative blood phosphorus. The C index of external validation of this model is 0.992 and the P value of the Calibration curve is 0.886[KG0.5mm]1. The decision curve analysis also shows that the evaluation effect of this model is perfect. Conclusion:The prediction model constructed in this study is useful for individualized prediction of recurrence after PTX in patients with secondary hyperparathyroidism.
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Humans , Parathyroidectomy/methods , Parathyroid Hormone , Retrospective Studies , Hyperparathyroidism, Secondary/surgery , Parathyroid Glands , Recurrence , CalciumABSTRACT
Objective:To evaluate the role of adiponectin in sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial ischemia/reperfusion (I/R).Methods:Thirty SPF healthy adult male wild-type C57 mice, aged 8-10 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using a random number table method: sham operation group (group Sham), myocardial I/R group (group MI/R) and sevoflurane pretreatment group (group SP). Another 10 SPF healthy male adiponectin knockout SPF mice, aged 8-10 weeks, weighing 20-25 g, were selected and served as APNKO group.Myocardial I/R was induced by 30 min occlusion of anterior descending branch of left coronary artery followed by reperfusion.In SP and APNKO groups, sevoflurane pretreatment included 3 cycles of 10-minute inhalation of 2% sevoflurane-93% O 2-5% CO 2 interspersed with 15-minute inhalation of 95% O 2-5% CO 2, and then the model was established.At 1, 2 and 4 days of reperfusion, cognitive function was assessed by Morris water maze test. Results:There was no significant difference in swimming velocity at each time point between the 4 groups ( P>0.05). Compared with group Sham, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group MI/R ( P<0.05). Compared with group MI/R, the escape latency was significantly shortened, and the frequency of crossing the original platform was increased at each time point in group SP ( P<0.05). Compared with group SP, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group APNKO ( P<0.05). Conclusion:Adiponectin is involved in the process of sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial I/R.
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Objective:To study the value of ultrasound-guided endoscopic retrograde appendicitis therapy in children with uncomplicated appendicitis.Methods:This study was a single center, retrospective study, including all electronic cases of appendicitis diagnosed clinically in Department of Pediatrics, the Second Affiliated Hospital of Air Force Military Medical University from October 2018 to October 2020 and received ultrasound-guided endoscopic retrograde appendicitis therapy.The clinical features, treatment and prognosis of the children were retrospectively analyzed.Results:A total of 152 electronic cases were included, there were 77 males and 75 females, aged(6.84±3.09) years.All the 152 children were treated with ultrasound-guided endoscopic retrograde appendicitis therapy.Intubation success rate and clinical success rate was 98.03%(149/152 cases)and 97.99%(146/149 cases), respectively.The median time of endoscopic therapy was 42.50 (31.00, 56.00) minutes.Mean postoperative hospital stay was (2.81 ±1.41) days, and the mean total hospital stay was (4.19 ±1.71) days.A total of 139 patients were followed up with a median follow-up time of 5 (1, 26) months.During the follow-up, the recurrence rate was 7.19%(10/139 cases), and the median time of recurrence was 2 (1, 3) months.Conclusions:Ultrasound-guided endoscopic retrograde appendicitis therapy had high effective rate and low recurrence rate in children with uncomplicated appendicitis, preserved the physiological function of appendix and avoided radiation damage.It can be used as a safe and effective treatment for acute and chronic uncomplicated appendicitis in children.
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In recent years, the increasingly frequent contact between humans and wild animals, coupled with the continuous mutation and evolution of pathogenic microorganisms, has led to a continuous increase and frequent outbreaks in emerging infectious diseases (EIDs), which has posed big threats and challenges to the global public health. On the occasion of the next outbreak of EIDs, it is hoped that the two major questions of "what is the pathogen" and "where does the pathogen come from" can be answered accurately and quickly through the rational use of relevant technical methods, so as to timely and effectively warn and control the outbreak of EIDs from the source. This article summarizes the pathogen identification and traceability analysis techniques of current emerging infectious diseases, and discusses the advantages and disadvantages of various technologies and their respective application fields.
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The aim of this study is to evaluate the application of carbon nanoparticle lymphatic tracer in total thyroidectomy and bilateral Central District's thyroidectomy for papillary thyroid carcinoma. Sixty-four patients with cN0 papillary thyroid carcinoma that primary treated were random divided into two groups: Trial group and control group. Carbon nanoparticles suspension was injected into the thyroid gland of trial group patients.After ten minutes, total thyroidectomy plus bilateral central neck dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. The control group underwent total thyroidectomy plus bilateral central neck dissection. Total lymph node and parathyroid gland in the black stained tissue，and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.Total lymph node, the mis-cut parathyroid glands in the adipose tissue of central lymph node，post-operative blood calcium and parathyroid hormone（PTH）of two groups were contrasted and analyzed. There are 235 lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group.No parathyroid gland was found in the black-stained tissue.Five lymph nodes and 2 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 164 lymph nodes and 9 parathyroid glands in central compartment dissection specimen of control group. There is statistic difference between the number of lymph nodes in black stain tissue and that of control group（=8.291, =0.000）.Rate of staining lymph node were 97.9 percent. No parathyroid glands were found in the black stained tissue. Nine mis-cut parathyroid glands（7.0%） were observed in the control group，while 2（1.6%） in the trial group（<0.05）.None permanent hypocalcemia and PTH decrease were observed in the two groups.There were 10 patients（31.3%） with temporary hypocalcemia and 9 patients（28.1%）with temporary PTH decrease respectively in the control group，and there was 1 patient（3.1%） and 1 patient（3.1%） respectively in the trial group（<0.05）. The effect of nano-carbon is ideal, and the parathyroid gland can not be stained black. It can distinguish the thyroid tissue from the surrounding lymphoid adipose tissue and clearly mark the Central District lymph nodes, reduce the risk of parathyroid gland injury during thyroid cancer. Neck dissection in the central region can improve the efficiency of lymph node dissection, protect the parathyroid gland and reduce the risk of postoperative complications.
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Nowadays, ionizing radiation has become one of the risk factors for human healthy. Exploring effective protective strategies are important topics in radiological medicine. Timely using of the radiation protection agents are the most direct and effective medical protective strategy for reducing the damage of ionizing radiation to normal tissues of the body. A large number of new radiation protective agents based on mechanisms such as scavenging of free radicals, promoting DNA damage repair, inducing hypoxia of irradiated tissues and blocking bystander effect have been developed gradually. This review summarizes a variety of radiation protective agents, and their potential molecular biological mechanisms reported in recent years, to provide theoretical reference for exploring novel medical protective agents of ionizing radiation.
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Objective:To observe the variation of glutamate(AMPA) receptor interacting protein(GRIPs)and apoptosis of oligodendrocyte precursor cells (OPCs)under oxygen glucose deprivation (OGD) condition, so as to explore the role of GRIPs in AMPA receptor-induced excitotoxic injury.Methods:OPCs were divided into control group, 60 min OGD group and 120 min OGD group.Real-time polymerase chain reaction (PCR) and Western blot were used to detect the mRNA and protein expressions of GRIP1 and GRIP2 under OGD conditions.OPCs were divided into blank control group, OPCs+ OGD group, OPCs+ cyclic adenosine monophosphate(cAMP)+ OGD group, OPCs+ cAMP+ OGD+ GRIP1 small interfering RNA(siRNA) group, OPCs+ cAMP+ OGD+ GRIP1 siRNA negative control group, OPCs+ cAMP+ OGD+ GRIP2 siRNA group, OPCs+ cAMP+ OGD+ GRIP2 siRNA negative control group again, and terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL) kit was used to detect the apoptosis of each group.Fluo-4 fluorescent probe was used to measure the changes of intracellular free calcium.Results:OGD caused damage to OPCs, and the light microscope showed that the cell contour was not clear and the cell body retracts.The expressions of GRIP1 (1.233±0.060 vs.1.003±0.079, P<0.05) and GRIP2 (1.396±0.069 vs.1.001±0.037, P<0.05) were significantly higher than those in control group after 60 min of OGD was, and the longer the period of OGD, the higher the expression levels of GRIP1 (1.416±0.064 vs.1.233±0.060, P<0.01) and GRIP2 (1.680±0.018 vs.1.396±0.069, P<0.01) were.When GRIP1 and GRIP2 were down-regulated, the level of intracellular free calcium ion decreased(0.054±0.003 vs.0.074±0.003, P<0.01; 0.060±0.003 vs. 0.074±0.003, P<0.01), and the apoptosis rate decreased as well [(20.703±3.882)% vs.(11.470±1.679)%, P<0.05; (19.070±1.106)% vs.(14.448±0.849)%, P<0.01]. Conclusions:GRIP1 and GRIP2 are involved in the damage of OPCs that are caused by OGD, which may trigger AMPA receptor-mediated excitotoxicity by regulating Ca 2+ permeability.
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Objective@#The aim of this study is to evaluate the application of carbon nanoparticle lymphatic tracer in total thyroidectomy and bilateral Central District's thyroidectomy for papillary thyroid carcinoma.@*Method@#Sixty-four patients with cN0 papillary thyroid carcinoma that primary treated were random divided into two groups: Trial group and control group. Carbon nanoparticles suspension was injected into the thyroid gland of trial group patients.After ten minutes, total thyroidectomy plus bilateral central neck dissection was performed in the all patients. The black stained tissue in the dissection specimen of trial group was separated. The control group underwent total thyroidectomy plus bilateral central neck dissection. Total lymph node and parathyroid gland in the black stained tissue，and non-black stained tissue in the central compartment dissection specimen of trial group and central compartment dissection specimen of control group were counted respectively.Total lymph node, the mis-cut parathyroid glands in the adipose tissue of central lymph node，post-operative blood calcium and parathyroid hormone（PTH）of two groups were contrasted and analyzed.@*Result@#There are 235 lymph nodes in the black-stained tissue of central compartment dissection specimen of trial group.No parathyroid gland was found in the black-stained tissue.Five lymph nodes and 2 parathyroid glands were found in the non-black stained tissue of central compartment dissection specimen of trial group. There were 164 lymph nodes and 9 parathyroid glands in central compartment dissection specimen of control group. There is statistic difference between the number of lymph nodes in black stain tissue and that of control group（t=8.291, P=0.000）.Rate of staining lymph node were 97.9 percent. No parathyroid glands were found in the black stained tissue. Nine mis-cut parathyroid glands（7.0%） were observed in the control group，while 2（1.6%） in the trial group（P<0.05）.None permanent hypocalcemia and PTH decrease were observed in the two groups.There were 10 patients（31.3%） with temporary hypocalcemia and 9 patients（28.1%）with temporary PTH decrease respectively in the control group，and there was 1 patient（3.1%） and 1 patient（3.1%） respectively in the trial group（P<0.05）. @*Conclusion@#The effect of nano-carbon is ideal, and the parathyroid gland can not be stained black. It can distinguish the thyroid tissue from the surrounding lymphoid adipose tissue and clearly mark the Central District lymph nodes, reduce the risk of parathyroid gland injury during thyroid cancer. Neck dissection in the central region can improve the efficiency of lymph node dissection, protect the parathyroid gland and reduce the risk of postoperative complications.
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Objective@#To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP.@*Methods@#We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken.@*Results@#The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml. The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative. 4 weeks after surgery, no signs of urethral stricture were observed in urethrography. And the maximum flow rate was >15 ml/s in 13 cases, while 3 cases was 10-15 ml/s. The mean maximum flow rate in postoperative was [(20.4±7.3) ml/s], which was significantly higher than that in preoperative (t=7.7602, P<0.05). B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume <30 ml. All patients had no serious complications such as urinary fistula, urethral diverticulum and extravasation of urine. After 1 year of follow-up, 1 patient was lost to follow up, and none of the remaining15 cases had urethral obstruction due to re-stricture.@*Conclusion@#Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP.
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Objective@#To investigate the tumor necrosis factor receptor superfamily 1B gene (TNFRSF1B) polymorphism in relation to the outcomes of hepatitis C virus (HCV) infection.@*Methods@#One thousand six hundred and forty-five cases without HCV infection, 545 cases with HCV clearance, and 783 cases with chronic HCV infection were enrolled. TaqMan probe method was used to investigate genotype rs1061622 (T > G) and rs1061624 (G > A). Two single nucleotide polymorphisms (SNPs) sites were genotyped and haplotypes were constructed to evaluate their relation with the outcome of HCV infection.@*Results@#Logistic regression analysis showed that there was no relation to the two SNPs with HCV infection susceptibility and chronicity (P > 0.05). Haplotype analysis showed that carrier TA had an increased susceptibility to HCV infection [adjusted odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.01 to 1.30, P = 0.038)]. Carrier TA and GG haplotypes were conducive to chronic HCV infection (adjusted OR = 1.28, 95% CI: 1.08 to 1.53, P = 0.006; OR = 1.31, 95% CI: 1.03 to 1.66, P = 0.026).@*Conclusion@#The combinational effects of rs1061622 and rs1061624 in TNFRSF1B gene may increase the risk of HCV chronicity and infection.
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Objective@#To explore the relationship between the tumor necrosis factor receptor superfamily members 11A (TNFRSF11A) and 11B (TNFRSF11B) gene polymorphisms and the outcome of hepatitis C virus (HCV) infection.@*Methods@#In this case-control study, 749 cases of persistent HCV infection, 494 cases of spontaneous clearance and 1 486 control subjects were included from 2008 to 2016. TaqMan-MGB probe method was used to detect the genotype of TNFRSF11A rs1805034 and TNFRSF11B rs2073617. The genotypes distribution of the two single nucleotide polymorphisms (SNP) were analyzed in different populations.@*Results@#Co-dominant model showed that individuals carrying the rs2073617 CC genotype were prone to have chronic HCV infection, compared with individuals carrying the rs2073617 TT genotype (OR=1.517, 95%CI: 1.055-2.181, P=0.024). Recessive model results showed that individuals carrying rs2073617 CC genotype were more likely to develop chronic HCV infection compared with individuals carrying rs2073617 TT or TC genotype (OR=1.435, 95%CI: 1.033-1.996, P=0.032). Additive model showed that the risk for chronic HCV infection increased with the increase of the number of rs2073617 C alleles (OR=1.204, 95%CI: 1.013-1.431, P=0.035).@*Conclusion@#The genetic polymorphism of TNFRSF11B rs2073617 might be related with the chronicity of HCV infection.
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Objective To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP.Methods We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan'an hospital affiliated to Kunming medical university retrospectively.The patients' age ranged from 58 to 75 years,with an average of 64.3 years.The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month,with an average of 3.5 months.5 cases were urethral stricture at penis segment,11 cases were urethral stricture at the junction of penis and scrotum,and the length of the narrow urethra was 2-5 cm,with an average of 3.4cm.The average maximum uroflowmetry in preoperative was (5.3 ± 2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months,5 cases were treated with intraurethral incision combined with urethral dilatation (1 or 2 times).16 cases were not effective after receiving the above treatment,so that all cases were treated with dorsal mosaic surgery with penis free flap.Subarachnoid anesthesia combined with epidural anesthesia,the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator.Incision from the ventral side of the urethra.The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body.The length of the incision was extended 0.5 cm to the normal urethral mucosa.The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea,and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse,the full thickness of the penis flap was taken,and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra),the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side,Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra,the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine,and the fascia and skin were sutured layer by layer.The 5-0 absorbable thread sutures the wound after the foreskin was taken.Results The operations were successfully completed.The operation time was 90-120 min,with an average of 102.3 min.The intraoperative blood loss was 10-30 ml.The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative.4 weeks after surgery,no signs of urethral stricture were observed in urethrography.And the maximum flow rate was ＞ 15 ml/s in 13 cases,while 3 cases was 10-15 ml/s.The mean maximum flow rate in postoperative was [(20.4 ± 7.3) ml/s],which was significantly higher than that in preoperative (t =7.7602,P ＜ 0.05).B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume ＜ 30 ml.All patients had no serious complications such as urinary fistula,urethral diverticulum and extravasation of urine.After 1 year of follow-up,1 patient was lost to follow up,and none of the remaining15 cases had urethral obstruction due to re-stricture.Conclusion Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP.
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Objective To explore the feasibility and safety of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi.Methods The clinical data of 107 patients with renal calculi treated from January 2015 to October 2018 were analyzed retrospectively.Age ranged from 18 to 55 years,with mean of (32.1 ± 5.2) years.Calculi was single,locating in the middle or upper calyx,with the diameter less than 2.0 cm,the CT value ≤ 800 HU,and mild renal hydronephrosis.All patients were routinely indwelling double-J tube using cystoscopy 2 weeks preoperatively,and ureteroscopic lithotripsy was performed.Fifty patients in group A were received tubeless treatment,and 57 patients in group B were given routinely indwelling double-J tube.The 50 patients in group A were (30.4 ± 5.9) years of age,including 33 males and 17 females,28 cases on the left and 22 cases on the right,24 cases locating in the upper calyx and 26 cases locating in the middle calyx,and calculi diameter of (1.3 ± 0.5) cm.The 57 patients in group B were (31.3 ± 5.4) years of age,including 35 males and 22 females,26 cases on the left and 31 cases on the right,27 cases locating in the upper calyx and 30 cases locating in the middle calyx,and diameter of (1.4 ± 0.4) cm.There were no significant difference in the demographics between the two groups (P ＞ 0.05).Results There were no obvious ureteral malformations,stenosis,polyps or tumors in the 107 cases intraoperatively,and the flexible ureteroscope sheath was placed smoothly.The operation time in group A [(48.2 ± 9.7) min] was significantly lower than that in group B [(51.7 ± 7.8) min,P ＜ 0.05].There was no significant difference in the calculi clearance rate between the two groups on the first day [92.0％ (46/50) vs.91.2％ (52/57)] and two weeks[96.0％ (48/50) vs.98.2％ (56/57)] after operation(P ＞ 0.05),and the calculi clearance rate reached 100％ at 1 month after operation.The incidence of hematuria in group A [24.0％ (12/50)] was significantly lower than that in group B [54.4％ (31/57),P =0.001].The incidence of bladder irritative symptoms in group A [14.0％ (7/50)] was significantly lower than that in group B [36.8％ (21/57),P =0.007].The incidence of lumbar and abdominal pain at 1 week,2 weeks and 1 month after operation was significantly lower in group A [32.0％ (16/50),8.0％ (4/50),2.0％ (1/50)] than that in group B [57.9％ (33/57),49.1％ (28/57),33.3％ (19/57),P ＜ 0.05].There was no significant difference between the two groups about the incidence of lumbar and abdominal pain at first day after operation [86.0％ (43/50) vs.84.2％ (48/57),P ＞ 0.05].Conclusions It was feasibility and safety to perform flexible ureteroscope with tubeless for the patients with renal primary and single calculi,ideal ureteral conditions (no malformations,stenosis,polyps or tumors),mild renal hydronephrosis,calculi,diameter ＜ 2.0 cm,CT value ≤ 800 HU,locating in the middle or upper calyx,and no history of urinary calculi.This procedure had not only similar calculi clearance rate compared with routinely indwelling double-J tube,but also has a lower incidence of complications (hematuria,bladder irritative symptoms,lumbar or abdominal pain).
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Objective To investigate the effects and adverse reactions of apatinib in advanced gastric cancer patients.Methods Two hundred and forty cases of advanced gastric cancer patients who had failed chemotherapy were collected from January 30,2016 to November 1,2017 in the First Hospital of Zibo City of Shandong Province and the Central Hospital of Zibo City of Shandong Province.All patients took oral apatinib mesylate,850 mg/time,1 time/d,and 28 d as 1 cycle of treatment,during which clinical efficacy,adverse reaction and progression free survival (PFS) and overall survival period (OS) were evaluated.Adopting Cox regression model to analyze risk factors of PFS and OS.Results Of all 240 patients,no patient reached complete response (CR) standard,25 patients (10.4％) reached partial response (PR) standard,113 patients (47.1％) reached stable disease (SD) standard,and 102 patients (42.5％) reached progressive disease (PD) standard.Objective response rate (ORR) and disease control rate (DCR) were 10.4％ (25/240) and 57.5％ (138/240) respectively.When apatinib was taken as a 2nd line treatment,ORR and DCR were 62.5％ (5/8) and 75.0％ (6/8) respectively;as 3rd line treatment,the result came to 13.9％ (20/144) and 67.4％ (97/144);as 4th line treatment,it was 0 and 52.4％ (33/63);as 5th line treatment,it was 0 and 8.0％ (2/25).Among the various adverse effects of apatinib,the most common ones observed were skin lesion (65.8％,158/240),fatigue (57.9％,139/240),gastrointestinal reaction (45.4％,109/240),and hypertension (38.8％,93/240).Cox multivariate analysis showed that the change of treatment time (HR =5.028,95％CI:1.130-15.771,P =0.005) and body mass index (HR =21.069,95％CI:4.521-127.116,P ＜ 0.001) were the independent risk factors of PFS.BMI change (HR =6.550,95％ CI:1.080-38.455,P =0.039) was independent risk factor of OS.Conclusion For patients with advanced gastric cancer who failed with 2nd line and above chemotherapy,oral atatinib still obtain certain DCR and survival gain.Apatinib adverse reactions are various,involving a wide range of organ systems,however are generally controllable.
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Objective To report the effects of surgical treatment of old die-punch fractures of the distal radius.Methods A retrospective study of case series was made of the 21 old die-punch fractures of the distal radius which had been surgically treated from January 2012 to January 2017 at Department of Orthopaedics,Shandong Provincial Hospital.There were 13 males and 8 females,aged from 34 to 63 years (average,46.9 years).According to the preoperative definite diagnoses by the X-ray and CT images,there were 14 metacarpal compression fractures and 7 dorsal compression fractures.The palmar approach was used in 13 cases,the dorsal approach in 7 and the combined approach in one.Autogenous iliac bone grafting was performed for all the cases.Their preoperative and postoperative Cooney scoring and visual analogue scale (VAS) of the wrist,and postoperative complications as well,were observed and recorded.Results This cohort was followed up for 8 to 14 months (average,9.2 months).All their postoperative wounds healed by the first intention.Their Cooney functional scores of the wrist were,respectively,58.5 ± 4.2 and 84.0 ± 3.1 points preoperatively and at the final follow-up,and their corresponding VAS scores 7.6 ± 0.9 and 3.4 ± 1.3 points,showing significant differences between preoperation and the final follow-up (P ＜ 0.05).Carpal arthritis was observed in one case.Conclusion For old die-punch fractures of the distal radius,surgical treatment can obviously reduce pain,improve function of the wrist and enhance the quality of life of the patients.
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OBJECTIVE:To explore new method of prescription comment in medical institutions of Chongqing under the background of"New Medical Reform",and to provide reference for prescription comment innovation and promoting rational drug use in clinic. METHODS:Through analyzing policy background of prescription comment innovation and practice,referring to experience of other regions,the achievements and problems were analyzed by developing centralized prescription comment and prescription comment information construction in municipal and regional (county-level) medical institutions of Chongqing. The countermeasures suggestion was put forward. RESULTS&CONCLUSIONS:The prescriptions of 16 municipal medical institutions were commented centrally,involving more than 300 medical records and 1600 prescriptions or medical orders. The prescriptions of 135 regional (county-level) medical institutions were commented centrally,involving more than 3100 medical records and 12100 prescriptions or medical orders."Chongqing Medical Institution Prescription Comment Key Technology Monitoring System"was established. Above measures innovated centralized prescription comment mode,improved the quality of prescription comment and promoted prescription comment informatization. There were still problems as incomplete coverage of the system,inspection to become a mere formality. It is suggested to strengthen internal quality control of medical institutions by establishing rational drug use scoring management system,developing clinical pharmacist ward round and prescription checking in advance;establish and improve third-party external comment and supervision mechanism;improve the knowledge of prescriptions comment staff in all directions so as to further standardize prescriptions and promote rational drug use in medical institutions.
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Objective To explore the application value of external fixator in obsolete hip dislocation.Methods Retrospective analysis of 9 cases of obsolete hip dislocation treated with external fixator from January 2010 to January 2017.There were 6 males and 3 females,with an average of 32.0±8.3 years old (range 19-47).The time from injury to operation was 3-9 months,with an average of 6.2± 1.9 months.The patient's limb shortening length,traction time,traction length,operation time,surgical bleeding volume,preoperative and last follow-up VAS score,Epstein score,D'Aubigne functional score were recorded.Results The length of the limb shortened 5-11cm,with an average of 6.7±2.0 cm.The preoperative traction time ranged 20-45 d,with an average of 26.9±8.2 d.The length of traction ranged 5-12 cm,with an average of 7.1±2.2 cm.The second reconstruction operation time was 2.0-4.0 hours,with an average of 2.8±0.7 h.The bleeding volume was 800-2 000ml,with an average of 1 216.7±422.8 ml.The Epstein score at the last follow-up was excellent in 4 cases,good in 4 cases and improved in 1 case.The preoperative VAS score and the final follow-up VAS score were 0.9±0.8 points and 4.6±0.9 points respectively.There was a significant difference between preoperative and postoperative VAS scores (t=8.981,P=0.000).The D'Aubigne functional scores of preoperative and final follow-up were 5.2±1.0 points and 13.1±2.0 points respectively and the difference was statistically significant (t=-12.044,P=0.000).Conclusion The external fixation in the treatment of obsolete dislocation of the hip is helpful and accepted in patients with femoral head dislocation.It is easy to carry and tract for patients and convenient for functional exercise.The external fixation makes operation simple and flexible;the traction force is strong and the effect of the femoral head reduction is obvious,the operation method is simplified and the quality of the reduction is improved.