[The multisystem deformities features of Klippel-Feil syndrome patients combined with congenital scoliosis].

Objective: To summarize the characteristics of multisystem deformities in patients with Klippel-Feil syndrome (KFS) combined with congenital scoliosis (CS). Methods: Within the framework of the "Deciphering Disorders Involving Scoliosis and Comorbidities (DISCO)" research collaboration, a retrospective analysis was conducted on patients diagnosed with KFS and CS at Peking Union Medical College Hospital between April 2005 and August 2022. Patient data, including imaging examinations and medical records, were collected to summarize the spinal and associated deformities. Results: A total of 82 KFS patients with concurrent CS were included, comprising 42 males and 40 females. The average age was (12.8±8.9) years. Among the KFS patients, there were 31 cases of Type Ⅰ, 12 cases of Type Ⅱ, and 39 cases of Type Ⅲ. The most common location for the major curve of scoliosis was the mid-thoracic segment (42 cases, 51.2%). Hemivertebrae deformities were most frequently observed in the upper thoracic segment (31 cases, 60.8%). There were no statistically significant differences in age, gender, major curve Cobb angle, or region of hemivertebrae occurrence among the different types of KFS (all P>0.05). Apart from spinal vertebral deformities, intraspinal deformities had the highest comorbidity rate (33 cases, 40.2%). The subjects were divided into two groups based on the presence or absence of intraspinal deformity (absence as group G0, presence as group G1), there was a statistically significant difference in the main Cobb angle [M(Q1, Q3)] between the two groups, which was 45.0° (27.5°, 62.0°) and 60.0° (37.5°, 83.5°), respectively (P=0.044). Additionally, a portion of the patients had concurrent cardiovascular system abnormalities (13 cases, 15.9%), craniofacial-ocular-auricular abnormalities (8 cases, 9.8%), genitourinary system abnormalities (7 cases, 8.5%), and gastrointestinal abnormalities (2 cases, 2.4%). Conclusions: Patients with KFS combined with CS commonly present with a major curve of spinal deformity in the mid-thoracic segment and often have comorbidities involving multiple systems. When combined with intraspinal anomalies, the major curve exhibits a greater degree of curvature.

[Long-term efficacy evaluation of coated metal stent implantation for ureteroscopic lithotripsy related refractory ureteral stricture].

OBJECTIVE: To comprehensively evaluate the long-term efficacy and safety of coated metal stent implantation for ureteroscopic lithotripsy related refractory ureteral stricture (URL-rUS). METHODS: Electronic medical records of 30 patients (31 affected renal units) receiving coated metal stent implantation for URL-rUS from Sept. 2018 to Aug. 2021 at Peking University People' s Hospital were reviewed for analysis. Coated metal stents were implanted in retrograde approach via ureteroscope. Last outpatient follow-up was set as endpoint. Baseline information, stricture characteristics and decompression strategy before coated metal stent implantation were retrospectively collected. Serum creatinine (Scr) concentration and renal pelvis width (RPW) were used as renal function indicators. Peri-operative and long-term complications and according outcomes were recorded. For the patients who had double J tubes implanted for drainage before operation, Ureteral Stent Symptom Questionnaire (USSQ) was applied to evaluate the stent-related discomforts and quality of life (QoL) before and after surgery. Data analysis was conducted with SPSS (version 25.0; SPSS, Chicago, IL, USA). RESULTS: Totally 30 patients with 31 affected renal units were included. All the patients previously underwent unsuccessful traditional endoscopic balloon dilation or endoureterotomy before receiving coated metal stent implantation. The mean age was (45.5±9.3) years old. The median follow-up time were 14 (6-36) months. All coated metal stents were successfully placed with a median duration of 60 (30-195) min. No severe peri-operative complications occurred. At endpoint, 28 (90.3%) sides of coated metal stents remained unobstructed with a longest indwelling time of 36 months. Causes of failures included stent migration (1 case, 3.2%), encrustation (1 case, 3.2%) and repeated stent related urinary tract infection (1 case, 3.2%). When compared with the baseline, significant reductions were observed in both Scr concentration and RPW at endpoint [(90.7±19.5) mmol/L vs. (83.1±18.5) µmol/L, P < 0.01, for Scr; (2.5±1.3) cm vs. (1.9±0.8) cm, P < 0.01, for RPW], indicating good preservation of renal function and remission of hydronephrosis. For 26 patients with double J stents before operation, significant reduction of USSQ average score (100.4±6.6 vs. 82.1±4.9, P < 0.01) evidenced better life quality preserving ability of coated metal stent versus double J stent. CONCLUSION: Coated metal stent implantation is a safe and minimally invasive management of ureteral stricture providing a satisfying long-term patency rate, after which the patients' quality of life and renal function could be both improved. This method could serve as a promising alternative long-term maintenance treatment option for patients with URL-US, especially when traditional endoscopic interventions failed.

[Urodynamic and histological evaluation of cyclophosphamide-induced bladder pain syndrome in SD rats].

OBJECTIVE: To establish a model of bladder pain syndrome in SD rats by cyclophosphamide intraperitoneal injection, to evaluate the effectiveness of the model from the urodynamic and histological levels, to lay a zoological foundation for the clinical study of bladder pain syndrome, and to further guide clinical treatment. METHODS: Thirty-two 8-week-old SD rats were randomly divided into 4 groups, including acute test group, acute control group, chronic test group, and chronic control group, with 8 rats in each group. The acute test group received intraperitoneal injection of cyclophosphamide 150 mg/kg immediately after the measurement of urodynamic data on the first day, and urodynamic examination was performed again 2 days later. After that, the rats were sacrificed to obtain bladder tissue. In the chronic test group, after measuring the baseline data of urodynamics on the first day, cyclophosphamide 75 mg/kg was intraperitoneally injected on the first, fourth, and seventh days, and the rats were sacrificed after measuring the urodynamic data again on the eighth day to obtain bladder tissue. The acute control group and the chronic control group were injected with the same amount of normal saline during intraperitoneal injection, and the urodynamic testing time point were consistent with the corresponding test groups. Histopathological changes of the bladder were assessed by HE staining. RESULTS: In each acute and chronic group, there were no intragroup differences in baseline urodynamic levels between the test and control groups. The urodynamic maximum bladder volume was significantly reduced in the acute test group after administration(t=-2.961, P < 0.05), histologically, severe interstitial edema, obvious inflammatory cell infiltration, mucosal edema and submucosal hemorrhage, and partial urothelium were absent could be seen, which were consistent with acute cystitis performance. The urodynamic maximum bladder capacity was significantly reduced in the chronic test group after administration (t=-3.886, P < 0.05), and the bladder compliance was lower than that in the control group, but not significant, the histological manifestations were urothelial exfoliation, interstitial edema, submucosal hemorrhage, infiltration of inflammatory cells such as lymphocytes, and dense vascular distribution. CONCLUSION: In the acute test group, a single intraperitoneal injection of cyclophosphamide could induce acute bladder inflammation in the rats. In the chronic test group, repeated injections of cyclophosphamide could induce histological changes in chronic inflammation of chronic bladder pain syndrome in the rats. But the bladder function was not significantly impaired.

[Therapeutic effects of sacral neuromodulation on detrusor underactivity].

OBJECTIVE: To evaluate the effects of sacral neuromodulation (SNM) on detrusor underactivity (DUA). METHODS: From December 2019 to April 2020, 6 patients with DUA who had been treated with SNM were assessed retrospectively. The average age was 58 years (46-65 years), with 3 males and 3 females. All the patients were diagnosed with DUA by urodynamics examination. Obstruction of bladder outlet was excluded through the cystoscopy. No patient had the history of neurological disease. All the patients were placed with the bladder colostomy tube before SNM. One female patient accepted the trans-urethral resection of bladder neck. Two male patients accepted the trans-urethral resection of prostate. All the 3 patients had no improvement of void symptom after the urethral operation. Before SNM, the average 24 h times of voiding was 23.8 (18-33), average volume of every voiding was 34.2 mL (10-50 mL), average residual volume was 421.7 mL (350-520 mL). The preoperative and postoperative 24 h urine frequency, average voided volume, and average residual urine volume were compared respectively. RESULTS: Totally 6 patients underwent SNM with stage Ⅰ procedure. The operation time for stage Ⅰ procedure was 62-135 min (average 90 min). After an average follow-up of two weeks, stage Ⅱ procedure was performed on responders. Four patients accepted stage Ⅱ procedure (conversion rate 66.7%), the other two patients refused the stage Ⅱ procedure because the urine frequency did not reach the satisfied level. But all the patients had the improvement of residual urine volume. For the 4 patients at the follow-up of 10-15 months, the improvement of void was still obvious. For the all patients after stage Ⅰ procedure, the average 24 h urine frequency reduced to 13.5 times (9-18 times, P < 0.001), the average voided volume increased to 192.5 mL (150-255 mL, P < 0.001), and the average residual urine volume reduced to 97.5 mL (60-145 mL, P < 0.001). No adverse events, such as wound infection or electrode translocation were detected during an average follow-up of 11.3 months. Only one of the 4 patients who received the stage Ⅱ procedure did the intermittent catheterization for one time each day. CONCLUSION: SNM provides a minimal invasive approach for the management of DUA.

[Analysis of broadband sinusoidal harmonic acceleration test results for normal young people].

Objective: We tested more frequency (0.01-3.0 Hz) of the sinusoidal harmonic acceleration test(SHAT) by the NKI rotation chair, aimed to analyze the results of the normal youth. Methods: Fifty normal young people were tested with sinusoidal harmonic acceleration by NKI rotation chair. Including 24 men and 26 women, aged from 20 to 40 years old, with median age of 27 years, with no vestibular dysfunction participated in the present study. All the volunteers accepted the sinusoidal harmonic acceleration test by the NKI rotation chair, the frequency included 0.01 Hz, 0.02 Hz, 0.03 Hz, 0.05 Hz, 0.1 Hz, 0.2 Hz, 0.3 Hz, 0.6 Hz, 1.0 Hz, 1.5 Hz, 2.0 Hz, 3.0 Hz. Taken the gain, phase, and asymmetry as the parameters, the trait of each frequency was analysed. Results: From 0.01 Hz to 1.5 Hz, the gain increased close to 1 gradually, and with fluctuates slightly at the 2.0 Hz and 3.0 Hz frequencies. The phase decreased as frequencies increased close to 0 at 0.3 Hz. The frequency above 0.6 Hz presented negative. Asymmetric values were distributed on both positive and negative sides at each frequency and were different from each other, both values were less than 20%. Conclusion: Broadband SHAT can accurately assess the horizontal semicircular canal function at different frequencies in a wider frequency range, and objectively, reflect the physiological function of the horizontal semicircular canal, and expand the clinical value of traditional SHAT.

[Initial clinical experience and follow-up outcomes of treatment for ureteroileal anastomotic stricture with Allium coated metal ureteral stent].

OBJECTIVE: To summarize the initial clinical experience and follow-up results of the treatment for ureteroileal anastomotic stricture after radical cystectomy with Allium coated metal ureteral stent. METHODS: From September 2018 to September 2019, 8 patients with ureteroileal anastomotic stricture after radical cystectomy underwent Allium ureteral stent insertion in Peking University People's Hospital and People's Hospital of Daxing District. The preoperative renal pelvis width under ultrasound was collected to evaluate the postoperative hydronephrosis, creatinine and urea nitrogen (BUN) before and after surgery, perioperative infection, and stent-related complications. The serum creatinine and BUN, renal pelvis width under ultrasound, urography and abdominal plain film (KUB) were reviewed at the end of 1, 3, and 6 months and annually postoperatively to observe the stent position and morphology. The long-term stent patency rate, complication rate, renal function and hydronephrosis were followed up and analyzed. The t-test or rank-sum test was used to compare the measurement data of the matched sample from the preoperative to the last follow-up. RESULTS: In the study, 6 cases (7 sides) were ureteral ileal conduit stricture, and 2 cases (3 sides) ureteral orthotopic neobladder stricture. Before surgery, 5 patients underwent long-term indwelling of a single J ureteral stent, with an average indwelling time of (20.6±8.8) months and an average replacement frequency of (3.6±1.3) months/time. The mean width of renal pelvis was (26.5±9.1) mm on preoperative renal ultrasonography. Among them, 6 patients were successfully indwelled with Allium coated metal ureteral stent by retrograde approach, and 2 patients by combination of double-endoscopy and ante-retrograde approach. No surgery-related complications during perioperative period were observed. The mean follow-up period was 9.8 months and Allium stent and ureter remained unobstructed in all the patients at the last follow-up without replacement or removal. Compared with preoperative data, the mean width of renal pelvis and mean blood urea nitrogen (BUN) in the last follow-up period were significantly reduced [(26.5±9.1) mm vs. (13.4±2.5) mm, P=0.008; (11.6±2.3) mmol/L vs. (10.2±2.2) mmol/L, P=0.017], however, there were no significant differences in the average serum creatinine or hemoglobin (P>0.05). Ureteroileal anastomotic re-stricture and other stent-related complications were not observed in all the patients by antegrade urography. CONCLUSION: Allium coated metal ureteral stent could be used for the treatment for ureteroileal anastomotic stricture, which could maintain relatively long-term patency rate and protect renal function. The indwelling time was longer and it could improve quality of life of patients.

[Long-term analysis of safety and efficacy of standard percutaneous nephrolithotomy in patients with solitary kidneys].

OBJECTIVE: To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones. METHODS: The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function. RESULTS: In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) µmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) µmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) µmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%. CONCLUSION: This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.

[Primary development of visual uroflow scale].

OBJECTIVE: To develop the visual uroflow scale (VUS), analyze the relationship of VUS score and index of free uroflowmetry, assess urination function preliminarily and improve the work efficiency in the clinic. METHODS: Male lower urinary tract symptoms (LUTS) patients, who attended the Department of Urology in Peking University People's Hospital from March 2016 to March 2017, were assessed for their urination function according to the Visual Uroflow Scale without help from clinicians before undertaking a free uroflowmetry test. And afterwards, a free uroflowmetry was undertaken, and variables including maximal flow rate (Qmax), the average flow rate (Qave) and voiding volume (VV) was obtained. During the study, 124 cases were collected and 53 cases met the inclusion and exclusion criteria and were included in the study cohort. The Spearman correlation analysis was used for analyzing the correlation of VUS scores with free uroflowmetry variables and age. The validity of VUS was evaluated. RESULTS: Most of the patients could choose the very figure matched with self-condition by first instinct without any help from the clinician. The data were analyzed by Spearman correlation analysis. In the present study, voiding time was positively correlated with the VUS score (correlation coefficient, 0.62, P < 0.05). In the present cohort, the patients chose the third and fourth figures to take longer time to urinate, implying worse LUTS situation. Flow time and VUS scores were positively correlated (correlation coefficient, 0.61, P < 0.05). The patients with higher VUS scores would spend more time on urinate, no matter how long urinary hesitation was. Both Qmax and Qave were negatively correlated with the VUS score (correlation coefficient －0.54, －0.62, P < 0.05). The study illustrated that the VUS score suggested that the Qmax basically and further reflected the urination function. And its relationship to age revealed the decreased urination function of aging male, which had reached a consensus. CONCLUSION: Development of VUS has helped the clinician assess the urination function preliminarily at the first time. Patients are assessed for a VUS score before getting surgery or receiving the drug for treatment, and can be re-assessed after. The VUS score can provide an objective quantitative basis to evaluate the treatment efficacy. In addition, considering that it is convenient, timesaving and easy to understand, the VUS is available for follow-up.

[Investigation on a cluster epidemic of COVID-19 in a supermarket in Liaocheng, Shandong province].

Objective: To explore clustered epidemic of COVID-19 in Liaocheng city and analyze infection status and chain of transmission of the cases. Methods: A joint investigation team of emergency response for COVID-19 epidemic by CDC professional workers of Liaocheng city and district at two levels on January 30, 2020. According to a indicator case from ZH supermarkets, close contacts and related subjects were tracked and screened on February 1, including ZH supermarket employees, family members having contact history with related cases during January 13-26, supermarket clients during January 16-30 and family members of related cases. an epidemiological investigation was carried on and their swab of nose/throat were collected and were sent to Liaocheng CDC laboratory, real-time fluorescence quantitative RT-PCR was used to detect nucleic acids of SARS-CoV-2. Results: a total of 8 437 people were screened during January 30 to February 9, 2020 (120 employees of supermarket, 93 family members, and 8224 clients of supermarket). The epidemic was caused by ZH cases and brought clustered cases in four families. A total 25 cases of SARS-CoV-2 infection, the total infection rate of subjects was 0.30% (25/8 437) with 22 confirmed cases (0.26%, 22/8 437) and 3 asymptomatic patients (0.04%, 3/8 437), asymptomatic patients accounted for 12.00% (3/25) of all infection cases. The infection rates of supermarket employees, family members of confirmed cases and supermarket clients were 9.17% (11/120), 12.90% (12/93) and 0.02% (2/8 224). Conclusions: This was a cluster epidemic caused by one imported case of COVID-19 in a supermarket of Liaocheng city. Prevention and control of cluster epidemic should be focused on chain of community transmission and family cluster cases. It must also be an attention for transmission risk of asymptomatic patients.

[Urodynamic classification of male patients with symptoms of overactive bladder and the outcome classification].

OBJECTIVE: To introduce a urodynamic classification of male patients with symptoms of overactive bladder (OAB) and discuss its clinical significance in practice. METHODS: From January 2015 to January 2017, there were 181 male patients from Peking University People's Hospital who were diagnosed clinically with OAB and underwent preoperative urodynamic test. Finally 126 male patients were enrolled in the research. Male OAB patients could be stratified into four groups based on the chief complaints (whether or not presenting urgency) and the results of urodynamic test (whether or not presenting detrusor overactivity and the ability to stop the involuntary contraction). The contents of this follow-up study included the basic information, the preoperative and postoperative scores of the OAB symptom score (OABSS), the preoperative and postoperative scores of the international prostate symptom score (IPSS), and the amount of the concomitant diseases. RESULTS: According to the classification, the amounts of the four types of OAB patients were 32 (25.40%) for type I, 27 (21.43%) for type II, 59 (46.83%) for type III, and 8 (6.35%) for type IV, respectively. The data of their heights showed no statistical significance (P>0.05). The ages, weights and the amount of the concomitant diseases of type IV were obviously higher than those of the other three types (P<0.05). And the ages, weights and the amount of the concomitant diseases of the other three types had shown no statistical significance (P>0.05). The improvement of the OABSS and IPSS scores of the type IV were obviously inferior to the other three types (P<0.05). The improvements of the OABSS and IPSS scores of type III were obviously higher than those of the other three (P<0.05). The discrepancy of the OABSS and IPSS scores of type I and type II had shown no statistical significance (P>0.05). CONCLUSION: Type IV has the worst outcome and type III has the best among the four types of OAB. And this classification system will certainly have a profound significance in guiding and directing our clinical diagnosis and treatments, and evaluating the prognosis of the patients with OAB.

[Outcome of surgical management and pathogenesis of female primary bladder neck obstruction].

OBJECTIVE: To investigate the effect of transurethral resection of bladder neck on primary female bladder neck obstruction and to analyze the expression of three kinds of sex hormone receptor (SR) in female bladder neck tissues diagnosed as primary bladder neck obstruction by the immunochemistry and statistics. METHODS: The clinical data of 40 female patients, admitted into Peking University People's Hospital for difficulty of voiding during Oct.2008 and Dec.2013 and eventually diagnosed as bladder outlet obstruction (BOO) by urodynamics, were retrospectively reviewed. BOO was defined as a maximum flow rate (Qmax) less than 12 mL/s together with a detrusor pressure at maximum flow rate (Pdet Qmax) more than 25 cmH2O in urodynamic study in the absence of neurological disorders. Diagnosis was confirmed by the cystoscopy. Preoperative and postoperative AUASS scores were recorded and analyzed for observation of curative effects and complications. The immunochemical expression of SR of primary female bladder neck obstruction (PBNO) tissues and normal control was examined and applied to statistical analysis. RESULTS: There were significant changes postoperatively in voiding scores, storage scores and total scores (P<0.001). Postoperatively, 1 patient newly presented with overactive bladder (OAB), 4 patients newly presented with hematuria, and 1 patient underwent cystostomy. The symptoms of urinary retention with overflow incontinence in 2 patients disappeared after the surgery, and 3 patients complicated with OAB complained without urgency. In addition, pre-hydronephrosis improved postoperatively in six patients. The subjective satisfactory rate to the surgery of TURBN was 77.5% (31/40). Sex hormone receptor, including androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR), expressed in both bladder neck tissues of normal control and PBNO patients. In PBNO group, the expression of PR was significantly lower than that of control group (P<0.05), while the other 2 SRs expressed with no significantly statistical difference. PBNO patients were divided into 2 groups, according to their symptoms scores, and the expression of SRs showed no significant differences among the mild, moderate and severe groups (P>0.05). CONCLUSION: The transurethral bladder neck resection is valid in treating with female PBNO patients, with rarely occurrence of complications. PR expressed less in the female bladder neck tissues, and is possibly correlated with the occurrence of female PBNO.

[Objective characteristics of nystagmus in patients with posterior semicircular canal benign paroxysmal positional vertigo].

Objective: To analyze and discuss the parameters and clinical significance of nystagmus in patients with benign positional paroxysmal vertigo (BPPV) of posterior semicircular canal. Methods: The subjects of the study were 564 BPPV patients diagnosed with posterior semicircular canal canalithis (PSC-can) from January 2016 to July 2017 in Tianjin No.1 Central Hospital, including 186 males and 378 females, with a median age of 57 years. The induced nystagmus in Dix-Hallpike test was recorded by video nystagmuo graph(VNG), and the direction, latency, duration time and intensity characteristics of nystagmus were compared with the position of hanging and sitting.SPSS17.0 software was used for statistical analysis. Results: Vertical torsional nystagmus was both induced with the position of hanging and sitting during Dix-Hallpike test. The vertical direction of the induced nystagmus was upward and downward respectively. The latency, duration time and intensity of lesion side were L(2.65±1.92; 1.44±1.24), D(14.90±10.46; 15.28±8.06), and P(29.75±21.26; 14.08±9.48). The latency and intensity in hanging position were higher than those of sitting. The intensity rate was about 2∶1, with statistically significant difference (t=13.831, and 17.296, P all<0.01). The direction of the induced nystagmus was opposite to turning in HSC-Can BPPV. The intensity turning to normal side was larger than lesion side obviously. The intensity rate was about 2∶1, the difference was statistically significant (t=17.296, P<0.01). There was no statistical difference of nystagmus during time between the two positions(t=-0.735, P>0.05). Conclusions: The nystagmus intensity rate in Dix-Hallpike test between hanging and sitting position of lesion side in PSC-Can is 2∶1, which conforms to the Ewald's law. The direction, latency and intensity of nystagmus can be used as a reference index for the localization diagnosis of PSC-Canotolith.

[Analysis of urodynamic study of female outpatients with lower urinary tract symptoms and follow-up of the patients with detrusor underactive].

OBJECTIVE: To find out the prevalence of lower urinary tract symptoms (LUTS) and analyze the characteristics of the urodynamics diagnosis in female outpatients. To study the natural history of detrusor underactive (DU) by the followed up. METHODS: A retrospective study of the female LUTS outpatients in Peking University People's Hospital from Jan. 2005 to Dec. 2015 was performed. The basic information and the urodynamic results of a total of 656 female outpatients were collected. The distribution of storage symptoms, voiding symptoms, complications and urodynamic diagnosis were analyzed. The symptoms and urodynamic results were compared among the groups, which were divided according to age, urodynamic diagnosis and diabetes mellitus. A follow-up of 163 female DU outpatients was performed, including the treatments and the American Urological Association symptoms scores (AUAss). RESULTS: Frequency (25.03%) is the most common symptom in female outpatients, followed by stress urinary incontinence (20.04%), urgency (19.97%), and difficulty of voiding (17.32%). Stress urinary incontinence (SUI) accounted for the first (36.04%) of the whole outpatients, followed by the DU (24.08%), and bladder outlet obstruction (17.58%). The patients aged 51-60 years occupied the peak of almost all the diagnosis. There was a higher proportion of the young female patients than that of the middle and old patients diagnosed with no abnormal after the urodynamic study. The first, strong, urge and maximum bladder capacity were significantly larger in DU patients with diabetes than without diabetes. Follow-up results of the DU patients showed there was no significantly difference of the AUAss scores in both the two groups before and after the follow-up, but the quality of life decreased significantly. CONCLUSION: Female LUTS outpatients showed a main complaint of storage symptoms. SUI ranked the first in female patients with LUTS. With the increase of age, bladder sensation and detrusor function decrease. In elderly patients, DU became the first ranked disease instead of SUI. Diabetes can affect the sensory function of bladder in patients with DU, and then increase the difficulty of voiding. The patients with DU, absent from treatment, experienced a lower quality of life.

[Long-term follow-up of the efficacy of tension-free vaginal tape and trans-obturator tape for different types of stress urinary incontinence].

OBJECTIVE: To evaluate the long-term efficacy of tension-free vaginal tape (TVT)and trans-obturator tape (TOT)for different types of female stress urinary incontinence (FSUI). METHODS: The clinical data of all female patients with stress urinary incontinence (SUI) who underwent mid-urethral slings (MUS) in Peking University People's Hospital from January 2008 to June 2016 were retrospectively analyzed, and all the patients were followed up. Based on the level of abdominal leak point pressure (ALPP), the patients with ALPP lower than or equal to 60 cmH2O (1 cmH2O=0.74 mmHg) were regarded as intrinsic sphincter deficiency (ISD) type, and the patients with ALPP higher than 60 cmH2O were regarded as non-ISD type. According to the degree of remission of leakage of urine by using the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), the surgical outcomes were divided into three categories: cured, improved or failed. The efficacy of TVT and TOT for different types of FSUI was evaluated by comparing the cure rate of TVT with the cure rate of TOT in ISD type and non-ISD type separately. RESULTS: A total of 170 patients were included in this study. The patients were among 30-78 years, and the follow-up period were among 12-110 months. In the study, 117 patients belonged to non-ISD type. Of whom 30 underwent TVT with a cure rate of 86.7% (26/30), and the other 87 underwent TOT with a cure rate of 69.0% (60/87). The cure rate of TVT was higher than that of TOT in non-ISD type, however, Chi-square test showed that there was no significant difference (χ2=3.589, P>0.05). In addition, 53 patients belonged to ISD type, of whom 16 underwent TVT with a cure rate of 87.5% (14/16), and the other 37 underwent TOT with a cure rate of 51.4% (19/37). The cure rate of TVT was higher than that of TOT in ISD type, and Chi-square test showed that the difference was statistically significant (χ2=6.212, P<0.05). CONCLUSION: For the treatment of FSUI, MUS can achieve satisfactory long-term efficacy. For non-ISD type, the cure rates of TVT and TOT are similar, while for ISD type, the cure rate of TVT is higher than that of TOT.

[Comparison of effectiveness and complications between two different methods of augmentation cystoplasty].

OBJECTIVE: To compare the effectiveness and complications between enterocystoplasty and small intestinal submucosa (SIS) cystoplasty through follow-ups of patients with augmentation cystoplasty in Peking University People's Hospital, offering alternative approach for future treatment. METHODS: In this study, retrospective analyses were carried out in 10 patients who underwent enterocystoplasty or SIS cystoplasty in Peking University People's Hospital from November 2011 to December 2016. Clinical data were collected including medical history, surgical procedures, laboratory examinations and complications. And then regular follow-ups were developed. Ten patients were separated into groups of enterocystoplasty (n=6) and SIS cystoplasty (n=4), to compare their outcomes. RESULTS: Ten patients all completed the follow-up interview. Five cases underwent augmentation cystoplasty with sigmoid colon, one with ileum and four with SIS cystoplasty successfully. The mean operative time was (302.0±66.6) min, and blood loss was (167.0±135.0) mL. The outcomes of the group of SIS cystoplasty were better in respects of the time of operation, intestinal function recovery, postoperative hospitalization duration and drainage removal. The average scores of American Urological Association symptom score (AUASS), overactive bladder syndrome score (OABSS), International Consultation on Incontinence questionnaire short form (ICI-Q-SF), and O'Leary-Sant Questionnaire were all improved in two groups. Two cases carried clean intermittent self catheterazion and two used long-term indwelling catheter. There were three patients with dilations of renal pelvises and ureters consistently or during bladder was filling preoperatively, and the situations were not going bad after the operations. The short-term complications included two cases of postoperative infection, one case of mild intestinal obstruction and one case of metabolic acidosis. The long-term complications included one case of ureteroinstestinal anastomosis strictures, three of urinary tract infection and one of long-term metabolic acidosis. CONCLUSION: Enterocystoplasty and SIS cystoplasty are both effective operations to improve symptoms and protect upper urinary function, with no severe complications. Cystoscopic results showed satisfactory mucosa regeneration after SIS cystoplaty in refractory interstitial cystitis/painful bladder syndrome. But the number of patients included were quite small and the follow-up period was not long enough. Prospective control study of larger number of patients with longer follow-ups are expected to find out the effectiveness and safety of SIS cystoplasty.

[The characteristics of semicircular canal injury frequency in vestibular neuritis patients].

Objective:To evaluate the frequency characteristics of semicircular canal injury in patients with vestibular neuritis. Method:Fifty-three patients with vestibular neuritis were respectively evaluated by caloric test(CT)，head shaking test(HST),video head impulse test (vHIT),which reflects semicircular canal function in the low, middle, high frequency region. The asymmetric value of CT unilateral semicircular canal reaction (UW), head shaking nystagmus induced by HST, gain value of VHIT (VHIT-G) and presence or absence of saccade (VHIT-S) were used as observation indicators. The data were analyzed by SPSS 17.0 statistical software.The characteristics of the results of the three tests in patients with vestibular neuritis was analyzed and the functional status of the high, middle and low frequency regions of the semicircular canal was evaluated. Result:The positive rates of CT, HST, VHIT-G and VHIT-S in 53 patients with vestibular neuritis were 94.3%（50/53）,75.5%（40/53）,81.1%（43/53）,96.2%（51/53）,respectively. The positive rates of CT, HST, VHIT-G and VHIT-S were 92.9%（26/28）,89.3%（25/28）,92.9%（26/28）,96.4%（27/28）in 28 cases with disease course ≤ 7 days, and the positive rates in 25 patients with disease course >7 days were 96.0%（24/25）,60.0%（15/25）,68.0%（17/25）,96.0%（24/25）,respectively. Compared with the positive rate of each index, CT and VHIT-G (P=0.076), HST and VHIT-G (P=0.480) had no statistical significance. The difference between CT and HST (P=0.015), VHIT-G and VHIT-S(P=0.032) was statistically significant. The positive rates of CT, HST, VHIT-G and VHIT-saccade in patients with course of disease ≤7 days were compared, and there was no significant difference. In patients with disease course >7 days, except HST and VHIT-G, there were statistical differences in other indexes. The correlation test between VHIT-G and VHIT-S：r=-0.437, P=0.006. Conclusion:The vestibular injury in patients with vestibular neuritis showed in a manner of full frequency injury. The multi-frequency detection technique is helpful for the clinical diagnosis of vestibular neuritis, and also can reflect the compensation and recovery of vestibular function.

[The nystagmus characteristics of two positions of the horizontal semicircular canal cupulolithiasis].

Objective: To analyze the characteristics of nystagmus of horizontal semicircular canal cupulolithiasis(HSC-Cup) in Roll test and Dix-Hallpike test. Methods: Between December 2016 and December 2017, a total of 164 patients with BPPV from Tianjin First Center Hospital, 124 HSC-Can BPPV and 40 HSC-Cup BPPV, were involved.The induced nystagmus in Roll test and Dix-Hallpike test were recorded by video-nystagmograph(VNG), whose direction and intensity characteristics were compared in various BPPV. Results: HSC-Can patients were induced a horizontal nystagmus with Roll test, the nystagmus intensity of the disease and healthy side were (41.3±20.1)°/s (mean standard deviation)and(21.9±9.4)°/s respectively, the difference was statistically significant (t=6.709, P<0.05). HSC-Cup patients were induced a horizontal nystagmus that was opposite to the direction of the Roll test, the nystagmus intensity of the disease and the healthy side were (12.9±6.4)°/s and(29.1±9.3)°/s respectively, with significant difference (t=9.066, P<0.05). Among 124 cases of HSC-Can patients, 120 cases of horizontal nystagmus were recorded in the left and right sides of the Dix-Hallpike test in the same direction as the turning direction, the horizontal nystagmus intensity of the disease and the healthy sides were (15.1±10.0)°/s and(9.4±7.4)°/s respectively, the difference was statistically significant (t=2.365, P<0.05). And 40 cases of HSC-Cup patients were recorded at the head of the Dix-Hallpike test in the opposite direction to the horizontal eye earthquake.The horizontal nystagmus intensity of the disease and the healthy side were (5.3±2.8)°/s and(13.9±4.4)°/s respectively, the difference was statistically significant (t=10.579, P<0.05). Conclusions: Characteristic horizontal nystagmus can be induced by HSC-Cup in both roll test and Dix-Hallpike test. Preliminary localization of Dix-Hallpike Test can also be used for HSC-Cup.

[The characteristics and clinical significance of vestibular autorotation test in patients with vestibular migraine].

Objective: To investigate the characteristics and clinical utility of vestibular autorotation test (VAT) in patients with vestibular migraine(VM). Methods: This study included two groups, a VM group (441 patients from Tianjin First Center Hospital between January 2015 and May 2016) and a control group (65 healthy subjects). Both groups undertook VAT; the parameters evaluated were horizontal gain/phase, vertical gain/phase and asymmetry. The differences in VAT results between the two groups were investigated. Results: There were statistically significant differences in VAT results between the VM and the control group, namely elevated horizontal gain at frequency 2, 3, 4 and 5 Hz, delay horizontal phase at frequency 2, 4, 5 and 6 Hz, elevated vertical gain at frequency 2-6 Hz and delay vertical phase at frequency 4-6 Hz. There was no significant difference in asymmetric values between the VM group and the control group. Conclusions: The results of this study indicate that VM patients have elevated horizontal gain and vertical gain, and delay horizontal phase and vertical phase. It is suggested that VAT represents a useful diagnostic tool which may provide objective evidence for the diagnosis and differential diagnosis of VM.

[A pilot study of the unilateral centrifugation subjective visual vertical in healthy young people].

Objective: To evaluate the data of unilateral centrifugation subjective visual vertical (UC-SVV) in healthy young people.To study the function of utricle. Methods: Between Decem ber 2017 and May 2018, thirty-two healthy young volunteers were tested by static subjective visual vertical(SVV) and low velocity UC-SVV with Neuro Kinetics Inc I-portal 6.0 Video nystagmus recording system and NOTC rotating chair system.The static SVV preset angle were -15.00°, 15.00°, -20.00°, 20.00°, -12.00° and 12.00° respectively.UC-SVV test parameters: rotating chair's peak speed was 60°/s.The shift time from the middle to the lateral position was 30 s and the displacement was 3.85 cm.The chair rotated at 60 s at left, right and middle positions.Subjects underwent SVV during this period.SPSS 17.0 software was used to analyze the data. Results: The mean and standard deviation of static SVV deviation in 32 volunteers was 0.21°±0.17°, 95%CI (-0.14°, 0.55°). The mean and standard deviation of UC-SVV in the left, middle and right positions of the clockwise was 0.24°±0.25°, -0.10°±0.27°, -0.63°±0.26°, 95%CI(-0.26°, 0.74°), (-0.65°, 0.44°), (-1.16°, -0.10°). The mean and standard deviation of UC-SVV in the left, middle and right positions of the counter clockwise was 0.03°±0.27°, -0.11°±0.26°, -0.23°±0.26°, 95%CI(-0.52°, 0.59°), (-0.65°, 0.42°), (-0.76°, 0.30°). There was significant difference in the deviation between the left and the right side of counter clockwise rotation of UC-SVV(t=2.432, P<0.05), however, there was no significant difference in the angle of deviation between the left and right sides and the median position(t value was 0.951, -1.400, both P>0.05). There was no significant difference among each position in clockwise rotation of UC-SVV(F=0.253, P>0.05). Conclusion: UC-SVV test with peak speed of 60°/s can cause vertical line deviation in the left and right lateral position, but the angle is small and the value of clinical application is limited.

[Cytotoxic effects of γδT cells on bladder cancer cells and expression of MICA/B in bladder cancer].

OBJECTIVE: To explore the role of γδT cells against bladder cancer and to detect the expression of stress proteins MICA/B recognized by γδT cells in bladder cancer. METHODS: γδT cells from peripheral blood drawn from 6 bladder cancer patients with pamidronate stimulating were expanded. Flow cytometry was used to detect the purity and expansion folds of γδT cells, and the expression of CD107a on γδT cells after PMA/ionomycin stimulated. The cytotoxicity assay was carried out to test the cytotoxicity of γδT cells against human bladder cancer cell lines. The expression of MICA/B on bladder cancer cell lines and in bladder cancer tissues were detected through flow cytometry and immunohistochemistry respectively. RESULTS: γδT cells from peripheral blood drawn from 6 bladder cancer patients were successfully expanded. The purity was 75%-94% and the expansion folds were 109-371 times. After being stimulated by PMA/ionomycin, the proportion of CD107a+ γδT cells increased significantly, reaching 40%-82%. γδT cells from the 6 bladder cancer patients showed obvious cytotoxic effects on 3 human bladder cancer cell lines which was enhanced as the effector: the target ratio increased. MICA/B were detected both in 3 bladder cancer cell lines and in 26 bladder cancer tissues. The staining score of MICA/B in invasive bladder cancer was slightly higher than that in non-invasive bladder cancer, and in advanced bladder cancer was higher than that in low grade bladder cancer, but the statistical analysis showed that the staining score of MICA/B was no significant correlation between the tissue and the tumor stages and grades. CONCLUSION: γδT cells from the peripheral blood of the bladder cancer patients could be successfully expanded in vitro, and showed significant anti-bladder cancer effect. MICA/B were detected both in bladder cancer cell lines and in bladder cancer tissues. The statistical analysis showed that there was no significant correlation between the staining scores of MICA/B in the tissue and the tumor stages and grades.