Research Progress on Estimation of Postmortem Interval Based on Ocular Tissues Structure / 法医学杂志

Estimation of postmortem interval (PMI) is one of the important research contents in forensic pathology, and it has always been the focus and hot spot of research work. In recent years, scholars at home and abroad have made some research progress in estimating PMI by using ocular tissue. After death, the changes of cornea, aqueous humor, iris, lens, vitreous humor and retina all show time sequence change rule highly related to PMI. This paper reviews the research progress of PMI estimation based on the morphological, biochemical, molecular and genetic material changes of different ocular tissue structures after death, and discusses the existing problems and development trends.

Discussing tuina for atlantoaxial subluxation in adults based on the theory of 'tendon-bone balance' / 针灸推拿医学（英文版）

According to Chinese medicine, the atlantoaxial joint is a composite joint composed of tendons and bones, and the stability of the joint depends on the 'tendon-bone balance' involving tendons, ligaments, atlas and axis. Multiple causes of 'tendon off-position, joint subluxation' will lead to joint 'tendon-bone imbalance', which will evolve into atlantoaxial subluxation (AAS), endangering human health. Chinese therapeutic massage (tuina) is a very effective treatment for AAS in adults, but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the 'tendon-bone imbalance' and inappropriate manipulations. Compared with conventional manipulations, the rational choice of modified manipulations under the guidance of 'tendon-bone balance' theory is more effective and less risky, and more worthy of clinical promotion. From the 'tendon-bone balance' theory, we considered the shortcomings of conventional manipulations, and introduced several modified manipulations that have their own strengths in 'tendon smoothing' and 'bone setting', in order to provide new ideas for treatment of AAS in adults.

Formation and Development of Environmental Forensics System in China / 法医学杂志

With the growing attention on ecological environment problems and gradual realization of ecological environment value, environmental damage has jumped from administrative penalty to a new stage, judicial penalty, and environmental damage appraisal has provided a legal weapon to safeguard ecological security. As a new forensic category of China with high comprehensiveness and technical difficulty, environmental damage appraisal involves diversified and complex subjects, fields and appraisal objects, and is still in an early stage in terms of theory and practice. This study aims to provide an important reference for the improvement of the Chinese environmental damage appraisal system of environmental damage by summarizing advanced international experience in areas such as laws and regulations, working mechanism and technical system, and putting forward targeted countermeasures and suggestions based on the problems existing in the development and practice of environmental damage appraisal in China.

Research Progress on Artifcial Conduits for Urological Application with Antibacterial Function / 中国医疗器械杂志

Artificial conduits, including ureteral stents and catheters, are used widely as drainage tools in the urinary system. However, various bacteria in the urine and long duration of insertion can arouse the biofilm formation on the pipeline surface, which calls for effective antibacterial strategy. In this article, the mechanism of Catheter Associated Urinary Tract Infections (CAUTI) is explained from the perspective of etiology. Then, the biofilm formation conditions and the features of urine are analyzed, the antibacterial agents and approaches suitable for ureteral stents and catheters are introduced and their pros and cons are discussed respectively.

Open reduction and external fixation with two parallel Kirschner wires for treatment of Gartland type Ⅲ fractures in children / 医疗卫生装备

Objective To compare the clinical effects on Gartland type Ⅲ fractures in children by open reduction and external fixation with two parallel Kirschner wires and closed reduction.Methods From February 2013 to October 2016,84 children with Gartland type Ⅲ supracondylar fracture of humerus were selected and randomly divided into a control group and an observation group,each with a total of 42 cases.The control group received closed reduction treatment,and the observation group received open and external fixation with two parallel Kirschner wires.The two groups were compared on intraoperative blood loss,incision length,operating time,decreased degrees of carrying angle,reduced flexion-extension at the fractured side and the rates for good and excellent clinical effects.Results The observation group behaved significantly better than the control group in intraoperative blood loss,incision length and operating time (P＜0.05).The rates for good and excellent effects was 90.47％ in the observation group and 73.81％ in the control group,and there was obvious difference between the values in the two groups (P＜0.05).The observation group had the decreased degree of carrying angle statistically lower than that in the control group (P＜0.05),while the reduced flexion-extension at the fractured side was not significantly different from that in the control group (P＞0.05).Conclusion Open reduction and external fixation with two parallel Kirschner wires and closed reduction both gain their advantages when used to treat Gartland type llⅢ fractures in children,the former has high clinical effect,significantly recovered elbow joint function and low incidence rate for cubitus varus,and the latter has slight invasion,small incision while relatively low clinical effect and high incidence rate for cubitus varus.

Open reduction and external fixation with two parallel Kirschner wires for treatment of Gartland type Ⅲ fractures in children / 医疗卫生装备

Objective To compare the clinical effects on Gartland type Ⅲ fractures in children by open reduction and external fixation with two parallel Kirschner wires and closed reduction.Methods From February 2013 to October 2016,84 children with Gartland type Ⅲ supracondylar fracture of humerus were selected and randomly divided into a control group and an observation group,each with a total of 42 cases.The control group received closed reduction treatment,and the observation group received open and external fixation with two parallel Kirschner wires.The two groups were compared on intraoperative blood loss,incision length,operating time,decreased degrees of carrying angle,reduced flexion-extension at the fractured side and the rates for good and excellent clinical effects.Results The observation group behaved significantly better than the control group in intraoperative blood loss,incision length and operating time (P＜0.05).The rates for good and excellent effects was 90.47％ in the observation group and 73.81％ in the control group,and there was obvious difference between the values in the two groups (P＜0.05).The observation group had the decreased degree of carrying angle statistically lower than that in the control group (P＜0.05),while the reduced flexion-extension at the fractured side was not significantly different from that in the control group (P＞0.05).Conclusion Open reduction and external fixation with two parallel Kirschner wires and closed reduction both gain their advantages when used to treat Gartland type llⅢ fractures in children,the former has high clinical effect,significantly recovered elbow joint function and low incidence rate for cubitus varus,and the latter has slight invasion,small incision while relatively low clinical effect and high incidence rate for cubitus varus.

Metabolomic profiling reveals distinct patterns of tricarboxylic acid disorders in blood stasis syndrome associated with coronary heart disease / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the underlying metabolomic profifiling of coronary heart disease (CHD) with blood stasis syndrome (BSS).</p><p><b>METHODS</b>CHD model was induced by a nameroid constrictor in Chinese miniature swine. Fifteen miniature swine were randomly divided into a model group (n=9) and a control group (n=6), respectively according to arandom number table. After 4 weeks, plasma hemorheology was detected by automatic hemorheological analyzer, indices including hematocrit, plasma viscosity, blood viscosity, rigidity index and erythrocyte sedimentation rate; cardiac function was assessed by echocardiograph to detect left ventricular end-systolic diameter (LVED), left ventricular end-diastolic diameter (LVEDd), ejection fraction (EF), fractional shortening (FS) and other indicators. Gas chromatography coupled with mass spectrometry (GC-MS) and bioinformatics were applied to analyze spectra of CHD plasma with BSS.</p><p><b>RESULTS</b>The results of hemorheology analysis showed signifificant changes in viscosity, with low shear whole blood viscosity being lower and plasma viscosity higher in the model group compared with the control group. Moreover, whole blood reduction viscosity at high shear rate and whole blood reduction viscosity at low shear rate increased signifificantly (P <0.05). The echocardiograph results demonstrated that cardiac EF and FS showed signifificant difference (P <0.05), with EF values being decreased to 50% or less. The GC-MS data showed that principal component analysis can clearly separate the animals with BSS from those in the control group. The enriched Kyoto Encyclopedia of Genes and Genomes biological pathways results suggested that the patterns involved were associated with dysfunction of energy metabolism including glucose and lipid disorders, especially in glycolysis/gluconeogenesis, galactose metabolism and adenosine-triphosphate-binding cassette transporters.</p><p><b>CONCLUSIONS</b>Glucose metabolism and lipid metabolism disorders were the major contributors to the syndrome classifification of CHD with BSS.</p>

Effects of pyruvate on retinal oxidative damage and retinal ultrastructure in diabetic rats / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To investigate the changes of retinal histology and oxidative stress in diabetic retinopathy and its reversal by pyruvate in diabetic rats. METHODS: Eighty Wistar rats were divided into 3 groups:control group ( 20 rats ) , model group ( 30 rats ) and treatment group ( 30 rats ) . After streptozotocin ( STZ) induced diabetes mellitus in the model group and the treatment group, the treatment group received 2%pyruvate in diet and drinking. The changes of body weight and blood glucose were observed and the changes of glutathione peroxidase ( GSH-PX ) , malonie dialdehyde ( MDA) , and Na+-K+-ATPase levels of retinal tissue and retinal ultrastructure were investigated in three groups at 12wk after occurrence of diabetes. RESULTS: Compared with control group, the body weight of the model group were significantly decreased, the activities of GSH-PX and ATP in the retina of diabetic rats were significantly lower, the MDA was signigicantly higher and significant changes occurred in retinal ultrastructure. Compared with model group, the blood glucose of the treatment group had no significant changes. However, the activities of GSH and ATP in the retina of diabetic rats were higher, the MDA was lower and the retinal ultrastructure was comparatively mild. CONCLUSlON:Pyruvate can alleviate oxidatie stress reaction, improve the energy metabolism of retina, and delay the development of retinopathy.

Long-term results of the surgical treatment of penile curvature with 16-dot plication : a retrospective analysis of 86 patients / 中华泌尿外科杂志

Objective To assess the long-term surgical outcomes,patient's satisfaction and functional results of correction for patients with penile curvature by 16-dot minimal tension plication.Methods Between August 2004 and December 2010,92 patients with penile curvature underwent surgical correction of penile curvature by 16-dot minimal tension plication.Of them,86 patients (53 patients with congenital penile curvature and 33 patients with Peyronie's disease (PD)) were reached for long-term follow-up.Indications for operation included patients with 30 to 90 degrees of penile curvature,penile length greater than 10 cm and patients who had one or more symptoms,such as difficulty or inability to vaginal penetration and partner discomfort during sexual intercourse.Patients were excluded from study if they had severe penile curvature (greater than 90 degrees),hourglass deformities or large plaques.Preoperative evaluation included international index of erectile function 5 (IIEF-5) questionnaire score,pain on erection and physical examination.Patients were recommended daily low dose phosphodiesterase type 5 (PDE-5) inhibitors 2 weeks after surgery and maintained for 2 to 3 months.At follow-up,recurrence rate,complications,erectile function,patients and partner's satisfaction with the surgery were assessed.Results The mean time of follow-up was 79 months (range,35-107 months).Of 86 patients who had been reached for long-term follow up,82 patients (95.3％) and 77 partners (89.5％) reported overall satisfaction after the surgery.Complete penile straightening was achieved in 79 patients (91.8％).Slight residual curvatures were observed in 7 patients,but did not affect their sexual intercourse.Postoperative penile length shortening (median penile length loss 1.3 cm) was noted in 35 patients (40.7％),which did not affect their sexual intercourse.In addition,no de novo erectile dysfunction was observed,and sexual function was significantly improved evidenced by the IIEF-5 scores,especially in the patients who had received PDE-5 inhibitors for 2 to 3 months.There were no surgery-related complications,such as hematoma,urethral injury,or infection.Conclusion The longterm results demonstrate that correction of penile curvature using 16-dot plication is a simple and safe method to achieve cosmetic and functional satisfaction in patients with mild to moderate penile curvature.

Energy metabolism disorder and myocardial injury in chronic myocardial ischemia with Qi deficiency and blood stasis syndrome based on 2-DE proteomics / 中国结合医学杂志

<p><b>OBJECTIVE</b>To inquire the characteristic proteins in chronic myocardial ischemia by testing twodimensional electrophoresis (2-DE) map to explore the possible inherent pathological mechanism and the therapeutic intervention of qi deficiency and blood stasis syndrome.</p><p><b>METHODS</b>Ameroid constrictor ring was placed on the first interval of left anterior descending coronary artery to prepare chronic myocardial ischemia model on Chinese miniature swine. Animals were randomly divided into sham group and model group with 10 animals in each group, respectively. The dynamic symptoms observation of the four diagnostic information was collected from 0 to 12 weeks. Echocardiography was employed to evaluate cardiac function and the degree of myocardial ischemia, 2-DE and matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS) were used to carry out proteomics research on animals. Enzyme-linked immunosorbent assay was applied to identify the relevant differential proteins on chronic myocardial ischemia with qi deficiency and blood stasis syndrome.</p><p><b>RESULTS</b>The preliminary study found that at the 12th week, chronic myocardial ischemia with qi deficiency and blood stasis syndrome model was established stably. Compared with the sham group, there were 8 different proteins down-regulated, 22 proteins up-regulated significantly. After validated by MALDITOF-MS/MS, 11 protein spots were identified. Distinct proteins were mainly associated with energy metabolism and myocardial structural injury, including isocitrate dehydrogenase 3 (NAD+) alpha, NADH dehydrogenase (NAD) Fe-S protein 1, chain A (crystal structure of aldose reductase by binding domain reveals a new Nadph), heat shock protein 27 (HSP27), oxidoreductase (NAD-binding protein), antioxidant protein isoform, cardiac troponin T (cTnT), myosin (myosin light polypeptide), cardiac alpha tropomyosin, apolipoprotein A-I and albumin.</p><p><b>CONCLUSION</b>Down-regulated energy metabolism disorder mediated by NADH respiratory chain and myocardial injury may be the pathogenesis of myocardial ischemia with qi deficiency and blood stasis syndrome. These proteins may be the potential diagnostic marker(s) for qi deficiency and blood stasis syndrome, finally provided new clues for new therapeutic drug target of Chinese medicine.</p>

Clinical application of double balloon endoscopy in the elderly / 中华老年医学杂志

Objective To investigate the diagnostic value of double balloon endoscopy (DBE) in the elderly. Methods Clinical manifestations and endoscopic findings of 42 elderly patients (aged 60-80 years) and 73 young and middle-aged patients (aged 12-59 years) with small bowel lesions were obtained and compared. Factors influencing the diagnostic outcome of DBE in patients with small bowel bleeding were identified,and the optimal check time after the latest bleeding was determined.Results The procedures of 85.7％ (36/42) in the elderly and 79.5％(58/73) in young and middle aged were completed (P＞0.05).There was no significant difference in the procedure time between the two age groups.No severe complications were observed in the elderly group.The overall positive rate by double balloon enteroscopy examination were 71.4 ％ (30/42) and 63.0 ％ (46/73),respectively in the two groups (P＞ 0.05). Ulcer and tumor lesions were the most common findings,and diverticula and angiodysplasia were the second common findings. Longer duration of bleeding and higher number of bleeding episodes were found in the elderly with positive DBE findings than those with negative findings. Positive diagnostic rate was significantly higher when DBE was performed within 7 days than that after 7 days (90％ vs. 40％). Conclusions DBE is a safe,reliable diagnostic modality,especially in the elderly patients with small bowel bleeding in which ulcer and tumor lesions are the most common identifications.DBE is of greater benefit in patients with more bleeding episodes over a long period,and should be performed within 7 days after the last bleeding.

Experimental study of the effect of adipose stromal vascular fraction cells with VEGF on the neovascularization of free fat transplantation / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of adipose stromal vascular fraction cells (SVFs) with VEGF on the neovascularization of free fat transplantation.</p><p><b>METHODS</b>SVFs were obtained from subcutaneous fat and labelled with DiI. 0.3 ml autologous fat tissue was mixed with 0.2 ml cells: 1) autologous SVFs with VEGF (Group A); 2) autologous SVFs (Group B); 3) complete DMEM (Group C) And then the mixture was injected randomly under the back skin of 12 nude mice. The transplanted fat tissue in three groups was harvested at 2 months after implantation. Wet weight and diameter of fat grafts was measured. After HE and CD31 staining,blood vessel density, viable adipocytes and fibrous proliferation were observed.</p><p><b>RESULTS</b>Trace of SVFs labeled by DiI in vivo could be detected by fluorescent microscope. The wet weight of fat grafts was (191.90 +/- 9.81) mg in group A, (177.01 +/- 10.50) mg in group B, and (92.05 +/- 8.30) mg in group C (P<0.01). The diameter of fat grafts was (0.49 +/- 0.24) cm in group A, (0.40 +/- 0.26) cm in group B, and (0.32 +/- 0.28) cm in group C (P<0.01). Histological analysis showed the blood vessel density was (14.58 +/- 2.06)/HPL in group A, (11.55 +/- 2.18)/HPL in group B, (7.87 +/- 1.55)/HPL in group C. Compared with group B and group C, group A had more adipose tissue with less fat necrosis and fibrosis and had significantly higher capillary density.</p><p><b>CONCLUSIONS</b>The autologous adipose stromal vascular fraction cells with VEGF could improve the neovascularization of free fat significantly. It indicates a wide clinical application in the future.</p>

Effects of huoxue jiedu recipe on retinopathy in diabetic rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effects of Huoxue Jiedu Recipe (HJR) on the hemodynamics of central retinal artery (CRA) and central retinal vena, as well as the morphology of blood vessels of diabetic rats.</p><p><b>METHODS</b>Sixty SD rats were selected and fasted for 12 h. Streptozotocin (STZ, 65 mg/kg) was intraperitoneally injected to induce diabetic rat models. The modeled rats were randomly divided into the model group, the high dose HJR group (15.4 g/kg), the middle dose HJR group (7.70 g/kg), the low dose HJR group (3.85 g/kg), and the Doxium Capsule group (the Western medicine group, 0. 167 g/kg), 10 in each group. Another 10 rats were recruited as the normal control group. Equal volume of distilled water was given to rats in the normal control group. The intervention was carried out once daily in each group, totally for 20 weeks. The peak systolic velocity (PSV), the end diastolic velocity (EDV), the mean velocity (MV), the pulsatile index (PI), the resistive index (RI), and the central retinal vena velocity (CRV) were detected in each group. The retinal vascular morphologies were observed and compared using trypsin digestion.</p><p><b>RESULTS</b>Compared with the normal control group, the PSV, EDV, MV, and CRV decreased, PI, RI, and capillary density increased in the model group with statistical difference (P<0.01). The retinal capillaries rowed disorderly. The calibers of capillaries were not even. The hyperplasia of endothelial cells and less pericytes could be seen. Compared with the model group, PSV, EDV, MV, and CRV all increased, PI and RI decreased in the high and middle dose HJR groups with statistical difference (P<0.01). There was no statistical difference among all the medication groups (P>0.05). The distributions of capillaries in the 3 HJR groups were even. The vascular morphous was comparatively regular, without obvious twisting and dilation. The hyperplasia of endothelial cells was not obvious. Compared with the model group, the capillary density significantly decreased (P<0.01). There was no statistical difference among the 3 HJR groups. Compared with the model group, the capillary density significantly decreased in the Western medicine group (P<0.01).</p><p><b>CONCLUSION</b>HJR could obviously improve the retinal hemodynamics parameters of diabetic rats, increase the retinal capillary blood flow and reperfusion, and restrain the hyperplasia of endothelial cells in the capillary.</p>

Small-dose vardenafil restores erectile function after penile surgery / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the impact of penile surgery on the erectile function of the patient and to evaluate the role of small-dose vardenafil in restoring the impaired penile erection.</p><p><b>METHODS</b>Sixty cases of penile cavernosum surgery were equally and randomly divided into a vardenafil and a control group, the former treated 5 - 7 days after surgery with 10 mg vardenafil every other day, while the latter given vitamin E at 100 mg once a day, both for 12 weeks. The penile erectile function of the patients was evaluated with the IIEF-5 questionnaire before surgery and at 3 and 6 months after vardenafil medication.</p><p><b>RESULTS</b>The mean IIEF-5 scores of the vardenafil group were 18.83 +/- 2.98 and 20.13 +/- 2.98 at 3 and 6 months after vardenafil medication, significantly higher than 14.21 +/- 3.62 before surgery (P > 0.05), while that of the control group was significantly decreased at 3 months as compared with the preoperative score (13.38 +/- 2.82 versus 15.80 +/- 3.02, P < 0.05). The vardenafil group showed the highest IIEF-5 score after surgery (P < 0.05).</p><p><b>CONCLUSION</b>Long-term administration of small-dose vardenafil after penile surgery helps to restore and maintain penile erectile function.</p>

Analysis and management of complications caused by holmium laser ureterolithotripsy / 国际外科学杂志

Objective To study the the causes, management and preventive measures for complications of holmium laser ureterolithotripsy. Methods Three hundred and seven cases of uteteral calculi from Jan. 2006 to Jan. 2010 were reported (203 men and 104 women, age ranged from 18-83 years,mean age 51.6 years). One hundred thirty-three patients had calculi in the lower ureter,94 in the middle part and 80in the upper ureter. Results The overall comminution rate was 89.9% (276/307 cases). sixteen cases (5.2%) were followed by ESWL due to the shift of the stones to the renal pelvis. The operation failed in 9 cases(2.9%), 3 cases(1%) had perforation,and recoveried after open operation. Deep infection was found in 3(1%)cases,which recoveried after anti-infective therapy. Conclusions Holmium laser ureterolithotripsy is an effective method for treating ureteral calculi, with advantage of high efficiacy,safety and minimal invasion. To master the operating induction, to raise operating technique and to take correct measure could reduce complications effectually.

Gene expression change study in hypospadias by microarray / 中华泌尿外科杂志

Objective To detect the gene expression changes between urethra plates from hypospadias patients and foreskins from non-hypospadias patients by microarray and to investigate the underlying mechanisms of hypospadias.Methods Twelve hypospadias patients,aged 6-12 months (mean,8 months),were enrolled as the test group,including 5 moderate and 7 severe hypospadias patients.Six age-matched patients underwent circumcision were enrolled as controls.Samples from hypospaidas patient's urethra plates during hypospadias repair and samples from the foreskins during circumcision were obtained and processed into Tri-Reagent immediately for RNA extraction.Oligonucleotide expression microarrays were used to detect genes expression changes in tissues from patients with and without hypospadias.This microarray analysis incorporated 22 000 genes.The intensity of all genes present was analyzed by one-way ANOVA (P＜0.01) and Tukey's test.Four estrogen responsive genes,CYR61,CTGF,ATF3 and GADD45β,were tested by RT-PCR in 8 controls,8 moderate hypospadias and 8 severe hypospadias as well.Results Ninty-four genes were detected differentially expressed in hypospadias patients compared with phimosis patients.There were 47 genes upregulated in moderate hypospadias compared with controls(P＜0.01),68 genes up-regulated in severe hypospadias compared with controls(P＜0.001),17 genes up-regulated in severe hypospadias compared with moderate hypospadias(P＞0.05).These genes were involved in different cell functions such as growth regulation and signal transduction.CYR61,CTGF,ATF3 and GADD45β,known to be estrogen responsive or to interact with estrogen receptor were found up-regulated in microarray and the up-regulations were confirmed by RT-PCR.Conclusions The up-regulated genes contribute to the development of hypospadias.Up-regulation of estrogen responsive genes may play important roles in the development of hypospadias.

Repair and functional reconstruction of the penis (a report of 62 cases) / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the effects of surgery treatment on serious penile lesions and malformation.</p><p><b>METHODS</b>Sixty-two patients, aged from 19 to 63 years old (mean 35 ys), were included in the study. Among them, 4 patients suffered from penis partial defection were respectively treated with restoring defective penis, penis lengthening and urethroplasty; three patients with penis completely missing were treated with penis reconstruction surgery; 22 cases with serious penile curvature were treated with the 16-dot plication technique (Lue's procedure); 15 cases with penile fracture were treated with conservative treatment for 1 case and with patch penis, corpus spongiosum, and deep penile dorsal vein ligation for 14 cases; 5 cases with post-operative complications of 3-pieces of penile prosthesis, including the prosthesis perforating to the urethra, water pump failure, broken connection tube, erection angle < 60 degrees and failure to expansion the corpus cavernosum, were treated by taking out prostheses, urethral repair cracks, replacement of the prostheses, excision of fibrosis scar and re-implantation prostheses respectively. Four cases with penis complete amputation were treated with the penis replantation; three cases of avulsion injury were treated with the replantation and free flap skin; 6 with Paget's disease of penises were treated with the lesion free skin buried in the scrotum and penis.</p><p><b>RESULTS</b>All these patients were followed up for 3 months to 4 years, with the average of 9 months. Among the 4 cases of penis partial defection, 2 patients were satisfied with the penile appearance and sexual function; 1 got some satisfactory and 1 was unsatisfied. Three cases with the loss of the penis completely were satisfied with both the postoperative appearance and urination, and 1 was not satisfied. Twenty-two cases of penile curvature deformities were corrected, and one case was recurrence. Fourteen of the 15 patients with penile fracture were followed, and all got the restoration of sexual function. Among them, 5 cases with post-operative complications, including mild bending, algopareunia, subcutaneous induration, poor hardness and poor sexual pleasure, were not further treated, and another case lost; Five cases with post-operative complications of three-pieces penile prosthesis were treated successfully, and 4 of their spouses were satisfied with their sexual function after operation, only 1 of their spouse not satisfied. Among four cases with complete amputation of penis, two cases of penis were replanted successfully while two necrosis. Three cases with avulsion were treated with skin grafting successfully. All 6 cases with penile Paget's disease were followed for 2 -4 years, and free skin grafts were all survival. One patient died of brain metastases 18 months after operation and five cases were disease-free survival.</p><p><b>CONCLUSION</b>The patients should be treated based on the procedure of andrological and urological surgery, together with microsurgical, flap or skin graft technique. The urologist should design personalized surgical procedure. Most of the patient's penis shape and erectile dysfunction can be reconstructed by our procedures, but some patients can not achieve the desired appearance or function of penis. New approaches of the treatment ought to be developed to restore both of the shape and function for those severe injury of the penis.</p>

Snodgrass technique, Duckett repair and bladder mucosa grafting for hypospadias: an analysis of 251 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To present the experience in using the Snodgrass technique, Duckett repair and bladder mucosa grafting for hypospadias.</p><p><b>METHODS</b>We retrospectively reviewed 251 cases of middle and posterior hypospadias treated by the Snodgrass technique, Duckett repair and bladder mucosa grafting from February 1997 to December 2008.</p><p><b>RESULTS</b>The success rates of the Snodgrass technique, Duckett repair and bladder mucosa grafting were 80.3% (53/66) , 76% (19/25) and 78.9% (15/19) for middle hypospadias and 68. 3% (41/60) , 63.6% (14/22) and 88. 1% (52/59) for the posterior type without statistical significant differences (all P > 0.05). Bladder mucosa grafting showed a significantly higher success rate than the other two procedures in either one-stage or two-stage surgical repair of posterior hypospadias (P < 0.05). Duckett repair achieved a significantly higher rate of success in children under 14 years than in the older ones (P < 0.05).</p><p><b>CONCLUSION</b>Of the three surgical options, bladder mucosa grafting is the most suitable for posterior hypospadias, and Duckett repair is recommended for children under 14 years of age.</p>

Expressions of ATF3 and CTGF and their regulation by estradiol in the prepuce of hypospadias patients / 中华男科学杂志

<p><b>OBJECTIVE</b>Estrogen is closely associated with hypospadias. The present study was to explore the molecular mechanism of hypospadias caused by estradiol.</p><p><b>METHODS</b>Fibroblasts obtained from the prepuce of hypospadiac and normal children were cultured in vitro and treated with 17-beta ethinyl estradiol (17-EE) at the concentrations of 1 micromol/L to 0.1 nmol/L for 2 hours, or at 0.1 micromol/L for 0.5, 1, 2, 4, 8, 16 and 24 hours. MTT assay was used to evaluate the effect of 17-EE on the proliferation of the cells, and RT-PCR was employed to detect the expressions of the activating transcription factor-3 (ATF3) and connective tissue growth factor (CTGF) in the hypospadiac tissue. The results were compared with those obtained from the nonhypospadiac tissue.</p><p><b>RESULTS</b>The expressions of ATF3 and CTGF were significantly upregulated in the hypospadiac tissue as compared with the nonhypospadiac group. At the concentration of 1 micromol/L, 17-EE significantly inhibited the proliferation of the cells. ATF3 mRNA was elevated at 1-2 hours, while CTGF mRNA showed no significant changes in 24 hours.</p><p><b>CONCLUSION</b>ATF3 and CTGF are two candidate genes involved in the etiology of hypospadias. And estradiol may induce hypospadias by upregulating the expressions of ATF3 and CTGF.</p>

Human foreskin acellular matrix graft: a good scaffold for urethral tissue engineering / 中华男科学杂志

<p><b>OBJECTIVE</b>To provide evidence of using the human foreskin acellular matrix graft for urethral tissue engineering. METH-ODS: The human foreskin acellular matrix graft was prepared, its safety and biocompatibility as urethral material were determined by histological observation, cytotoxicity test using primary epithelial cells and experiment in vivo.</p><p><b>RESULTS</b>Intact cells were absent from the foreskin acellular matrix graft. The cytotoxicity test showed that the relative growth rate of the cells was between 75% and 99%, and the cytotoxicity of the foreskin acellular matrix graft was grade 1, consistent with the national standard. With the lengthening of time, the foreskin acellular matrix graft became perfectly compatible with the urothelial cells and the urethral multi-layer structure was restored to normal gradually.</p><p><b>CONCLUSION</b>The human foreskin acellular matrix graft, with its low antigenicity and good biocompatibility, could be a good scaffold for urethral tissue engineering.</p>