Application of acellular bovine pericardium patch in implant based immediate breast reconstruction / 中华外科杂志

Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

Prostate biopsy guided by transrectal ultrasound combined with MRI compartmental localization in diagnosis of prostate cancer / 第二军医大学学报

Objective To explore the value of prostate biopsy guided by transrectal ultrasound combined with MRI compartmental localization in the diagnosis of prostate'cancer. Methods Fifty patients with elevated prostate specific antigen levels were recruited in this study. All the patients underwent MRI scan before biopsy and the prostate was divided into 12 compartments accordingly. The direction and region of the division were consistent with the ultrasound. Systematic 12-samples needle biopsy was performed and additional biopsy was done for the suspected compartments. According to histopathology, the positive detection rates of systematic 12-samples needle biopsy and systematic biopsy combined with added punctures of suspected compartments were analyzed and compared. Results Prostate cancer detection rate of systematic biopsy combined with punctures of suspected compartment was significantly higher than that of systematic 12-samples needle biopsy (42. 0% vs 36. 0%,P<0. 05). Systematic biopsy combined with punctures of suspected compartment caused hematuria in 5 cases, bloody stools in 13 cases, and fever in one, and there were no other complications. Conclusion Transrectal ultrasound combined with MRI compartmental localization can improve the outcome of prostate biopsy, benefiting the early diagnosis of prostate cancer.

Feasibility of the aging males' symptoms scale for the male population of Shanghai / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the reliability and validity of the Aging Males' Symptoms (AMS) scale in the male population of Shanghai.</p><p><b>METHODS</b>We enrolled 973 males aged 40 years and over in a community of Shanghai, China. Using the AMS scale, we calculated the split-half reliability coefficient and Cronbach's alpha coefficient, assessed the validity through confirmatory factor analysis and correlation analysis, and obtained the domain scores of different people by analysis of variance and independent sample test.</p><p><b>RESULTS</b>The split-half reliability was > 0.78 (P < 0.01) and Cronbach's alpha coefficients of all the dimensions > 0.82 (P < 0.01). Confirmatory factor analysis showed 3 domains in the AMS scale, Pearson correlation coefficients of all the items to their domains were > 0.49 (P < 0.01), and the total testosterone level was not correlated with AMS scores, with Pearson correlation coefficient of -0.04 (P > 0.05). Statistically significant differences were found in AMS scores among different age groups as well as among those with different chronic disease histories, but not in the psychological domain among different age groups.</p><p><b>CONCLUSION</b>The reliability and validity of the AMS scale are acceptable in assessing aging males'symptoms among the male population of Shanghai, but further studies are needed to determine whether it could be used as a tool for screening late-onset hypogonadism (LOH) in males.</p>

Combined transgastricand transvesical approach for porcine partial nephrectomy and application of V-loc suture / 第二军医大学学报

Objective To perform partial nephrectomy via combined transgastric and transvesical approach in porcine and to use V-loc suture for suturing the renal defect, so as to further assess the safety and feasibility of combined transgastric and transvesical approach. Methods Three female pigs were used in this study. The transvesical access was established by incising the anterior wall of the bladder under ureteroscope, and a self-designed Trocar was inserted. Under the guidance of ureteroscopy, the transgastric accesswas established by a needle knife with cautery, and the gastroscope was introduced after balloon dilation. Under the guidance of gastroscope, laparoscopic ultrasonic scalpel was introduced via the bladder Trocar; the kidney artery and veinwere separated, the arteries were blocked and some lower part of renal parenchyma was resected; and the wound was closed by 2-0 V-loc suture which was introduced percutaneously. The specimens were collected from the bladder. Results Six partial nephrectomy procedureswere done in the 3 pigs. The first case was transferred to traditional laparoscopy due to incompleted blocking of the artery, bleeding and loss of vision. The rest 5 cases were successfully completed, with a mean operation time of 174 min(140-220 min), a warm ischemia time of 21 min (17-28 min), and with no significant bleeding. The average size of incised tissue was 1. 5 cm X1. 5 cm. Conclusion Partial nephrectomy via combined transgastric and transvesical approach is extremely difficult, but it can be done by using the V-loc suture and auxiliary needle laparoscopic instrument; however, its clinical prospect still needs further verification.

Effect of nuclear transcription factor kappaB pathway on proliferation in rat pulmonary artery smooth muscle cells induced by platelet-derived growth factor / 中华实用儿科临床杂志

Objective To explore the effect of nuclear transcription factor kappaB(NF-κB) pathway on proliferation of rat pulmonary artery smooth muscle cells (PASMC) induced by platelet-derived growth factor (PDGF).Methods PASMC isolated from rats and cultured in vitro were divided into 3 groups according to the randomization principle:control group(cultured by M199),PDGF treatment group(cultured by M199 and stimulated by PDGF),PDGF + parthenolide treatment group (cultured by M199 and stimulated by PDGF,and intervented by the NF-κB inhibitors parthenolide).MTT colorimetric assay and flow cytometry were performed to detect cell proliferation and cell cycle distribution.Immunohistochemistry was performed to detect the expressions of NF-κB and COX-2 protein.Fluorescence quantitative RT-PCR was performed to detect NF-κB and COX-2 mRNA expressions.One-way ANOVA was used for statistical analysis,multiple comparisons were analyzed by LSD.Results Compared with the control group,MTT value of PASMC was increased significantly when induced by PDGF at each time points(all P ＜ 0.05).MTT value decreased dramatically after the intervention of NF-κB inhibitor parthenolide(P ＜0.05).Data from flow cytometry detection showed that cell proportion of S phase and G2 + M phase increased significantly in PDGF treatment group,which had statistical difference compared with control group (all P ＜ 0.05).Compared with PDGF induced group,after the intervention of parthenolide,cell proportion of S phase and G2 + M phase ratio decreased dramatically (P ＜ 0.05).The expressions of NF-κB and COX-2 protein and mRNA were promoted in the PDGF induced group compared with the control group (all P ＜ 0.05).Compared with PDGF induced group,after the intervention of parthenolide,the expressions of NF-κB and COX-2 protein and mRNA decreased dramatically(all P ＜ 0.05).Conclusions PDGF can induce proliferation of PASMC,promote cell cycle process and enhance the expressions of NF-κB and COX-2 protein and mRNA.NF-κB pathway involves in the proliferation of PASMC induced by PDGF.

Risk factors of heart and lung failure in children with severe hand, foot and mouth disease and treatment experience / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study risk factors for severe hand, foot and mouth disease (HFMD) complicated by heart and lung failure and treatment experience.</p><p><b>METHODS</b>A total of 198 children with severe HFMD between March and August in 2011 were enrolled. Univariate analysis and logistic regression model were used to analyze the risk factors severe HFMD complicated by heart and lung failure. The effects of combination therapy with immunoglobulin+dexamethasone+ribavirin were observed.</p><p><b>RESULTS</b>Univariate analysis indicated that HFMD patients with heart and lung failure had higher proportions of consciousness, tachypnoea, abnormal hemodynamics, increased troponin and EV71 infection than HFMD patients without heart and lung failure (P<0.05).Multivariate logistic regression analysis indicated that tachypnoea, abnormal hemodynamics and EV71 infection were the main risk factors for heart and lung failure. Compared with combination therapy with dexamethasone+ribavirin, combination therapy with immunoglobulin+dexamethasone+ribavirin was more effective for preventing hemodynamic changes in children with severe HFMD (P<0.01). Compared with HFMD patients with heart and lung failure, the effect of the combination therapy with immunoglobulin+dexamethasone+ribavirin was better in HFMD patients without heart and lung failure (P<0.01).</p><p><b>CONCLUSIONS</b>The main risk factors for heart and lung failure in children with severe HFMD include tachypnoea, abnormal hemodynamics and EV71 infection. Early combination therapy with immunoglobulin+dexamethasone+ribavirin can reduce the incidence of heart and lung failure in children with severe HFMD.</p>

Laparoscopic adrenalectomy for adrenal tumor with diameter longer than 10 cm: An experience with 5 cases / 第二军医大学学报

Objective To summarize our clinical experience on laparoscopic adrenalectomy for ≥10 cm adrenal tumors. Methods From June 2011 to September 2012, 5 patients received laparoscopic adrenalectomy for ≥10 cm adrenal tumors in our department. The outcomes of patients were observed. The surgical approach, Trocar sites, exposure of operation field, and the management of "dangerous triangle" were all summarized and analyzed. Results All the 5 cases were successfully operated via intraperitoneal approach, with no complications during or after operation. The operation time was 130-270 min (a mean of [180±65)] min), the bleeding was 50-300 ml, the anal exhaust time was 2-3 d after operation, and the hospital stay was 5-7 d. Pathological reports included 1 pheochromocytoma, 1 adrenal cortical adenoma, 1 schwannoma, and 2 myelolipoma. Conclusion Adrenal tumor with diameter ≥ 10 cm is no longer a contraindication for performing laparoscopic adrenalectomy when the followings are ensured: highly skilled, accurate surgical approach, comfortable Trocar sites, full exposure of operative field, complete separation of the "three planes", and safe management of the "dangerous triangle".

Lower urinary tract symptoms and prostatic growth pattern among old and middle-aged males in Shanghai community / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of lower urinary tract symptoms (LUTS) and the age-related growth pattern of the prostate among 40 -70 year-old males in Shanghai community.</p><p><b>METHODS</b>Using cluster and stratified random sampling and IPSS, we investigated the prevalence of LUTS among 1000 males aged 40 -70 years in the general population of Shanghai from November 2009 to June 2010. We measured the transverse, anteroposterior and vertical diameters of the prostate and its transition zone in each volunteer by transrectal ultrasonography and established the equation for the age-related growth pattern of the prostate.</p><p><b>RESULTS</b>In the 40 to 49-, 50 to 59- and 60 to 70-year groups, the incidence rates of moderate and severe LUTS (IPSS > or = 8) were 10.0%, 15.0% and 28.7%, respectively. The length, width, height and volume of the prostate and its transition zone were positively corrected with age (P < 0.05). The prostatic growth pattern equations based on the parameters of the transverse, anteroposterior and vertical diameters were Y = 1.6 x 10(-5)X3-0.002 1X2 + 0.074 6X + 0.677 2, Y = -2.4 x 10(-5)X3 + 0.003 3X2-0.1312X + 1.269, and Y = 1.6 x 10(-5)X3-0.001 8X2 + 0.073X- 0.690 9, respectively. The transverse and anteroposterior diameters of the prostate grew at a relatively similar rate, while the transverse diameter grew obviously faster than the vertical diameter before 60 years old, but the latter significantly increased and even exceeded the former after 60 years old.</p><p><b>CONCLUSION</b>The prevalence of LUTS among old and middle-aged males in Shanghai community is similar to that recently reported at home and abroad. The transverse and anteroposterior diameters of the prostate grow at a relatively similar rate, but the vertical diameter increases faster after 60 years old.</p>

A novel set of surgical instruments facilitate the procedure of laparoscopic pyeloplasty / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Open pyeloplasty has been historically described as the gold standard for the surgical treatment of ureteropelvic junction obstruction (UPJO), even if new techniques have recently gained a prominent role in this field. Laparoscopic pyeloplasty (LP) is not widely prevelant because of the technically challenging nature and it represents the gold standard for UPJO only in expert hands. To overcome some difficulties and technical challenges encountered during pure laparoscopic pyeloplasty, we designed a set of new instruments and assessed them using porcine model.</p><p><b>METHODS</b>According to the ideas from the surgeons, our medical engineer designed three new instruments, including the right angle laparoscopy scissors, the petal-shape ureter dilator and the guide tube. Four experienced laparoscopic experts were involved in a no survival porcine study to assess the help of these new instruments. Four experiments were conducted on live pigs that weighed 22 to 25 kg at the same time. After general anesthesia was administered, transperitoneal ureteroureterostomy was performed using standard laparoscopic instruments, including placing the double J stent anterograde. Then, the opposite lateral was done by the same surgeon plus these new devices for side-by-side comparative analysis. All experts were interviewed to assess these new instruments by the questionnaire based on the visual analog scale (VAS) from 1 (none) to 10 (very much).</p><p><b>RESULTS</b>The procedures were all technically successful. The right angle laparoscopy scissors and the guide tube were accepted by all participants and the Help Score were 6.75 and 4.25 respectively, at the same time the New Difficulty Score 1.25 and 1.75. However, the petal-shape ureter dilator got 1.5 Help Score and 6.5 New Difficulty Score. These surgeons made a negative comment and one of surgeons recommended the stone basket was more suitable.</p><p><b>CONCLUSION</b>The right angle laparoscopy scissors and the guide tube may be helpful to minimize some difficulties in pure laparoscopic pyeloplasty.</p>

Reserved sutures for incision closure of transvesical natural orifice transluminal endoscopic surgery in pigs / 第二军医大学学报

Objective: To close the incision of transvesical natural orifice transluminal endoscopic surgery (NOTES) with reserved sutures in pigs, and to assess the feasibility and safety of the technique, so as to lay a foundation for future clinical application. Methods: Five female pigs were inserted with self-made Trocar into the bladder under general anesthesia. Guided by ureteroscope, the needle passed the top wall of the anterior bladder and reached the abdominal wall, with two suture ends reserved for closure, one at the abdominal wall and the other in the urethra (out of Trocar). After finishing the transvesical NOTES, we pulled the suture end at the abdominal wall to the bladder and knotted outside the Trocar; then we dragged the urethra suture end to make the knot on the abdominal wall locating on the lateral wall of bladder, and then the urethral suture was knotted in Trocar and the knot was pushed to the bladder wall using a knot pushing device; finally the bladder incision was closed. The closure of the bladder incision was observed and tested with water filing method. Results: The first two cases failed due to the overweight and large size of the pigs, or because the bladder incision was to close to the bladder neck, or due to the poor quality of the suture. The procedures were successful in the following 3 pigs, with the operation time periods being 45 min, 30 min, and 25 min, and with satisfactory closure. Conclusion: Reserved suture for incision closure of transvesical NOTES procedure is safe and feasible; the technique is easy to perform and needs no special surgery devices; and it deserves further study.

Expression of iNOS protein and gliacyte apoptosis in neonatal rats with white matter damage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Inducible nitric oxide synthase (iNOS) is a main rate-limiting enzyme resulting in over-production of nitric oxide following hypoxia-ischemia (HI). The aim of this study was to observe the expression of iNOS protein and gliacyte apoptosis in the brains of premature rats after HI, in order to explore possible relationships of iNOS with white matter damage (WMD).</p><p><b>METHODS</b>One hundred and twelve 2-day-old premature rats were randomly subjected to right carotid ligation followed by 4 hrs hypoxic stress (WMD group) or sham operation (control group). The pups were sacrificed at 1, 3, 6, 12 hrs, and 1, 3 and 7 days after HI. Immunohistochemical technique was applied to determine the iNOS expression in periventricular white matter tissues. Gliacyte apoptosis was detected in these tissues by TUNEL.</p><p><b>RESULTS</b>Compared with the control group, iNOS expression began to increase 1 hr after HI and reached the peak 1 day after HI in the WMD group. Gliacyte apoptosis increased 1 hr after HI and peaked 1 day after HI in the WMD group compared with the control group.</p><p><b>CONCLUSIONS</b>In the neonatal rats with WMD, the expression of iNOS may be involved in the ischemic cellular events including apoptosis, and plays a role in the pathophysiological process of WMD.</p>

Experimental studies of kidney biopsy by natural orifices: transgastric and transvesical combined approach / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility of kidney biopsy by transgastric and transvesical combined approach in the porcine model.</p><p><b>METHODS</b>Five female pigs (20 to 30 kg) were included in this study. All procedures were performed with pigs under general anesthesia. The transvesical access was established by the ureteroscope. Then monitored by ureteroscopy, the transgastric access was established by a needle knife with cautery. The puncture dilation was performed with balloon through the gastroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath. The kidney biopsy was finished by the scissor from the transvesical access and the grasping forcep from the work channel of gastroscope.</p><p><b>RESULTS</b>Among five cases the procedure were successful in three cases with 380 min, 180 min, 78 min respectively. Establishment of transvesical and transgastric accesses took place without complications. The exposure and biopsy of the kidney were easily achieved during operation. The transgastric and transvesical access were not closed in the end.</p><p><b>CONCLUSIONS</b>This new method is a technically feasible procedure in a porcine model. But the safety and the clinical future of it needs more study.</p>

Expression of GRP78 and caspase-12 in neonatal rats with experimental hypoxic-ischemic white matter damage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>GRP78 is a sensitive marker of endoplasmic reticulum stress. Caspase-12 is involved in apoptosis induced by endoplasmic reticulum stress. This study was designed to explore the changes of GRP78 and caspase-12 mRNA in neonatal rats with experimental hypoxic-ischemic white matter damage (WMD) and investigate the roles of endoplasmic reticulum stress in the WMD.</p><p><b>METHODS</b>Two-day-old rats were randomized to WMD and control groups (n=49 each). The pups were sacrificed at 0, 2, 4, 6, 12, 24 and 72 hrs after hypoxia-ischemia (HI). The light microscope was used to observe the brain pathological changes. Real time PCR was used to detect the expression of GRP78 mRNA and caspase-12 mRNA in the white matter tissue.</p><p><b>RESULTS</b>The expression of GRP78 mRNA began increasing 2 hrs after HI and peaked at 6 hrs in the WMD group, demonstrating significant differences at 2, 4, 6, 12, 24 and 72 hrs compared with the control group (P<0.05). The caspase-12 mRNA expression in the WMD group began increasing 6 hrs after HI and demonstrated significantly increased levels 6, 12 and 24 hrs after HI compared with those in the control group (P<0.05).</p><p><b>CONCLUSIONS</b>GRP78 and caspase-12 mRNA expression increased significantly in neonatal rats with WMD. This suggests that endoplasmic reticulum stress may be induced following HI. Endoplasmic reticulum stress seems to be involved in the apoptosis of oligodendrocytes induced by HI in neonatal rats with WMD.</p>

A new synthetic tripeptide inhibits L-arginine transport in macrophages / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of a new synthetic tripeptide [Arg(NO(3))- Lys(OCH(3))- Arg(NO(3))] on L-arginine/NO pathway in the macrophage cell strain RAW246.7.</p><p><b>METHODS</b>The cultured macrophages exposed to lipopolysaccharide (LPS, 1 microg/L) treatment were randomly divided into 3 groups (n=6) and treated with distilled water, 1x10(-4) mol/L tripeptide and 1x10(-4) mol/L L-arginine, NG-monomethyl-L-arginine (L-NMMA) for 24 h, respectively. The macrophages were incubated for 24 h with LPS (1 microg/L) and in the presence of different concentrations of L-arginine (0 to 2 mmol/L), or in normal culture medium (containing 0.5 mmol/L L-arginine) for 24 h with LPS (1 microg/L) and in the presence of tripeptide of 0 to 10x10(-4) mol/L. The changes of [(3)H]-L-arginine transport and NO production from the macrophages were measured.</p><p><b>RESULT</b>NO release from macrophages incubated in the LPS-containing culture medium was 50 folds, and [(3)H]-L-arginine uptake 2.7 folds that in cells in normal culture medium. Tripeptide (1x10(-4) mol/L) inhibited [(3)H]-L-arginine transport and NO production by 67% and 71% respectively. The effect of tripeptide was stronger than L-NMMA (P<0.05). Extracellular L-arginine caused a concentration-dependent increase in nitrite production, which reached the maximum at concentrations above 0.5 mmol/L Km for nitrite production of 0.162+/-0.015 mmol/L and Vmax of 91.2+/-2.3 micromol/(24h.10(6) cells). L-arginine transport and NO production were inhibited by tripeptide, but their dose-dependent pattern of changes was different with EC50 of 0.21x10(-4) mol/L and 1.27x10(-4) mol/L, respectively.</p><p><b>CONCLUSIONS</b>Activation of macrophages with LPS induces nitrite accumulation in the culture medium, which is dependent on the presence of extracellular L-arginine. The tripeptide induces dysfunction of L-arginine/NO pathway in macrophages, potently inhibits L-arginine transport and competitively combine the active sites of nitric oxide synthase.</p>