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Objective@#To investigate the prevalence of anxiety and depression among inpatients with AIDS and its influencing factors, so as to provide the evidence for improving the psychological health among inpatients with AIDS.@*Methods@#The inpatients with AIDS that were hospitalized in an infectious disease hospital in Chengdu City were recruited using the convenient sampling method. The demographic features, depression and anxiety were collected using a self-designed questionnaire, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale ( SDS ), respectively, and factors affecting the development of depression and anxiety were identified using a multivariable linear regression model among inpatients with AIDS.@*Results@#The 228 AIDS inpatients included 186 men (81.58%) and 42 women ( 18.42% ), and had a mean age of ( 48.04±16.03 ) years. There were 113 inpatients ( 49.56% ) with a CD4+T cell count of ≤200 cells/μL, and the mean SAS and SDS standardized scores were 35.87±8.01 and 42.07±11.08 among AIDS inpatients, which were both significantly greater than in normal populations ( P<0.05 ). The prevalence rates of anxiety, depression, and comorbid anxiety and depression were 5.26%, 16.23% and 4.82% among the participants, respectively. Multivariable linear regression analysis identified unemployment as a risk factor of anxiety ( β'=0.168, P<0.05 ), and CD4+T cell count as a risk factor of anxiety ( β'=-0.151, P<0.05 ) and depression ( β'=-0.238, P<0.05 ) among inpatients with AIDS.@*Conclusions@#Anxiety and depression are prevalent among inpatients with AIDS. Unemployment and a low CD4+T cell count may cause a rise in the risk of developing anxiety and depression among inpatients with AIDS.
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This research aims at the existing problems of medical students' information literacy to cultivate medical students' information literacy through the construction of cloud libraries, medical school characteristic library, medical schools sharing electronic resources and the establishment of medical student information literacy competitions. The results show that the total scores of medical students' information awareness, information knowledge, information ability, information ethics and information literacy have been greatly improved after the teaching reform [(11.56±1.37) vs. (15.64±1.88), (10.28±1.33) vs. (16.50±1.64), (9.50±1.29) vs. (15.22±1.90), (10.04±1.23) vs. (14.81±1.57), (41.92±3.20) vs. (61.59±3.57)], with statistical significance ( P<0.001). The medical significance shows that the teaching reform based on the construction of the library's diversified information source system can significantly improve the information literacy level of medical students.
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Objective:To evaluate the therapeutic characteristics of laparoscopic repair in children with ure-terovesical junction malformation through internal or external bladder.Methods:From February 2018 to August 2019, 29 cases of hydronephrosis combined with ureter expansion treated in the First Affiliated Hospital of Zhengzhou University, with 17 boys and 12 girls confirmed through the preoperative examinations.Inspection results revealed 15 cases of ureteropelvic junction obstruction, 12 cases of vesicoureteral reflux, and 2 cases of single ectopic ureter.Totally, 21 cases were treated by pneumovesical laparoscopic Cohen means, including 17 unilateral cases and 4 bilateral cases, 5 cases of ureterocele, and 8 cases of ureteral clipping.A total of 8 cases were treated by laparoscopic Lich -Gregoir surgical treatment, including 7 unilateral cases and 1 bilateral case.Meanwhile, 4 cases of ureteral clipping were performed among them.There was 1 case of duplex kidney with the ectopic upper ureter outside iliac blood vessels, 1 case of bilateral cryptorchidism and 1 case of unilateral cryptorchidism.Ureteral stents were implanted for those with ureteral tailoring.The catheters were removed 7 days after operation, and the indwelling ureteral stents were removed by cystoscope under general anesthesia after about 6 weeks.Results:All the cases with hydronephrosis and ureteral dilatation were completed in laparoscopic surgery, without open surgery or blood transfusion, 21 cases were treated by pneumovesical laparoscopic Cohen means, with the average time being 1.8 hours in unilateral side and 2.8 hours in bilateral sides.At the same time, 8 cases were treated by laparoscopic Lich-Gregoir means, with the unilateral average time being 1.7 hours and bilateral time being 3.0 hours.All cases were followed up at an average month of 9 (4-20 months), and all children underwent voiding cystourethrography 4 months after the operations.The voiding cystourethrogram(VCUG) of all the cases was confirmed successfully, with only 1 case of vesicoureteral reflux in level Ⅲ, and their hydronephrosis were relieved.There was no vesicoureteral reflux in the others.The short-term urinary retention occurred in 1 patient with bilateral ureteral reimplantation in Lich-Gregoir group, and the symptom disappeared after 1 week of indwelling catheterization.Among them, 1 patient in Cohen group had hematuria that disappeared gradually for 4 days after surgery.There were no significant differences in operation time and postoperative recovery between the two groups.The length of hospital stay in laparoscopic Lich -Gregoir group was slightly longer than that in pneumovesical laparoscopic Cohen group.Conclusions:As for children with ureterovesical junction malformation, laparoscopic Lich-Gregoir surgery is suitable for the ectopia of ureter opening, overexpansion of ureter, and other abdominal malformation complicated and expansive ureter without tortuosity.Pneumovesical laparoscopic Cohen surgery is suitable for hydronephrosis and ureteral expansion with ureterocele, especially with the symptom of dysuria, and ureteral tortuosity obviously.The two ways are safe and reliable, and the advantages and disadvantages should be weighed before being chosen.
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Objective:To explore the feasibility and precautions of laparoscopic pyeloplasty for children with hydronephrosis combined with renal trauma.Methods:The clinical data of 6 cases with hydronephrosis and renal trauma admitted to the Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019, aged from 5 to 11 years old (average age 7 years old) were reviewed.These patients had suffered renal trauma for 1 to 4 days.All patients had the symptoms of pain in the affected kidney, and 4 patients had hematuria.The renal pelvis diameter of all patients was more than 25 mm.The patients underwent laparoscopic pyeloplasty and renal rupture repairment, with the ureteral stent, perirenal drainage tube and catheter placed inside the body during the operation.Results:All operations were completed successfully without any blood transfusion and open surgery.Intrao-perative time was from 2.5 to 3.5 hours.Two cases had renal parenchymal contusion in the front lower pole of kidneys and 4 cases in the lateral lower pole.Five cases had renal cortex and pelvis rupture, and 1 case had renal cortical fracture and subcapsular hematoncus.After the operation, the perinephric drainage tube was pulled out in 3 to 5 days, the catheter was pulled out in 7 to 10 days, and the ureteral stent was removed in 6 to 8 weeks.All children recovered well and hydronephrosis was ameliorated.The glomerular filtration rates and fractional renal function were all improved.Conclusions:One stage laparoscopic pyeloplasty is safe and effective for the treatment of hydronephrosis with renal trauma in children.Renal trauma in children usually occurs at the lower pole of the kidney.Early operation is needed if hydronephrosis is aggravated and symptoms are not relieved after the trauma.Intraoperative impairment of renal parenchymal rupture can be conducted.For intraoperative bleeding in grade 3 renal injury, renal parenchyma suturation and removal of necrotic renal tissue should be adopted to arrest bleeding.
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Objective:To explore the reasons for the retention of long time testicular torsion and the surgical selections of contralateral testis in children.Methods:The data of children with acute scrotal emergencies treated by the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2019 were retrospectively analyzed.All the testicular torsion was included in the study sequence to summarize the clinical characteristics of the testicle that could be saved and different treatment methods adopted in the contrary side according to the anatomy of testes.Results:A total of 80 children with testicular torsion were included in the study.The onset time ranged from 2 hours to 15 days.All patients came to the hospital with unilateral scrotal pain or inguinal pain, including 74 cases of unilateral testicular torsion and 6 cases of cryptorchidical testicular torsion.All the children were treated with surgery.Orchiectomy was performed in 69 cases of testicular necrosis, and 11 cases were saved, among which 4 cases took a long time for testicular torsion, the main reason for the retention was the longer spermatic cord in the tunica vaginalis.Of the 80 healthy testes, the adhesion of the testis to tunica vaginalis was normal in 63 cases and abnormal in 17 cases.There were 20 children (including 5 children with abnormal anatomy) were routinely treated with partial removal of the tunica vaginalis and orchiopexy.Among the remaining 60 cases, 12 cases with abnormal adhesion of the testis to tunica vaginalis underwent partial removal of the tunica vaginalis and orchiopexy, and the other 48 cases with normal anatomy received the testis examination and the original incision closure.During the follow-up of 80 cases, 5 cases of the 11 children with the testis preserved returned to normal, 6 cases of them showed atrophy to varying degrees, and no discomfort such as torsion or pain was found in all the healthy testes.Conclusions:The long spermatic cord in the tunica vaginalis is the reason for long time testicular torsion in children with the testis saved.It buys time for the rescue of their testes.Orchiopexy is not necessary for those who have normal anatomy of the healthy testes, while partial removal of the tunica vaginalis and orchiopexy are recommended for patients with bell clapper anomaly.
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Objective@#To learn the status of knowledge,attitude and behaviors of road traffic safety in primary and secondary school students in Xiacheng District of Hangzhou. @*Methods@#The students of fourth to seventh grade from seven schools in Xiacheng District were selected and surveyed for their knowledge,attitude and behaviors of road traffic safety by self-designed questionnaires. @*Results@#Totally 4 006（99.98%）students completed the survey,who mostly had awareness rates of over 90% in knowledge about safe behaviors when walking,walking across the road and riding a bicycle or an electric bicycle. The awareness rates of"should not run across the road","should not ride side by side"and"should not ride on the motorway"were relatively low,which were 81.65%,85.72% and 82.78%,respectively. About 68.47% of students thought it necessary to wear a helmet when riding a bicycle or an electric bicycle,72.22% of students thought it necessary to wear seatbelt or use child safety seat when taking a car. The two rates were significantly higher in girls than boys and in primary school students than secondary school students（P<0.05）. The top three unsafe behaviors the students did in the past six months were"not wear a helmet when riding a bicycle or an electric bicycle","run across the road"and"ride on the motorway",the rates of which were 86.84%,10.06% and 7.91%,respectively. @*Conclusion@#The knowledge of road traffic safety among primary and middle school students in Xiacheng District is mastered well. Interventions should be focused on unsafe behaviors including not wearing a helmet when cycling,riding on the motorway and running cross the road.
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Objective @#To evaluate the risk of cardiovascular disease in hypertensive patients managed by communities in Tongxiang in the next 10 years,and to provide evidence for the development of cardiovascular disease prevention strategies. @*Methods@#The information about hypertensive patients managed by communities was collected from Tongxiang resident health records management system. The risk of ischemic cardiovascular disease（ICVD）in the next 10 years was assessed by the Assessment Scale of 10-Year ICVD Risk in Chinese.@*Results@# A total of 27 173 hypertensive patients managed by communities with complete data were recruited,including 11 868 males,accounting for 43.68%,and 15 305 females,accounting for 56.32%. The median（inter-quartile range）of the total scores of 10-year ICVD risk in hypertensive patients was 8.00（3.00）,with 9.00（2.00）in males and 8.00（2.00）in females. The total scores of 10-year ICVD risk in males was significantly higher than those in females（P<0.05）. A total of 8 764 patients had high 10-year ICVD risk,accounting for 32.25%. The proportion of high10-year ICVD risk in females with hypertension was higher than that in males（P<0.05）. The weights of ICVD risk factors in males were 54.58% in age,17.42% in systolic blood pressure,14.27% in smoking,7.77% in body mass index,4.51% in total cholesterol and 1.45% in diabetes;the ones in females were 63.57% in age,14.63% in systolic blood pressure,9.81% in body mass index,6.00% in total cholesterol,5.88% in diabetes and 0.11% in smoking.@*Conclusion @#The ICVD risk of hypertensive patients managed by communities in Tongxiang is higher in the next 10 years. Male patients should focus on the control of blood pressure and smoking,while female patients should focus on the control of blood pressure and body weight.
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Objective@#To understand the epidemiological characteristics of product-related injuries among children in Changshan County from 2011 to 2017 and to provide evidence for targeted intervention. @*Methods@#The surveillance data of product-related injuries among children aged below 18 years from 2011 to 2017 was collected from three sentinel hospitals in Changshan County. The characteristics of product-related injuries among children were analyzed,especially those injuries caused by furniture,stationery and sporting goods,commodities and toys. @*Results@#A total of 5 111 product-related injury cases among children were reported,accounting for 13.49% of product-related injury cases of all age. There were 3 138 boys and 1 973 girls,accounting for 61.40% and 38.60%. There were 2 973 cases less than 10 years old,accounting for 58.17%. The main causes of product-related injuries were road traffic injury（49.46%）,blunt（16.02%）,stab/cut（12.39%）and fall（10.37%）. The main categories of products included transportation equipments（not including motor vehicles,36.83%）,motor vehicles（17.82%）,furniture（12.23%）,stationery and sporting goods（8.45%）,commodities（4.89%）and toys（3.25%）. Stab/cut（53.01%）was the main cause of commodities related injuries;blunt was the main cause of furniture,stationery and sporting goods and toys. The stationery and sporting goods related injuries occurred mainly in schools/public places（64.57%）and sports venues（18.48%）when engaging in sports（54.13%）;furniture,commodities and toys related injuries injured cases occurred at home when engaging in leisure activities. Commodities mainly resulted in sharp/bite/open wound（51.50%）;furniture,stationery and sporting goods and toys mainly resulted in bruises. Most cases were injured in head,slight and allowed home after treated.@*Conclusion@#The product-related injuries among children in Changshan County are more boys. The products mainly involve transportation equipments（not including motor vehicles）,motor vehicles,furniture,stationery and sporting goods,commodities and toys,with emphasis on the latter four categories in the prevention of product-related child injury.
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Objective @#To explore the positive rates and influencing factors of depression and anxiety among managed diabetic patients in community and to provide evidence for the future mental health intervention.@*Methods@#Random sampling method was used to select the diabetic patients from the local health information platform in Ningbo. The anxiety and depression symptoms of the diabetic patients were evaluated by 9-Item Patient Health Questionnaire（PHQ-9）and 7-Item Generalized Anxiety Disorder Scale（GAD-7）. Logistic regression model was applied to analyzing the influencing factors for anxiety and depression in diabetic patients.@*Results@#A total of 1 032 diabetic patients were enrolled,with a response rate of 91.98%. The positive rate of depression was 9.01% and the positive rate of anxiety was 3.78%. The results of multivariate logistic regression analysis showed that divorced/widowed（OR=3.046,95%CI：1.522-6.100）,having two comorbidities or more（OR=6.723,95%CI：2.495-18.120）and suffering diabetes for more than ten years（OR=2.668,95%CI：1.406-5.062）were the risk factors for depression in diabetic patients,while having a college education or above（OR=0.288,95%CI：0.093-0.893）was the protective factor for depression in diabetic patients;unmarried（OR=13.244,95%CI：1.268-138.377）,having two comorbidities or more（OR=6.979,95%CI：2.164-22.503） and suffering diabetes for more than ten years（OR=3.109,95%CI：1.241-7.787）were the risk factors for anxiety in diabetic patients.@*Conclusion@#Marital status,the number of comorbidity,course of diabetes and education level could affect the occurrence of depression in diabetic patients;marital status,the number of comorbidity and course of diabetes could affect the occurrence of anxiety in diabetic patients.
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Objective@#To learn the current status of injury among community residents in Zhejiang Province,and to provide reference for injury prevention strategy.@*Methods@#A total of 38 005 residents were recuited from 11 counties or districts in Zhejiang Province by multi-stage cluster random sampling. A retrospective questionnaire survey was conducted to collect their injury occurrence from June 1st of 2017 to May 31st of 2018,then analyzed the incidence,mortality and types of injury.@*Results@#Among 38 005 respondents,2 186 injuries occurred,the incidence rate of injury was 5.75%. The incidence rate of injury in males and females were 5.67% and 5.84%,respectively. The incidence rate of injury in rural respondents（6.97%）was higher than that（4.79%）in urban respondents（P<0.05）. Seven respondents died of injury and the mortality rate was 18.42/100 000. The top five types of injury were falls（2.27%）,traffic accidents（1.53%）,animal bites（0.69%）,sharp articles（0.50%）and blunt articles（0.41%）. The lowest incidence rate of injury lay in 15 to 24 years old,and the highest lay in 65 to 74 years old. The incidence rate of injury increased with age（P<0.05）. The first type of injury in respondents aged 15 to 44 years old was traffic accidents,while others was falls.@*Conclusion@#The incidence of injury is higher in rural residents than in urban residents in Zhejiang Province,which increase with age. Falls and traffic accidents are the main threats to residents in Zhejiang Province.
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Objective@#To explore the treatment effect of pedicled myocutaneous island flap of anterolateral thigh muscle on the suprapubic defect caused by bladder exstrophy in children.@*Methods@#The clinical data of 3 adolescents with bladder exstrophy were analyzed. All 3 cases underwent one-stage Kelly procedure and received the treatment using pedicled myocutaneous island flap of anterolateral thigh muscle to repair the suprapubic defect. The bladder expansion was performed with ileal sarcoplasmic layer graft, and the Cohen ureteral reimplantation was performed as well, for 1 case 1, 1 year after the first operation. The others 2 patients didn′t receive the second operation.@*Results@#All operations were successful. The femoral donor regions were directly closed. Postoperative follow-up period was 1-7 years. The myocutaneous island flaps were survived and grew well. All incisions of the femoral donor region were primary healing without scar hypertrophy. Urinary continence was achieved in 2 cases, and partially achieved in 1 case. Recurrent urinary tract infection, recurrent fever or abdominal pain were not observed in all patients.@*Conclusions@#The pedicled anterolateral thigh myocutaneous island flap is an alternative way to repair suprapubic defect caused by bladder exstrophy.
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Objective To evaluate the clinical effect of treatment for high intra-abdominal cryptorchidism of children with transumbilical single-site and multichannel laparoscopic single stage Fowler-Stephens (F-S) orchiopexy.Methods The case records of the intra-abdominal cryptorchidism of children who had undergone transumbilical single-site laparoscopic single stage F-S orchiopexy were reviewed retrospectively in Children's Hospital Affiliated to Capital Institute of Pediatrics between January 2011 and January 2017,were assigned as the observation group,whose age ranged from 1 to 8 years and average age was 18 months,with 22 unilateral and 8 bilateral,38 testis in total.A total of 31 children with intra-abdominal cryptorchidism who had undergone laparoscopic two stage F-S orchiopexy were assigned as the control group,whose age was from 11 months to 9 years and average age was 20 months,with 23 unilateral and 8 bilateral,39 testis in total.Postoperative follow-ups were conducted with the evaluation index included the testical position,with or without atrophy.The procedure effect and postoperative complications were observed,and the difference between two operation methods was evaluated.Results Operations in all cases were successful in both groups without intraoperative complication.A total of 38 testis were operated with single stage F-S orchiopexy in the observation group,and 39 testis were operated with two stage F-S orchiopexy in the control group.Postoperative complications included scrotum wound infection one case and scrotum hematoma in one case in the observation group,and abdominal wall emphysema in one case,intestinal obstruction in one case as well as umbilicus infection 1 case in control group.Follow-ups ranged from 6 months to 6 years,median 24 months.All testicals were within the scrotum,and each group had 1 case of testical atrophy.The difference of postoperative complication and effect between two groups had no statistical significance(x2 =0.184,0.107,all P ＞ 0.05).Conclusions Outcomes between single stage and two stage F-S orchiopexy are similar.The transumbilical single-site laparoscopic F-S orchiopexy not only has the satisfactory effect,but also saves some patients from reoperation and secondary anaesthesia,but doctors must be aware of the indications and contraindications of this procedure should be brought to attention.
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Objective To explore the choice of handling methods for bilateral internal ring during the transumbilical single-site laparoscopic orchiopexy for cryptorchidism with bilateral processus vaginalis unclosed in children,and evaluate the clinical effect.Methods Retrospective analysis was conducted for the clinical data of 102 children with cryptorchidism and bilateral processus vaginalis unclosed who were hospitalized at Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2011 to January 2016.They were divided into the observation group (55 cases) and the control group(47 cases).In the observation group,the internal rings of the affected side were destroyed and stitched with a needle between the edge of arcuate of musculus trasversus abdominis and fascia trans versalis of posterior peritoneum.If the diameter of opposite internal ring was less than 0.5 cm,only a circle was destroyed.Otherwise,a circle was destroyed and sutured with a needle.In the control group,the processing methods for orchiopexy and affected side internal ring were same as the observation group.Purse string suture was done for opposite internal rings of all cases in the control group.The parameters of operative duration,intraoperative blood loss,postoperative hospital stay,postoperative complications were compared between 2 groups.Results All operations were successful in both groups,spermatic cords were reserved and testicles were in scrotum of all cases.Operative duration was significantly shorter in the observation group than that in the control group [(42.02 ± 3.21) min vs.(48.43 ± 4.18) min,t =-8.739,P ＜ 0.01].The differences in intraoperative blood loss,postoperative hospital stay and postoperative complications between 2 groups were not statistically significant[(4.38 ± 1.42) mL vs.(4.80 ± 1.37) mL,t =-1.533,P ＞0.05;(2.87 ±0.64) dvs.(2.98 ±0.61) d,t =-0.853,P ＞0.05;1.8％ (1/55 cases) vs.2.1％(1/47 cases),x2 =0.013,P ＞ 0.05].During a mean follow-up of 30(12-72) months,there was no case of testicular ascent or atrophy,or hernia,or hydrocele.Conclusions The transumbilical single-site 3-port laparoscopic orchiopexy for cryptorchidism has stable efficacy.The improved method for bilateral internal ring is simple and has satisfactory effect,which is worthy of clinical promotion.
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Objective To analyze the relationship between clinical features and age of operation on children with hypospadias,and to explore and determine the factors for hypospadias associated with age at surgery.Methods Retrospective study was conducted in children with hypospadias undergoing operation at the First Affiliated Hospital of Zhengzhou University between January 2011 to December 2016.The demographics,the degree of hypospadias,complications,age at first urethroplasty and the other factors in patients were recorded,t-test was used to determine the factors associated with surgical timing and the difference was significant when P ＜ 0.05.Results A total of 1 051 cases were included in the study.Among these patients with hypospadias 268 cases (25.5％) were of mild cases,525 cases (50.0％) of moderate,and 258 cases(24.5％) of severe.Nine hundred and forty-six cases(90.0％) did not have complications,while 105 cases(10.0％) had complications.The median age at first urethroplasty was 5.3 years old and 66.22％ of them were operated after 3 years,and 4.09％ of them were after 18 years old.Insurance types,household income,race did not influence with surgical timing statistically (P ＞ 0.05).Multivariate analysis showed that the several factors were significantly associated with time of surgery:the severity of hypospadias (t =28.10,P =0.000),with or without complications (t =64.17,P =0.000),urban-rural gap (t =7.49,P =0.000),parental education level (t =36.90,P =0.000) and the age of receiving advice from pediatric surgeon (t =5.00,P =0.000).Conclusions The age of surgery in children with hypospadias were significantly affected by the severity of hypospadias,the presence of complications,differences between urban and rural areas,the degree of parental education,and the time of medical advice in the pediatric department of urology.,and the education of hypospadias knowledge for children's parents and related medical personnel at the grass-roots level will advance the age of surgery in children with hypospadias.
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Objective To analyze the relationship between clinical features and age of operation on children with hypospadias,and to explore and determine the factors for hypospadias associated with age at surgery.Methods Retrospective study was conducted in children with hypospadias undergoing operation at the First Affiliated Hospital of Zhengzhou University between January 2011 to December 2016.The demographics,the degree of hypospadias,complications,age at first urethroplasty and the other factors in patients were recorded,t-test was used to determine the factors associated with surgical timing and the difference was significant when P ＜ 0.05.Results A total of 1 051 cases were included in the study.Among these patients with hypospadias 268 cases (25.5％) were of mild cases,525 cases (50.0％) of moderate,and 258 cases(24.5％) of severe.Nine hundred and forty-six cases(90.0％) did not have complications,while 105 cases(10.0％) had complications.The median age at first urethroplasty was 5.3 years old and 66.22％ of them were operated after 3 years,and 4.09％ of them were after 18 years old.Insurance types,household income,race did not influence with surgical timing statistically (P ＞ 0.05).Multivariate analysis showed that the several factors were significantly associated with time of surgery:the severity of hypospadias (t =28.10,P =0.000),with or without complications (t =64.17,P =0.000),urban-rural gap (t =7.49,P =0.000),parental education level (t =36.90,P =0.000) and the age of receiving advice from pediatric surgeon (t =5.00,P =0.000).Conclusions The age of surgery in children with hypospadias were significantly affected by the severity of hypospadias,the presence of complications,differences between urban and rural areas,the degree of parental education,and the time of medical advice in the pediatric department of urology.,and the education of hypospadias knowledge for children's parents and related medical personnel at the grass-roots level will advance the age of surgery in children with hypospadias.
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Objective To explore treatment scheme and surgery for hypospadias with small glans.Methods Between January 2014 and January 2017,40 cases of hypospadias with small glans were enrolled in the study including 13 cases with penile hypospadias and 27 cases with penoscrotal hypospadias.The boys's average age was 1.5 years,aged from 1 to 5 years old.The boys whoes glans width less than 10 mm received the treatment of topical testosterone propionate smeared on penis once a day for 1 or 2 months.The patients received operation when their glans width reached 10 mm to 14 mm.Among of 27 cases of severe penile recurvation patients,17 cases received staging operation,one-stage was correction of penile recurvation and two-stage was Tubularized incised plate with pull-through procedure,10 cases received adopted modified Duplay combined with Duckett operation,then overturn split-skin graft for incision in the urethra located in glans penis.Among of 13 cases with mild and moderate recurvation,after penile correction,3 cases received Tubularized incised plate urethroplasty and 10 cases received Onlay island flap urethroplasty.All of the patients received modified plastic surgery for glans.Results All of patients were followed-up,from 3 months to 3 years.The surgical success rate was 70％ (28/40).12 cases got operative complications,including urinary fistula 6 cases and glans dehiscence 1 case,who were cured by reoperation,external orifice stricture 1 case and urethral stricture 4 cases who were healed by Urethra dilatation.All patients acquired good appearance glans and satisfied void stream.Conclusions Topical use testosterone propionate for hypospadias with small glans helps the growth of penis.Individualized diagnosis and treatment plan should be made for the particular case of hypospadias with small glans.The modified plastic surgery of glans is suitable for hypospadias with small glans,which could improve surgery success rate and reduce the postoperative complication.
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The pharmacokinetics/pharmacodynamics ( PK/PD) of antimicrobials aims to establish and evaluate dose-concentration-response relationship, and subsequently to describe and predict the effect-time courses resulting from a drug dose.Nowadays, PK/PD is playing an important role in dosage regimen optimizing, reducing toxicity and drug tolerance of antibiotics.And it is also of great significance in determining susceptibility breakpoints and development in new drug.This paper reviews the progress on PK/PD studies of antibacterial and antifungal agents to provide theoretical basis for safe and effective individual dosage regimens.
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Objective To evaluate the efficacy and safety of solifenacin in the treatment of bladder spasm after surgical operation of chlidren hypospadias.Methods From January 2014 to May 2015,60 cases of children more than 4 years old after surgical operation of hypospadias who had symptom of bladder spasm on the day of surgery were assigned into the study group (n =30) and control group (n =30),based on simple randomization.On the first day,the frequency of spasm,the duration of spasm and the incidence of urine extravasation were recorded regarded as the first day condition of bladder spasm.Patients in the study group were treated with solifenacin (5 mg once daily) for a nine days period from l th day postoperation.Patients in the control group were not treated with solifenacin.The frequency of spasm,the duration of spasm and the incidence of urine extravasation of the two groups were recorded and compared on the 3th and 9th day.Adverse events with solifenacin of two groups were recorded.The function of liver and kidney in the study group were recorded and compared.Results There were statistically significant differences(P ＜0.01) in favor of the study group over the control group in the aspect of the frequency of spasm,the duration of spasm and the incidence of urine extravasation on the 3th and 9th day.In the study group,the data compared among l th,3th and 9th was statistically significantly different,opposite to the control group.There was no statistically significant difference between the liver and kidney function of preoperation and the 9th day in the study group.The frequency of adverse events between two groups had no statistically significant difference.Conclusions Solifenacin is effective and safe in the treatment of bladder spasm after surgical operation of chlidren hypospadias
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Objective To evaluate the feasibility and efficacy of endoscopic push?radial dissection (EPRD)for benign esophageal stricture(BES). Methods Clinical data of 24 patients diagnosed as having BES who received EPRD were analyzed. The procedure and efficacy were evaluated. Results All 24 patients underwent EPRD successfully with mean operation time being 32 min(15?45 min).The mean esophageal stric?ture incision length was 3?? 2 cm (1?? 0?8?? 0 cm).No severe complications related to EPRD occurred, or trans?ferred for surgery. Patients were followed up for 1?5 months (mean 2?? 8 months). Dysphagia was relieved signif?icantly during the follow?up in 23 patients where endoscopy could go through smoothly. But dysphagia re?oc?curred in one patient 2 weeks after the operation, who underwent a second EPRD and stent implantation, then dysphagia was relieved. Conclusion EPRD is safe, feasible and effective for benign esophageal stricture.
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Objective To explore the effect of responsibility system of family doctors( RSFD) for community management of the patients with diabetic retinopathy ( DR ) .Methods Fifty -two cases with non -proliferative diabetic retinopathy( NPDR) found in annual health examination in community health care centers were selected and randomly divided into intervention group(30 cases) and control group(22 cases).The intervention group received RSFD service mode and the control group received conventional management mode for 1 year.Patients'visual acuity, fundus,fasting blood-glucose(FBG),glycosylated haemoglobin(HbA1c) were observed and compared before and after intervention.Results In this study,the efficacy in improving patients'visual acuity and retinopathy was 73.3%in the intervention group and 45.5%in the control group,there was statistically significant difference between the two groups(χ2 =4.168,P=0.041).Before intervention,the control rates of patients'FBG were 36.4% and 30.0%respectively,and HbA1c was 27.3%and 33.3%.There were no statistically significant differences between the two groups(P>0.05).After intervention,the control rates of patients'FBG and HbA1c were 86.6% and 80.0% in intervention group,and 59.1%and 54.5%in the control group,there were statistically significant differences between the two groups (χ2 =5.147,P=0.023;χ2 =3.861,P=0.049).Conclusion RSFD service mode was conductive to control patients'blood sugar and improve visual acuity and retinopathy,we could disseminate and apply it to manage-ment of DR in community.