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Objective:To explore the efficacy of pedicled bladder muscle flap in the repair of urinary tract obstruction.Methods:The data of 26 patients with urinary tract obstruction admitted to Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2016 to June 2021 were retrospectively reviewed. There were 14 males and 12 females, with the age ranged from 2 to 75 years old. Refractory bladder neck obstruction after prostatic hyperplasia surgery in 12 cases, with the age of (70.0±3.5) years old.They all experienced at least 2 times of transurethral stenosis incisionor resection. Transpubic cystostomy tube was placed in 9 patients. Posttraumatic pelvic fractures lead to bladder neck atresia and urethral injury in 6 girls, with the age of (10.5±2.1) years old. The bladder neck atresia and urethral obliteration length was 1-2 cm determined by urethrography. Eight cases suffered ureteral strictures after gynecological myomectomy or ureteroscopy holmium laser lithotripsy(4 cases of each type), including two males and six females, with the age of (55.0±3.2) years old. The length of ureteral stricture or defect was 5-6 cm determined by intravenous urography(IVU) or CT urography(CTU). The patients with bladder neck obstruction underwent the following surgery: The "Y" incision of the bladder and stenosis of the prostate urethra was performed and the pedicled bladder muscle flap was inserted into the normal urethral mucosa to complete the Y-V plasty. In the 6 girl patients, pedicled bladder muscle flap(2-4 cm) augmented reconstruction were performed. All above 18 patients, whose urethral catheter was indwelled for 3-4 weeks, urinary flow rate and urethroscopy examination were performed to evaluate the effect of surgery 4 weeks and 3 months after the operation. As the 8 cases with ureteral strictures, the pedicled bladder muscle flap (7-8 cm) ureteroplasty was performed and the ureteral stent was retained for 4 weeks. Ultrasonography and IVU/CTU were performed 4 weeks and 3 months postoperatively. The patency of the ureteral lumen and whether it is accompanied by hydronephrosis, lower back pain, and urinary tract infection were assessed.Results:All patients underwent pedicled bladder muscle flap reconstructive surgery successfully and no serious complications occurred postoperatively. The patients were followed up for (8.2± 2.2) months. As urethral catheters were removed, 10 patients with refractory neck obstruction could return to normal urination with the urinary flow Q max (17.2±2.8)ml/s, while 2 patient had dysuria and were treated with regular urethral dilatation. The catheter was removed 4 weeks after the reconstructive surgery in 6 girls with bladder neck atresia and urethral injury after posttraumatic pelvic fracture. Five could successfully urinate with the urinary flow Q max of (16.7±1.1)ml/s, and one girl had urinary incontinence, waiting for further operation.The ureteral stent was removed after ureteroplasty in 8 patients. CTU and IVU examination showed no ureters with obstruction.No one had low back pain, discomfort, or urinary tract infection. Conclusions:The reconstruction using the pedicled bladder muscle flap was a convenient, minimally invasive and effective technique for the management of adjacent lower ureters, bladder neck, and proximal urethra.
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The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.
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Objective:To investigate the clinical efficacy of lingual mucosa graft coupled penis flap urethroplasty for crippled hypospadias.Methods:Between January 2016 and August 2019, 16 patients with crippled hypospadias in Shanghai Sixth People's Hospital were included in this study. Their mean age was 35.2 years (range from 25 to 44 years). All patients presented voiding difficulty and failed after 2 or more times of urethroplasty. Their mean times was 4.6(range from 2 to 7 times). Uroflowmetry examination showed their mean Q max was 6.7 ml/s (range from 3.8 to 9.6ml/s). Chordee was found in six patients. Urethrocele was found in 2 patients. Urethrocutaneous fistula was found in 2 patients. All patients received lingual mucosa graft coupled penis flap urethroplasty. By removing the ischemic and fibrotic urethra, urethral plate was reconstructed with lingual mucosa graft and the penis flap was transplanted to cover the reconstructed urethra plate to form a new urethral lumen, which was used to repair the defective urethra. The catheters were removed three weeks after the surgery. Uroflowmetry examination, cystourethrography and cystoscope were performed after the catheters out. Results:All patients underwent smooth surgery with an average duration of 128.4 minutes (range from 105 to 150 minutes). After mean follow-up of 18.6 months (range from 3 to 30 months), successful outcome was achieved in 14 patients and uroflowmetry examination at the seventh week after surgery showed their mean Q max was 22.4 ml/s (range from 15.6 to 29.8 ml/s). 2 cases had urethrocutaneous fistula which were cured after repair of penile urethral fistula. 2 patients still had a certain level of chordee while they were satisfied with the appearance of their penis, so there was no further treatment. Conclusions:Single stage lingual mucosa graft coupled penis flap urethroplasty has short operation period, relatively high success rate and relatively few complications. Single stage lingual mucosa graft coupled penile flap urethroplasty is an available option for crippled hypospadias with several times of failed urethroplasty.
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Objective To investigate the effect of S-phase kinase-associated protein 2 antisense oligodeoxynucleotide (Skp2 ASODN) on the growth and proliferation of colorectal cancer cells SW480 and its mechanism .Methods The liposome-mediated dif-ferent concentrations of Skp2 ASODN was adopted to transfect SW480 cells ,the final concentrations of 0 .050 ,0 .125 ,0 .250 ,0 .500 , 1 .000 ,2 .000 ,4 .000 μmol/L were respectively set up with Skp2 nonsense oligodeoxynucleotides(NSODN) and blank group as con-trol .Then the inhibited effect of growth and proliferation of colorectal cancer cells were measured by the inverted microscope obser-vationandmethylthiazolyltetrazolium(MTT),thecellcyclewassurveyedbytheflowcytometry(FCM).TheexpressionofmRNA and protein of Skp2 and P27kip1 were inspected by reverse transcription-polymerase chain reaction(RT-PCR) and immunocytochem-istry methods .Results The inverted microscope observed that the SW480 cells had no change in form and grew at a slower speed . When the Skp2 ASODN concentration reached 0 .125 μmol/L ,the inhibition rate was 14 .48% (P0 .05) ,but its protein expression was elevates obviously (P<0 .01) .Conclusion Skp2 ASODN can inhibit the growth and proliferation of SW480 cells .Its possible mechanism is that the ubiq-uitin degradation of the Skp2 to P27kip1 is decreased by the gene occlusion effect of Skp2 ASODN ,thus the cell cycle progression is arrested .
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Problem-based learning(PBL) is a method of the self-study primarily and teacher' s guiding.By using the PBL in the clinical teaching application,we discuss our experience gained in carrying,out PBL and the existing problems.
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Objective To evaluate the effect of different cold preservation time on liver regeneration after partial liver transplantation in rats,and study the role of IL-6/STAT3.Methods SD rats were divided into 3 groups:group Ⅰ underwent liver resection,group Ⅱ received partial liver transplantation after one-hour cold preservation and group Ⅲ received partial liver transplantation after 8-hour cold preservation.Radioimmunoassay was used to measure the levels of TNF-? and IL-6 in liver tissues.The protein expressions of PCNA and STAT3 were assessed by immunohistochemical staining in paraffin sections.The liver regeneration ratio and the expressions of the proliferative cell nuclear antigen(PCNA)and STAT3 were compared among three groups at 1,6,12,24,48,72 and 168 h after operation.Results The remnant liver in group Ⅰ and grafts in group Ⅱ grew rapidly;The regeneration ratio in group Ⅲ was significantly lower than that in group Ⅰ and group Ⅱ during postoperative day 2 to 3(P
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Objective To dectect the expression of CD54 in thyroid tissue of Hashimotos thyroiditis patients,and expression changes of CD54 on thyroid cells interferred by different agents.Methods The thyroid tissues from 41 cases of Hashimotos thyroiditis were collected and 26 normal thyroid tissues served as normal controls.All thyroid tissues were identified by pathological examination.The positive expression rate and area of CD54 were investigated by immunohistochemical method and quantitative analysis of image analysis system in all thyroid tissues.The expression changes of CD54 in the isolated thyroid cells interferred by 100,500,1 000 pg/ml IL-1? or 10 mg/L NaI or 1 000 pg/ml IL-1? and 10 mg/L NaI for 48 h were detected by flow cytometry.Results The positive expression rate of CD54 in Hashimotos thyroiditis tissues was much more than that of control tissues(P
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Objective:To study the clinical characteristics and prognostic factors in aged patients with acute generalized peritonitis(AGP)and make the satisfactory perioperative management of them to improve the curative efficacy.Methods:63 patients aged 60 years and older with AGP under emergency laparotomy were analyzed retrospectively.Results:AGP in aged patients was mostly secondary and had non-typical clinical manifestations.Their first consultation in outpatient clinic was late and the duration from incidence of abdominal pain to operation was long(mean time 42hs and 64.9hs respectively).These patients had a lot of preoperative concomitant diseases and high morbidity(36.5%)and mortality(20.6%) postoperatively.Conclusion:The operation time,concomitant diseases,types of primary diseases.types of complications and situation of abdominal cavity are the factors affecting prognosis.The key to perioperative management should be early diagnosis,preferable treatment for concomitant diseases and early operation,meanwhile,maintaining the important organs' function and preventing and controlling the complications postoperatively are very important.
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Objective To study the effect of tumor necrosis factor(TNF) and endothelin(ET) on the formation of murine hyperdynamic circulatory syndrome(HCS).Methods Circulation stable HCS model was produced in rats by partial portal vein ligation.Portal blood TNF and ET was determined pre and post injection of anti rat TNF and hemodynamics was monitored simultaneously.Results TNF level did not change 0 5 hour after partial portal vein ligation,but it increased significantly at 24 hour and maintained at this high level thereafter. ET was on a small increment at different time after partial portal vein ligation.The TNF level decreased significantly to the level in controls and ET remained unchanged after injection of anti rat TNF,while HCS was partially ameliorated. Conclusion [WT5”BZ] TNF may be related with the start and maintenance of HCS,and there is no causality between ET and the development of HCS.
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Objective To investigate the biological effects of human gastric carcinoma cell line SGC-7901 transinfected by antisence vascular endothelial growth factor-C (anti VEGF-C) gene on the tumorigenicity and vascular generation,and explore the role of VEGF-C gene in metastasis and vascular generation of gastric cancer.MethodsThirty nude mice were randomly divided into three groups (10 each):transgenic anti VEGF-C group,transgenic pure liposome group and non-transgenic group.0.2ml (1?107/ml) of SGC-7901 suspension,either transinfected by anti VEGF-C gene,or by pure liposome,or transinfected nil,was respectively subcutaneously injected into the three groups of mice,once every 2 days for 3 consecutive days.After injection,the size and growth velocity of the neoplasm were measured.The microlymphatic vessel density (MLVD) and microvessel density (MVD) of tumor were also determined.ResultsThe neoplasm grew more slowly and was smaller in the mice of transgenic anti VEGF-C group than in non-transgenic ones.At the end of the 1st,2nd and 3rd week,the MLVD in the mice of transgenic anti VEGF-C group was 4.0?2.2,6.0?3.1 and 9.0?2.7/high field (/HF),respectively.In the transgenic pure liposome group,the MLVD was 6.0?8.7,9.0?3.5 and 18.0?7.2/HF,respectively.In the non-transgenic group,the MLVD was 7.0?4.9,9.0?6.4 and 19.0?6.5/HF,respectively.The MVD in the transgenic anti VEGF-C group was 3.0?2.4,5.0?2.1 and 8.0?1.7/HF,respectively.In the transgenic pure liposome group was 4.0?1.8,6.0?2.7 and 10.0?1.3/HF,respectively,and in non-transgenic group was 4.0?1.5,6.0?1.3 and 9.0?1.2/HF,respectively.There existed significant difference in lymphangiogenesis of the tumor (P0.05).ConclusionsThe anti VEGF-C gene may suppress the tumorigenicity and lymphangiogenesis of human SGC-7901 gastric carcinoma cells,but have little effect on angiogenesis of the tumor.VEGF-C might participate in the lymphangiogenesis of gastric tumor.