Clinical characteristics and risk factors of renal function deterioration in children with renal dysplasia complicated with chronic kidney disease / 现代泌尿外科杂志

【Objective】 To explore the clinical characteristics and risk factors of renal function deterioration in children with renal dysplasia and chronic kidney disease (CKD), so as to provide a basis for the diagnosis, treatment, and management. 【Methods】 The clinical data of children with renal dysplasia complicated with CKD treated in the Children’s Hospital of Chongqing Medical University during 2012 and 2022 were retrospectively analyzed, including the gender, age of diagnosis, growth index, concomitant malformation and complications. According to the diagnostic criteria and staging standard of KDIGO2020 guidelines, patients with disease deteriorated to CKD stage 4-5 were enrolled into the regression group. Factors affecting the deterioration of renal function were determined with Cox regression analysis. 【Results】 A total of 122 children were involved, including 66 (54.1%) with CKD stag 4-5. There were more boys than girls. Bilateral and unilateral renal dysplasia occurred in 88 (72.13%) and 34 (27.87%) cases, respectively, and 64 (52.46%) cases were complicated with other urinary diseases. There were significant differences in weight, height and body mass index (BMI) among patients with CKD stage 1-5 (P<0.01). The age of onset of CKD <10 years, BMI lower than the 3rd percentile of the same sex and age, bilateral renal dysplasia, and one or more complications of congenital renal and urinary tract abnormalities (CAKUT) were the risk factors of deterioration of renal function (P<0.05). 【Conclusion】 Renal dysplasia complicated with CKD are more common in boys, with high incidence of bilateral renal dysplasia. Bilateral renal dysplasia, age of onset of CKD <10 years, BMI lower than 3% and complications are important influencing factors of renal dysplasia in children with CKD.

Research of early outcomes of cementless Oxford unicompartmental knee arthroplasty / 中华骨科杂志

Objective:To assess the early clinical outcomes of Oxford cementless unicompartmental knee arthroplasty (UKA) in the management of anteromedial osteoarthritis of the anterior medial knee (AMOA).Methods:A retrospective review was conducted on a cohort of 90 patients who underwent primary UKA for AMOA at the Fuzhou Second Hospital between January 2020 and June 2021. The patients were divided into two groups based on the type of prosthesis used: the cementless UKA group and the cemented UKA group. The cementless UKA group included 45 patients (22 males and 23 females), with a mean age of 65.6±7.0 years (ranging from 52 to 81 years). The cemented UKA group consisted of 45 patients, including 21 males and 24 females, with a mean age of 67.9±6.1 years (ranging from 55 to 79 years). The study compared various parameters between the two groups, including the duration of surgery, amount of blood loss, length of hospitalization, pain visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, and forgotten joint score (FJS). Additionally, radiolucency around the prosthesis, medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD) were observed and measured before and after surgery to assess prosthesis stability, improvement of knee deformity, and knee joint mobility, respectively.Results:Both groups were followed up for a minimum of 18 months. No statistically significant differences were found in demographic data such as gender, age, and body mass index between the two groups. The cementless UKA group demonstrated superior results in terms of shorter duration of surgery (97.8±21.1 min) and less blood loss (70.8±37.6 ml) compared to the cemented UKA group ( P<0.05). However, no significant difference in length of stay was observed between the groups. Postoperative VAS scores, HSS scores, MPTA, and MAD were significantly improved compared to preoperative values in both groups ( P<0.05). The median VAS scores for the cementless UKA group at 6, 12, and 18 months postoperatively were 4.0(3.0, 5.0), 2.0(2.0, 3.0), and 2.0(1.0, 3.0) respectively. The corresponding median HSS scores for the cemented UKA group were 78(75, 82), 85 (80, 89), and 86(82, 90) preoperatively and at 6, 12, and 18 months postoperatively, respectively. The median FJS scores for the cementless UKA group were 73.0(70.5, 76.0), 76.0(74.0, 78.0), and 66.0(63.0, 68.0) preoperatively and at 6, 12, and 18 months postoperatively, respectively. There was no statistically significant relationship between preoperative VAS scores and preoperative FJS scores ( P>0.05). However, there was a significant difference in VAS scores between the two groups at 6 months postoperatively ( P<0.05). The cementless UKA group consistently exhibited better VAS scores and HSS scores compared to the cemented UKA group at 6, 12, and 18 months postoperatively ( P<0.05). The median MPTA values for the cementless UKA group were 85.41°(84.22°, 86.54°), 85.80°(84.74°, 87.41°), 86.51°(85.47°, 88.14°), and 86.80°(86.09°, 88.27°) preoperatively and at 6, 12, and 18 months postoperatively, respectively. The median MAD values for the cementless UKA group were 2.29(1.79, 2.65) cm, 1.11(0.69, 1.75) cm, 1.02(0.65, 1.66) cm, and 0.91(0.61, 1.63) cm preoperatively and at 6, 12, and 18 months postoperatively, respectively. There were no significant differences in MPTA and MAD between the two groups at all time points, except for the preoperative MPTA and postoperative MAD at 6 and 12 months. The incidence of physiological radiolucency around the prosthesis was significantly lower in the cementless UKA group 3 than in the cemented UKA group 28 ( P<0.05). However, no complete radiolucency was observed in either group. Conclusion:Oxford cementless UKA is a highly effective treatment for relieving joint pain and correcting knee deformity in patients with knee AMOA. It offers the advantages of shorter surgical duration, reduced blood loss, and improved subjective outcomes for patients after the operation.

Predictors of testicular injury secondary to incarcerated inguinal Hernia in children / 中华内分泌外科杂志

Objective:To find out predictors of the testicular ischemia caused by incarcerated inguinal hernia and evaluate the ischemic injury of the testis more accurately, which can indicate testicle exploration in time or prevent unnecessary testicle exploration.Methods:Pediatric patients (median: 9 months) undergoing operation of unilateral incarcerated inguinal hernia and ipsilateral testicular exploration from 1 Jul. 2013 to 30 Jun. 2019 were retrospectively investigated. Age at surgery, incarcerate duration, degree of intestinal and testicular injury, times of manual reduction and preoperative ultrasound data were collected. Statistical analysis was performed by SAS 9.4 (Copyright ? 2016 SAS Institute Inc.Cary, NC, USA) .Results:460 patients (median: 9 months) , of which 57 (12.39%) (median: 1.4 months, interquartile range 0.8-10.7 months) had severe testicular injury, and their average incarceration time was (23.9±9.3) h. Univariate logistic regression revealed that increased times of manual reduction, ultrasound scores, incarcerate duration and degree of intestinal injury were positively correlated with the degree of testicular ischemia, while age at surgery was negatively correlated with the degree of testicular ischemia ( P<0.05) . A model for calculating the probability of severe testicular ischemia injury was established: P= through multivariate analysis with backward stepwise logistic regression and 10-fold cross-validation was used for preliminary verification of the model. Conclusion:This study provides a relative reliable model to predict the risk of irreversible testicular ischemia due to incarcerated inguinal hernia using readily available clinical characteristics in young pediatrics with testicular ischemia.

The diagnosis and treatment of ectopic ureter with bladder neck and urethral maldevelopment in children / 中华泌尿外科杂志

Objective:To discuss the diagnosis and treatment of ectopic ureter company with the bladder neck and urethral maldevelopment in children.Methods:The clinical data of the 6 patients admitted to Children’s Hospital affiliated to Chongqing Medical University from September 1993 to April 2019 diagnosed as ectopic ureter company with the bladder neck and urethral maldevelopment were retrospectively reviewed. The 6 children were girls and the median age was 7 years old , ranged from 2 to 15 years old. All children had ectopic ureter, including 3 in left-sided, 1 in right-sided, and 2 in bilateral-sided. Five children presented the intermittent dribbling incontinence and one child presented the continuously incontinence without normal voiding. Through ultrasound, IVP, MRI, cystoscopy and retrograde urography, seven ureters were found ectopic position, including bladder neck in 4 cases, two ureters inserted in the vagina in 2 cases. There were two cases with duplex kidney and 4 cases with renal dysplasia. Preoperative cystoscopy revealed wide and short urethra in 1 case, wide bladder neck combined with wide and short urethra in 4 cases. The surgery type included nephrectomy in cases 1-3, bilateral ureter reimplantation in case 4 who had the bilateral ectopic ureter , bilateral ureter reimplantation and bladder neck reconstruction at the same time in case 5. Nephrectomy associated with bladder neck and urethral reconstruction in case 6.Results:Five patients were followed-up and one patient was lost to follow-up after the first operation. Mean follow-up was 41.2 months (ranging 2 to 84 months). Four patients with bladder neck and maldevelopment that were not solved intraoperatively got reoperations due to incontinence without remission. Case 1, who underwent urethral reconstruction and extension, and urinary incontinence was partially relieved. Case 2 was found to have wide bladder neck deformity, and then retrospectively got bladder neck reconstruction and urethrovaginal fistula repair in 3 years and 5 years later. The urinary incontinence was completely relieved. The ureteral stump of case 3 was resected 2 years after operation due to recurrent urinary tract infection, and then got twice bladder neck and urethral reconstruction in 3 years and 6 years later of nephrectomy. His incontinence was partially relieved. The case 4 got bladder neck and urethral reconstruction in one year after bilateral ureter reimplantation, and incontinence was partially relieved too. Among the two patients underwent combined surgery, the case 5, who got bilateral ureteral bladder replantation combined with bladder neck reconstruction, were lost to follow-up after surgery. The case 6 got dysplasia nephrectomy combined with bladder neck reconstruction and urethroplasty were completely relieved of urinary incontinence.Conclusions:Bladder neck and urethra maldevelopment is one of the main causes of urinary incontinence after surgery in children with ectopic ureter. The diagnosis mainly relies on cystoscopy. The treatment mainly relies on surgery. Bladder neck and urethral reconstruction is expected to be available. If the operative conditions permit, synchronous surgical treatment of ectopic ureter and bladder neck and urethral maldevelopment will get a better prognosis than staging surgery.

Natural reduction at prone position in treatment of femoral subtrochanteric fractures with intramedullary nailing / 中华创伤骨科杂志

Objective:To evaluate natural reduction at prone position in the treatment of femoral subtrochanteric fractures with intramedullary nailing.Methods:The clinical data of 7 patients with subtrochanteric fracture were retrospectively analyzed who had been treated at Orthopaedic Department, Beijing Tsinghua Changgung Hospital from August 2016 to April 2018. They were 4 males and 3 females, aged from 31 to 87 years (average, 55.6 years). Their fractures happened on the left side in 3 patients and on the right side in 4. By the Seinsheimer classification, there were 3 cases of type Ⅱ, 2 cases of type Ⅲ and 2 cases of type Ⅴ. The time from injury to surgery ranged from 9 to 44 hours, averaging 26 hours. All patients were treated by intramedullary nailing after natural reduction at prone position. Their preoperative preparation time, time required for reduction, total operation time, fluoroscopic frequency for guide pin insertion, fluoroscopic frequency for reduction, reduction quality, complications and curative effect were recorded.Results:Closed reduction and intramedullary nail fixation were completed uneventfully in all the 7 cases. Their preoperative preparation time averaged 29.4 min (from 21 to 42 min), reduction time 6.3 min (from 3 to 10 min), and total operation time 157 min (from 82 to 275 min). Their fluoroscopic frequency averaged 37 times (from 14 to 96 times) for guide pin insertion and 23 times (from 10 to 49 times) for reduction, totaling 244 times (from 121 to 360 times). According to the modified Baumgaetner criteria, the fracture reduction was evaluated as excellent in 6 cases and as fair in one. The 7 patients were followed up for 12 to 34 months (mean, 20.1 months). A drill broke at the interlocking nail hole during operation in one patient, deep venous thrombosis occurred at a lower extremity in another during hospitalization, and fracture nonunion was observed after operation in another, but no complications related to the prone position were observed. The curative effect evaluated by Harris hip score at the last follow-up was excellent in 4 cases, as good in 2 cases and as fair in one.Conclusion:In the treatment of femoral subtrochanteric fractures with intramedullary nailing, the prone position benefits natural reduction and maintenance of reduction and allows convenient fluoroscopy and nail placement during operation, especially for obese patients.

Expert consensus on rehabilitation strategies for traumatic spinal cord injury / 中华创伤杂志

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Expression of miR-155-5p in Wilms tumor and its regulatory role in proliferation, migration and apoptosis of Wilms tumor cells / 南方医科大学学报

OBJECTIVE@#explore the expression of miR-155-5p in Wilms tumor and its effect in regulating the proliferation, migration and apoptosis of Wilms tumor cells.@*METHODS@#Specimens of tumor tissues and paired adjacent tissues were obtained from 40 patients with Wilms tumor for detection of the expression levels of miR-155-5p using RT-qPCR. Wilms tumor cell line G401 was transfected with miR-155-5p mimics and miR-155-5p inhibitor to induce miR-155-5p over-expression and its inhibition, respectively, and the changes in the cell proliferation, migration and apoptosis were assessed using cell counting kit-8 (CCK-8), wound healing assay and fl ow cytometry.@*RESULTS@#RT-qPCR showed that the expression of miR-155-5p decreased significantly in Wilms tumor tissues as compared with normal kidney tissues and was significantly associated with TNM stage ( < 0.05). In G401 cells, over-expression of miR-155-5p significantly inhibited the cell proliferation and migration and promoted cell apoptosis ( < 0.05), and down-regulation of miR-155-5p obviously enhanced the proliferation and migration and suppressed apoptosis of the cells ( < 0.05).@*CONCLUSIONS@#miR-155-5p is down-regulated in Wilms tumor and its expression level is correlated with TNM stage. miR-155-5p participates in the progression of Wilms tumor by inhibiting the proliferation and migration and promoting apoptosis of the tumor cells, and may serve as a novel biomarker for diagnosis, therapy and prognostic evaluation of Wilms tumor.

Predictive factors of outcome and observation period in children with unilateral hydronephrosis which caused by ureteropelvic junction obstruction / 中华泌尿外科杂志

Objective To evaluate the observation period and association between the initial visit data including initial APD measured by ultrasonography (USG) and outcome of unilateral hydronephrosis caused by ureteropelvic junction obstruction (UPJO) in children.Methods One hundred and ninety-three children with UPJO,who underwent the USG at the initial visit time.There were 155 boys and 38.166 cases in left side and other 27 cases in right side.All cases were divided by initial visit time and initial APD respectively.There were 109 infancy(≤ 12 months),36 toddler(12-36 months),19 preschooler(36-60 months),29 school-age children(＞ 60 months)and 11 cases in normal group (APD ＜ 0.5 cm),47 in mild (0.5 cm≤APD ＜ 1.0 cm),54 in moderate(1.0 cm≤ APD≤ 1.5 cm),81 in sever(APD ＞ 1.5 cm).All the patients were follow up for at least 24 months and divided into two groups depended on whether the patients received the surgery.Results Areas under the receiver operating characteristic plots were 0.924 (95％ CI 0.870-0.977,P ＜ 0.01);sensitivity,specificity,positive predictive value,and negative predictive value were 87.2％,88.9％,87.5％,and 95.5％,respectively,for the cut of APD is ≥ 1.85 cm.Infancy and initial APD ＞ 1.5 cm was the risk factors predicting operation with the hazard ratio of 2.991 (95％ CI 1.328-6.734,P =0.008) and 16.593 (95％ CI 5.893-46.719,P ＜ 0.01),respectively.Operation rate at one year of UPJO,for initial APD ＞ 1.5 cm,initial APD ≤ 1.5 cm,infancy and after infancy,were 43.20％(35/81),2.67％ (3/112),30.27％ (33/109),5.95％ (5/84),respectively.Conclusions Initial USG is an efficient diagnostic tool to detect pathologic hydronephrosis.Initial APD predicts the clinical outcome of UPJO in pediatrics accurately.Further investigation is recommended when initial APD ＞ 1.5 cm.Close observation is needed during the one year after initial visit to detect the deterioration of UPJO,especially in infancy.

Study progress on correlation between ultrasonography and prognosis of non-surgical treatment to hydronephrosis caused by ureteropelvic junction obstruction in children / 中华实用儿科临床杂志

Hydronephrosis caused by ureteropelvic junction obstruction(UPJO) is a common urinary abnormality in children which involves dilation in the urinary tract due to limitation in urinary drainage.Most cases would resolve spontaneously, but the others who were short of adequate treatment would lead to irreversible renal damage.Ultrasonography is the most common examination for UPJO.However, there exists disagreement in the way to define obstruction accurately or to predict which patient will benefit from surgical intervention by ultrasonography.By reviewing the related national data the authors analyzed the advance on prognosis of ultrasonography and the non-surgical outcomes of UPJO.

Di (2-ethylhexyl) phthalate-induced hypospadias in SD rats is related with Mafb expression: a transcriptome profiling-based study / 南方医科大学学报

OBJECTIVE@#To investigate the transcriptome profile of genital tubercles (GTs) in male SD rats and explore the mechanism of hypospadias induced by Di (2-ethylhexyl) phthalate (DEHP).@*METHODS@#Forty time-pregnant SD rats were randomly divided into 4 equal groups, namely GD16 group and GD19 group (in which the male GTs were collected on gestation day[GD]16 and GD19 for RNA-seq, respectively), control group and DEHP exposure group (with administration of oil and 750 mg/kg DEHP by gavage from GD12 to GD19, respectively).In the control and DEHP exposure groups, the GTs were collected from the male fetuses on GD19.5, and scanning electron microscopy and HE staining were used to observe the morphological changes.The differentially expressed genes (DEGs) in the GTs were screened using lllumina HiSeq 2000 followed by GO and KEGG enrichment analyses to characterize the transcriptome profile.Immunofluorescence assay was performed to verify the DEGs (Mafb) identified by RNA-seq results.Immunofluorescence assay and Western blotting were used to examine the expression levels of Mafb in the penile tissue.@*RESULTS@#A total of 1360 DEGs were detected in the GTs between GD16 group and GD19 group by RNA-seq.Among these genes, 797 were up-regulated and 563 were down-regulated.These DEGs were mainly enriched in the cell adhesion plaque signaling pathway, axon guidance signaling pathway, and extracellular matrix receptor signaling pathway.Compared with that in GD16 group, Mafb was significantly up-regulated in GD19 group, which was consistent with the sequencing results.Mafb and β-catenin were significantly down-regulated in DEHP-exposed group compared with the control group ( < 0.01).@*CONCLUSIONS@#Mafb expression increases progressively with the development of GTs in male SD rats.DEHP exposure causes significant down-regulation of Mafb and β-catenin, suggesting that β-catenin signaling pathway that affects Mafb is related to DEHP-induced hypospadias in SD rats.

Optimization of preparation of rat kidney decellularized scaffold by combining freeze-thawing with perfusion / 生物工程学报

We explored the improved method to prepare decellularized kidney scaffold and provide experimental basis for kidney tissue engineering and renal pathology and toxicology in vitro research. We perfused rat kidneys with PBS (group control) and prepared the decellularized kidney scaffolds with sodium dodecyl sulfate (SDS) (group S), Triton X-100 combined with SDS (group TS), and Triton X-100 combined with SDS after repeated freezing and thawing (group FTS) in different flow velocity. Meanwhile we measured their fluid distributions and vascular resistance. We examined the degree of decellularization of acellular scaffolds by HE, DAPI staining and DNA quantification. We examined the retention of main composition and structural integrity of decellularized scaffolds by Masson, PAS and immunohistochemical staining. We also detected the ultrastructure, cytotoxicity and the level of growth factor of the scaffolds by scanning electron microscope, MTT and ELISA, respectively. The results showed that the time of decellularization in group FTS was less than that in group S and TS. The vascular resistance of scaffolds decellularized at 10 mL/min flow velocity was lower. The fluid distribution in groups S, TS and FTS was different from that in control group. No residual cell was detected by HE and DAPI staining. DNA content was less than 50 ng/mg. Masson, PAS and immunohistochemical staining results showed that there was extracellular collagen, polysaccharide, type I collagen, type IV collagen, fibronectin and laminin in the decellularized scaffolds, and the scanning electron microscope result showed the scaffolds had the honeycomb structure. The cytotoxicity level of decellularized scaffolds was between grade 0 to 1. The level of VEGF, EGF, IGF-1 and PDGF-BB in group FTS were significantly higher than those in group S and TS. In concluding, combining freeze-thawing with perfusion can produce more ideal and effective whole organ decellularized scaffold of rat kidney, and make a foundation for the study of kidney tissue engineering and in vitro pathology and toxicology of kidney.

Effect of early involvement in clinical practice in improving comprehensive abilities and occupational cognition in medical students / 中华医学教育探索杂志

Objective To investigate the effect of early involvement in clinical practice in improving comprehensive abilities of medical students and strengthening their occupational cognition. Methods The students in the 5-year class of 2014 of pediatrics in our university were enrolled as subjects, among whom 78 students who received early involvement in clinical practice and teaching were enrolled as experimental group and 81 students who did not receive such teaching were enrolled as control group. A questionnaire survey was performed for the students participating in the teaching, including basic information, pre-training quality evaluation, development of personal knowledge and abilities, and comments or suggestions. The two groups were compared in terms of the score of the theoretical course of pediatric surgery, so as to explore whether"early involvement in clinical practice"could improve the theoretical study of students. Finally, the performance of students in clinical practice was evaluated and compared between the two groups to assess the role of "early involvement in clinical practice" in improving comprehensive abilities and occupational cognition. Results More than 90％of the students were satisfied with early involvement in clinical practice and they thought this activity helped them to improve clinical thinking, strengthen occupational cognition, enhance learning interests, improve communication skills, and promote the combination of basic and clinical knowledge. In addition, the follow-up analysis found that compared with the control group, the experimental group had a significantly higher average score [(74.59 ±0.50) vs. (68.89 ±0.67)] and a significantly higher proportion of students with a score of >70, and no students failed. As for the score of clinical practice, the experimental group had significantly better clinical work proficiency, clinical thinking, operational ability,and doctor-patient communication ability than the control group. Conclusion Early involvement in clinical practice among medical students can improve their comprehensive abilities and help to cultivate clinical thinking and doctor-patient communication skills and strengthen their occupational cognition, which lays a good foundation for cultivating high-quality talents through medical education.

Study progress on correlation between ultrasonography and prognosis of non_surgical treatment to hydrone-phrosis caused by ureteropelvic junction obstruction in children / 中华实用儿科临床杂志

Hydronephrosis caused by ureteropelvic junction obstruction(UPJO)is a common urinary abnormality in children which involves dilation in the urinary tract due to limitation in urinary drainage. most cases would resolve spontaneously,but the others who were short of adequate treatment would lead to irreversible renal damage. Ultrasonog_raphy is the most common examination for UPJO. However,there exists disagreement in the way to define obstruction accurately or to predict which patient will benefit from surgical intervention by ultrasonography. By reviewing the related national data the authors analyzed the advance on prognosis of ultrasonography and the non _ surgical outcomes of UPJO.

The applied anatomy of vascular variability of duplex kidney in children / 中华泌尿外科杂志

Objective To study the vascular anatomy of duplex kidney and to provide a scientific basis for surgical resection of the renal segment.Methods From February 2012 to April 2018,the clinical data of 84 children with renal duplex kidney disease admitted to our hospital,were reviewed and analyzed.Among them,75 cases (89.3％) were unilateral and 9 cases (10.7％) were bilateral.According to the preoperative CT + CTA and the duplicated renal morphology,size,location,and anatomical relationship of the kidney segment,combined with the branches and passage of the renal artery which supplies the upper moiety,it described the blood supply of the upper renal moiety.At the same time,it analyzed various types of embryological related factors and gender differences and summarized the tips for laparoscopic surgery.Results Of the 93 duplex kidneys,69 (74.2％) were supplied with 1 artery,and 25 (26.9％) were supplied with 2 or more arteries.Based on the shape and orifice of artery,they were divided into 3 types.The most common type was that the renal artery separated into two or more arteries near the renal parenchyma.The upper and lower renal poles were respectively supplied,which could be summarized as early branching,a total of 71 sides (76.3 ％).The second type was the arteries from abdominal aorta or its branches,directly flowing into the upper renal pole,which was classified into the sub-renal artery,a total of 18 sides (19.4％).The others (4 sides,3.3％) were less common,and most of them were a combination of the above-mentioned two types,and one of them whose upper pole was supplied by branches of adrenal artery.Based on the classification of vascular variability,no significant difference was found between males and fenmals,or left and right sides.Conclusions The upper renal moiety are mainly supplied by one branch of renal artery,and the most common type of this artery is prehilar branch,without gender difference.The determination of vascular variability before surgery can avoid bleeding during surgery and avoid accidental injury of normal blood vessels.

Cancer stem-like cell-derived exosomes promotes the proliferation and invasion of human umbilical cord blood-derived mesenchymal stem cells / 南方医科大学学报

OBJECTIVE@#To investigate the effect of Piwil2-induced cancer stem-like cell (Piwil2-iCSC)-derived exosomes on the proliferation,migration and invasion of human umbilical cord blood-derived mesenchymal stem cells (hucMSCs).@*METHODS@#Piwil2-iCSC-derived exosomes were isolated by ultracentrifugation and identified using transmission electron microscopy,nanoparticle tracking analysis and Western blotting.Exosome uptake assay was used to identify the pathway that Piwil2-iCSCderived exosomes utilized.HucMSCs were divided into control group,PBS intervention group and exosome intervention group,and CCK-8 assay,wound healing assay,Transwell assay,Western blotting and cell karyotype analysis were used to observe the proliferation,migration,invasion,expression levels of MMP2 and MMP9 proteins,and chromosome structure of hucMSCs.@*RESULTS@#The diameter of Piwil2-iCSC-derived exosomes ranged from 50 nm to 100 nm,and most of them were oval or spherical capsules rich in CD9,CD63 and Piwil2 proteins.Exosomal uptake assay showed that the exosomes executed theirs functions after entering the cells.Compared with the control cells and PBS-treated cells,hucMSCs treated with the exosomes showed significantly increased number of proliferating cells (<0.05) with accelerated healing rate (<0.05 at 24 h;<0.01 at 48 h),increased invasive cells (<0.01),enhanced protein expressions of MMP2(<0.05 PBS group;<0.01 control group) and MMP9(<0.05),but their karyotype still remained 46XY without any abnormalities.@*CONCLUSIONS@#Piwil2-iCSC-derived exosomes can promote the proliferation,migration and invasion but does not cause cancer-like heterogeneity changes in hucMSCs.

Pelvis peristalsis of hydronephrosis in children and its correlation with prognosis / 中华实用儿科临床杂志

Objective To analyze the frequency of pelvis peristalsis in children with hydronephrosis and its correlation with postoperative percentage of improvement in anteroposterior diameter (PI－APD).Methods From Oc-tober 2015 to September 2017,the data of the children with unilateral ureteropelvic junction obstruction (UPJO)hydro-nephrosis who underwent laparoscopic pyeloplasty were collected,and their pelvis peristalsis frequencies of 2 min were recorded after exposing the pelvis,while the APD and PI－APD were followed 1 year posto-peratively.The degrees of hydronephrosis were divided into mild,moderate and severe according to the Society of Fetal Urology(SFU)classifica-tion system.ANOVA was used to compare the pelvis peristalsis frequency and postoperative PI－APD between different degrees of hydronephrosis.Spearman analysis was used to analyze the correlation between pelvis peristalsis frequency and degree of hydronephrosis.Meanwhile,Pearson test was used to analyze the correlation between pelvis peristalsis fre-quency,hydronephrosis degree and PI－APD.Results A total of 50 children were included,of which 36 patients got follow－up for 1 year postoperatively.Pelvis 2 min peristalsis frequency between different degrees of hydronephrosis [mild:(8.1 ± 3. 3)times;moderate:(6.3 ± 3.5)times;severe:(7.8 ± 3.9)times]had no significant difference (F＝0.65,P＝0. 527);no statistical correlation was observed between pelvis peristalsis frequency and degree of hydro-nephrosis or PI－APD (all P ＞0.05).Preoperative hydronephrosis degree was positively correlated with PI －APD (r＝0.54,P＝0. 001).PI－APD in severe hydronephrosis (0.48 ± 0.29)was significantly higher than that of mild hydronephrosis (0.21 ± 0.20)(P ＝0.001 ). Conclusions For children with different degrees of hydronephrosis caused by UPJO,there was no significant difference in the pelvis peristalsis frequency recorded during laparoscopic pyeloplasty.Pelvis peristalsis frequency recorded during surgery was not correlated with PI －APD,but preoperative hydronephrosis degree was positively correlated with postoperative PI－APD.

"Discussion about""Internet plus"" used in teaching of basis of surgical operation and formative eval-uation" / 中华医学教育探索杂志

Objective To explore the application effect on theInternet plusused in basis surgical operation and formative evaluation. Methods The students of Chongqing Medical University who planned to study the basis of surgical operation in the 2015 academic year were randomly divided into two groups, with 166 students in the experimental group and 165 students in the control group.Internet plusmodel was used in the experimental group in surgery based teaching and the formative evaluation system; the control group used the traditional teaching mode and traditional formative assessment method. Indicators of forma-tive evaluation system include animal operation score, small group global impression, the homework score (small group overall form), the final exam results and operation examination results. After class, the ques-tionnaire was used to investigate the effect of students' learning. The t test or rank sum test of two groups of students were performed by using SPSS 17.0. Results Average scores of animals operation and homework score of the students in the experimental group were respectively (9.23 ±0.65) and (9.53 ±0.66), higher than in the control group (8.56 ±0.62) and (8.96 ±0.52), and the difference between the two groups had statistical significance (P<0.05). The results of the questionnaire showed that according to the students' self evaluation the students in the experimental group were superior to the control group (P=0.03) in the aspect of professional knowledge learning. Conclusion Internet plus used in surgery teaching and formative evaluation, can significantly improve the effect of teaching and promote students' learning.

Retrospective analysis of 553 patients with posttraumatic elbow stiffness / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the etiology of posttraumatic elbow stiffness and distinguish features of the patients by retrospective analyzing their records.</p><p><b>METHODS</b>This was a retrospective analysis of 553 patients with posttraumatic elbow stiffness who underwent arthrolysis performed in Beijing Jishuitan Hospital from January 1997 to December 2013. The patients' clinical and radiographic results were collected, and encoded into a survey database.</p><p><b>RESULTS</b>Total 366 male and 189 female patients were treated by the same treating team. The average age of 553 cases was 35 years (12-76 years). And the largest number of >30-40 years old group was 166 (30.8%). There were 301 cases (54.4%) causing by low-energy injury and 227 cases (41.1%) by high-energy injury. The patients of extra-articular fractures and injuries were 60 cases (10.8%) with average 6.1 weeks' immobilization, and the patients of intra-articular fractures or dislocations were 493 cases (89%) with average 4.9 weeks' immobilization. The mean range of motion of extension and flexion was 30° (0°-110°). Four hundreds and fifty-seven patients (82.6%) were diagnosed with Heterotopic Ossification (HO), the other 96 patients without HO.</p><p><b>CONCLUSIONS</b>Elbow stiffness commonly occurs following trauma. More attention needs to pay on the treatment procedures for minor injuries, extra-articular fractures and simple intra-articular fractures. It is not appropriate to immobilize the elbow more than 3 weeks, even for those complicated elbow fracture and dislocation. Heterotopic ossification has significant negative impact on the function of elbow. However its pathogenesis is still not clear, which need more fundamental research.</p>

Histological features of tumor-bearing tissues formed by human fibroblasts after reprograming by Piwil2 / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To observe the histological features of tumor-bearing tissues formed by human fibroblasts after reprograming by spermatogonial stem cell self-renewal key regulating gene Piwil2 (Piwil2-iCSC).</p><p><b>METHODS</b>Piwil2-iCSC tumor spheroids-like colonies were selected for tumor formation assay in four nude mice. Pathological features of Piwil2-iCSC tumors were observed by histology. Stem cell markers and common triploblastic markers were detected by reverse transcriptase-polymerase chain reaction (RT-PCR) assay and immunohistochemistry. Germ cell tumor markers were detected by immunohistochemical examination.</p><p><b>RESULTS</b>Two weeks after inoculation, subcutaneous tumors were formed in all the four nude mice with a tumor formation rate of 100%. In the Piwil2-iCSC tumor tissues, Piwil2-GFP(+) cells showed high-density nuclear expression and were widely observed in DAPI-stained sections. Numerous mitotic figure of the neoplastic cells were seen (>10 cells/field of vision under high magnification) in HE-stained sections. Enlarged abnormal cell nuclei were observed. RT-PCR assay showed that Piwil2-iCSC tumors still expressed Piwil2 and some self-renewal and pluripotent markers of stem cells and some markers of triploblastic differentiation. Immunohistochemical staining showed that the tumors expressed stem cell markers, triploblastic markers and germ cell tumor markers AFP and HCG.</p><p><b>CONCLUSIONS</b>Piwil2-iCSC tumors are probably undifferentiated embryonic small cell carcinoma, most likely to be immature teratoma, mixed with yolk sac tumor and choriocarcinoma components. It can be used as a useful model for the research of origin or genesis mechanism of cancer stem cells and the treatment of relevant tumors.</p>

Applied exploration of formative evaluation in teaching of pediatric surgery / 中华医学教育探索杂志

To explore the promotion of formative assessment for teaching, the surgery teaching and research section of Institute of Pediatric has carried out formative assessment in theory teaching of pediatric medicine pediatric surgery for seven-year program for two consecutive years , and the teaching effects and assessment results have been made detalled analysis. The results shows that for-mative assessment combining with summative assessment can guide the students to adjust learning method in time and improve teaching methods effectively. Compared with the pure summative evalua-tion, formative assessment has enhanced the students' learning initiative, and improved their abilityof learning and solving problems. Formative assessment can comprehensively measure the overall quality of students.