Modified penile augmentation by dermal-fat graft in post-operative hypospadias adults / 中华整形外科杂志

Objecive@#To assess the clinical outcomes of patients who received modified penile augmentation by free dermal-fat grafting.@*Methods@#From April 2012 to December 2014, a total of 15 male adults (18-24 years of age) after hypospadias repairs were included. They underwent modified penile augmentation, including girth enhancement using free dermal-fat grafting, and penile elongation (suprapubic skin advancement-ligamentolysis). Penile measurements were performed using ruler before operation and 6 months after operation. The outcome was evaluated by patients, based on the Male Genital Image Scale. SPSS 22.0 was used to analyze the data. In-paired t-test and Wilcoxon test were applied.@*Results@#In 6-84 months of follow-up, all patients achieved excellent cosmetic results, and satisfied with the appearance and diameter. In weak state, the penile length increased from (5.03±0.47) cm to (6.69±0.49) cm. The increased value was (1.67±0.24) cm (t=8.6, P<0.001). Under traction, the penile length increased from (7.29±0.74) cm to (9.21±0.73) cm. The increased value was (1.93±0.21) cm (t=7.8, P<0.001). In weak state, the diameter of the middle part of penis increased from (7.16±0.25) cm to (8.69±0.44) cm, with the increased value of (1.53±0.23) cm (t=8.2, P<0.001). The MGIS score grew from 31.73±4.86 to 40.20±4.54(Z=3.2, P=0.001).@*Conclusions@#This modified technique is safe and effective in enlarging penile size for patients who had underwent hypospadias repair. It is confirmed that physical dimensional enhancement does contribute to improving their self-estimation of penile size.

Application of oral mucosa graft transplant in the treatment of anterior urethral stricture / 中华整形外科杂志

Objective@#To evaluate the feasibility of buccal musoca grafting in the treatment of longer anterior urethral stricture.@*Methods@#From January 2012 to December 2017, 42 cases of anterior urethral stricture were treated in staged procedure. Stage 1 included the excision of the narrow urethra and the reconstruction of the urethra by transplanting buccal mucosa sheet or tube. In Stage 2, patients underwent operation including urethra anastomosis and transfer the scrotal flap for coverage, and perform suprapubic puncture cystostomy at the same time.@*Results@#Thirty-eight of 42 cases were followed up for 5-12 months with an average of 8 months. In the followed-up 38 cases, 35 of them obtained satisfactory result. Complications occurred in 2 patients, all of them suffered from urethra restricture. One patient′s urethra stricture was located in the anastomosis, stricture length was 0.5 cm. This patient received excision of the narrow urethra and anastomosis. Stricture in another patient was located in the external urethral meatus, this patient received expansion of the external urethral meatus. With proper treatment, all of them were recovered. One patient was not satisfied with the appearence of penis postoperatively. Of all these patients, no urethral fistula or penile curvature was observed. Urination and ejaculation were normal.@*Conclusions@#A successful treatment of long anterior urethral stricture can be achieved with the excision of affected urethra, reconstruction of defect urethra with buccal mucosa flap in staged procedure, and covering the new urethra by transferring the scrotal flap.

Histopathological evaluation of urethroplasty with buccal mucosa graft: an experimental study in rabbit / 中华整形外科杂志

Objective@#To evaluate the histological integration process of the buccal mucosa onlay graft applied on the dorsal corpora cavernosa for urethroplasty in an experimental study in rabbits, as well as to preliminarily investigate potential mechanism of the survival of the buccal mucosa and the impact of the tunica and corpus cavernos.@*Methods@#Six New Zealand rabbits were fed with finasteride powder(10 mg/kg, 7 d)from 19th days of gestation, and the rabbit model of congenital hypospadias was established.At the age of 4 months, after releasing the chordee of the dorsal corpora cavernosa, the urethral defect was created by applying buccal mucosa onlay graft for the penile urethral reconstruction. The animals were sacrificed at 1, 2, 4, 12, 24 and 36 weeks post surgery and their genitals were subjected to morphological observation and histological assessment with hematoxyiin-eosin (HE), Masson and Stirus staining.@*Results@#A total of 23 male rabbits were obtained from natural childbirth, 1 of them were normal rabbits, and the other 22 were hypospadias(1 glandular hypospadias, 15 penile hypospadias and 6 scrotal-perineal type). The buccal mucosa graft showed complete uptake in all animals the location of the graft was macroscopically identifiable, demonstrating its good integration. The typical squamous epithelium of buccal mucosa was observed. One week post operation, the tunica albuginea layer and the submucosa were blurred, with inflammatory cells infiltration. Two weeks after surgery, the epithelial layer was getting thick, few neovascularity and young fibroblasts were observed in the subepithelial layer. Gradual arrangement of epithelial layer was visible, the young fibroblasts were increasing and areas of mature collagen could be seen four weeks post operation. The typical squamous epithelium of buccal mucosa and minimal inflammatory cell infiltration in the subepithelial tissues were observed at the grafted mucosa twelve weeks after surgery. It was distinguishable to identify the cell level of subepithelial layer and the tunica of corpus cavernos. Twenty-four weeks after surgery, the epithelial layer was well integrated with adjacent urethral mucosa. Accentuated fibrosis was noticed with extensive mature collagen and without signs of inflammation and scar proliferation of the grafts.@*Conclusions@#The animal model of congenital hypospadias in rabbits could be established using Finasteride. It was feasible to use the animal model to carry out the experimental study of buccal mucosa grafts. The minimal inflammatory cell infiltrations in the subepithelial tissues were observed at the grafted mucosa twelve weeks after surgery. It was distinguishable to identify the cell level of subepithelial layer and the tunica albuginea of corpus cavernos. Buccal mucosa grafting had no obvious limitation effect on the tunica albuginea and the corpus cavernos development.

Secondary deformity of postoperation of hypospadias and its treatment / 中华整形外科杂志

Objective@#To sum up the clinical manifestations and the method for repairing of secondary deformities of postoperation of hypospadias.@*Methods@#Applying balanus tissue flaps and urethral meatus plastic could correct the flat balanus and prevent urethral meatus from falling back. Resecting scar completely in penis and rebuilding urethral tissues could treat secondary curved penis. Applying modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis) could correct shorter and much smaller penis.@*Results@#Among January 1st 2007 to December 31st 2016, 62 cases were treated.All of them were male. Their ages were from 14 to 34 years old.55 cases were followed up from 6 months to 9 years after operations, but 7 cases could not be followed up because of the change of addresses and phone numbers.All patients achieved excellent cosmetic result. None of them had complications like urethral fistula.@*Conclusions@#After operations of hypospadias, the secondary deformities may happen when the children grow up.And these deformities always need to be corrected with operations. Balanoplasty, correction of penis and the penile augmentation are good methods for secondary deformities.Consequently, a good penis appearance and function can be acquired.

Application of V shape flap for the urethral external meatus and glanuloplasty / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the methods for urethral external meatus and glanuloplasty after correction of hypospadias.</p><p><b>METHODS</b>The V shape flap on the dorsal side of glan, combined with the bilateral glan flaps were moved to the ventral side. The flap at the ventral side of urethral external meatus was turned over. Then the urethral external meatus was repositioned to the top end of glan with the ventral defects covered by the dorsal flaps. Then the coniform glan was reconstructed.</p><p><b>RESULTS</b>From January 2008 to December 2013, 28 cases were treated, including glandular hypospadias, postoperative retraction of external urethral meatus and meatal stenosis. 21 patients were followed up for 1 -12 months (average, 1 month) with marked improvement of glan appearance and retraction of external meatus. No meatal stenosis happened.</p><p><b>CONCLUSIONS</b>Postoperative retraction of urethral external meatus and meatal stenosis can be corrected by V shape flap on the dorsal side of glan combined with the bilateral glan flaps. The flat appearance of glan can be improved. It is an ideal method for glandular hypospadias.</p>

Influence of holistic nursing on serum levels of NT-proBNP,hs-cTnT and quality of life in patients with chronic heart failure / 心血管康复医学杂志

Objective:To explore influence of holistic nursing on serum levels of N terminal pro brain natriuretic peptide (NT‐proBNP) , high sensitive cardiac troponin T (hs‐cTnT ) and quality of life in patients with chronic heart failure (CHF) .Methods:A total of 108 CHF patients treated in our hospital from Jan 2015 to May 2016 were randomly and e‐qually divided into routine nursing group and holistic nursing group (received holistic nursing based on routine nursing group) .Serum levels of NT‐proBNP ,hs‐cTnT and score of Chinese questionnaire of quality of life in patients with cardio‐vascular disease (CQQC) were compared between two groups before and after nursing .Results:There were no significant difference in serum levels of NT‐proBNP and hs‐cTnT and CQQC score between two groups before nursing , P>0.05 all . Compared with before nursing ,after nursing ,there were significant reductions in serum levels of NT‐proBNP and hs‐cTnT , and significant rise in CQQC score in holistic nursing group , P<0.01 all .Compared with routine nursing group after nurs‐ing ,there were significant reductions in serum levels of NT‐proBNP [(2.65 ± 0.53)μg/L vs .(2.07 ± 0.52)μg/L] and hs‐cTnT [ (0.42 ± 0.12)μg/L vs .(0.31 ± 0.09)μg/L] ,and significant rise in CQQC score [ (52.87 ± 9.56) scores vs . (57.43 ± 10.20) scores] in holistic nursing group ,P<0.05 or <0.01. Conclusion:Holistic nursing contributes to reducing serum levels of NT‐proBNP and hs‐cTnT , it can improve cardiac function and quality of life in patients with chronic heart failure ,which is worth clinical application and extending .

Acellular dermal matrix for repair of porcine bile duct defects：to promote vascular and bile duct epithelial regeneration / 中国组织工程研究

BACKGROUND:Acelular dermal matrix is a cel-free natural tissue scaffold similar to human soft tissue, which is easy to shape and has non-toxic side effects. It has been used to repair the urethra and ureter. OBJECTIVE:To investigate the effect of acelular dermal matrix on the repair of bile duct injury. METHODS:Thirty Diannan miniature pigs were randomly divided into three groups: in blank group, the bile duct was resected folowed by end to end anastomosis; in experimental group, bile duct defect model was made folowed by repair with acelular dermal matrix; in control group, bile duct defect model was made folowed by repair with expanded polytetrafluoroethylene. At 6 and 24 weeks after repair, bile duct patches and surrounding tissues were taken for immunohistochemical observation and RT-PCR detection. RESULTS AND CONCLUSION: Compared with the control and blank group, the expression of cytokeratin was higher, but the expression of transforming growth factor β1 was lower in the experimental group. Within 24 weeks after repair, the total mRNA level of transforming growth factor β1 was lower in the experimental group than the other two groups (P < 0.05), but the total mRNA levels of insulin-like growth factor 2 and vascular endothelial growth factor were higher in the experimental group (P < 0.05). These findings indicate that the acelular dermal matrix for repair of bile duct injury can promote angiogenesis and bile duct epithelial regeneration, but not increase the formation of scars.

Techniques and improvements of establishing orthotopic liver transplantation rat models / 中国组织工程研究

BACKGROUND:At present, liver transplantation is the only way to cure end-stage liver disease, but the complications after transplantation is stil an important factor of affecting the long-term survival of patients who received orthotopic liver transplantation, therefore it is necessary to establish a stable animal transplantation model. OBJECTIVE:To establish rat models of orthotopic liver transplantation. METHODS:After inhalation anesthesia with ether, 204 SD rats were perfused with 2-4℃ Ringer’s solution through the abdominal aorta. In order to reduce warm ischemia of the liver, the liver was not turned over before perfusion. The suprahepatic inferior vena cava was cut off along the phrenic ring after perfusion. No further trimming was needed when dressing, so as not to damage the vena cava. The donor liver was removed and preserved in 4℃Ringer’s liquid. The receptor liver was cut off and alogeneic orthotopic liver transplantation was performed using modified two-cuff method. After transplantation, rats could automaticaly turn over and drink water. Surviving more than 3 days is regarded as a successful transplantation. RESULTS AND CONCLUSION:102 liver transplantations were performed in 204 rats, with 86 rats surviving more than 3 days. The success rate of transplantation was 84%. The results demonstrate that rat models of orthotropic liver transplantation can be constructed successfuly through improving techniques.

Effects of self-made KYL solution on preserving macaque liver / 中国组织工程研究

BACKGROUND:At present, liver transplantation is the best method to treat end-stage liver disease. UW solution is recognized as the best liver preservation solution, but it is expensive. Moreover, the extracel ular fluid of high K+condition is inconsistent with human physiology. Because transient hyperkalemia of UW solution often causes cardiac arrest, research and development of the new liver preservation solution already brook no delay. OBJECTIVE:To study the protective effect of self-designed KYL solution on ischemia reperfusion injury in macaque donor liver. METHODS:A total of eight recipient macaques and eight donor macaques were selected in this study. Each group contained KYL solution group (n=4) and UW solution group (n=4). Donor liver was perfused and cryopreserved for 4 hours and subjected to al ogenic orthotopic liver transplantation. At 30 minutes and 6 hours after transplantation, bile production was recorded. Blood was obtained and used to detect concentrations of aspartate aminotransferase, alanine aminotransferase, nitric oxide, endothelin-1 and tumor necrosis factor-α. Liver tissue was col ected and detected under the light microscope. RESULTS AND CONCLUSION:Bile secretion was found in both groups. Bile secretion production increased as time went on (P0.05). Under light microscope, morphological observation of liver tissue revealed that cel ular edema was evident in the UW solution group than in the KYL solution group. Results suggest that the effect of KYL solution on preventing ischemia/reperfusion injury was identical to the UW solution, and partial effect was better than UW solution.

Effect of different approaches of lentiviral vector transfection on target gene expression in rat liver / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the optimal approach of lentiviral vector transfection for effective delivery of exogenous gene into the liver.</p><p><b>METHODS</b>The lentiviral vector was delivered via the ileocolic vein of the ileocecus (portal vein group) or via the caudal vein of SD rats. The effect gene transfection into the liver was assessed by observing the expression of green fluorescence protein expression carried by the lentiviral vector, silencing of LXRα mRNA expression mediated by RNA interference, and liver transaminase changes. The efficiency and safety of the two approaches of transfection were evaluated.</p><p><b>RESULTS</b>All the rats receiving lentiviral transfection survived. In the portal vein group, abundant green fluorescence was detected in the liver at 96 h following the transfection and lasted till 14 days, whereas only weak fluorescence was observed in the caudal vein group. The results of RT-PCR demonstrated a significant higher rate of LXRα knock-down in portal vein group than in caudal vein group (0.135∓0.002 vs 0.713∓0.036, P<0.05). No significant difference in ALT levels found between the two groups.</p><p><b>CONCLUSIONS</b>Infusion via the potal vein is effective for gene transfection into the liver, and puncture from the ileocolic vein of ileocecus can guarantee the survival of rats and improve the transfection efficiency without causing liver injury.</p>

Risk factors of delayed gastric emptying after pancreaticoduodenectomy / 中华肝胆外科杂志

Objective To study the risk factors of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).Methods Between Ja(n)uary 1st 2013 and December 31st 2013,data from 196 consecutive patients who underwent PD at the Chinese PLA General Hospital were studied retrospectively.17 factors were examined.Univariate analysis and multivariate logistic regression analysis were used to determine the relative risks.Results DGE occurred in 71 patients (36.2％).The incidences of grade A,grade B and grade C DGE were 22.4％ (44/196),6.1％ (12/196) and 7.7％ (15/196) respectively.There were three postoperative deaths.The overall mortality rate was 1.5％.BMI,Braun anastomosis,clinically relevant postoperative pancreatic fistula (CR-POPF) and intra-abdominal collection were significantly correlated with DGE on univariate analyses.BMI ≥25 kg/m2,CR-POPF,and intra-abdominal collection were independent risk factors on univariate and multivariate regression analyses.Conclusions Post-operative complications were associated with DGE.Early diagnosis and timely treatment for pancreatic fistula and abdominal collection were helpful to decrease morbidity and to promote recovery of DGE.

Comparative study of acute lung injury induced by intraperitoneal injection of PAAF and PPAF / 中华肝胆外科杂志

Objective To establish a rat model of acute lung injury (ALI) induced by intraperitoneal injection of pancreatitis associated ascitic fluids (PPAF) and perforative peritonitis ascitic fluids (PAAF).A secondary objective is to study the non-specificity of acute lung injury induced by PAAF.Methods Acute necrotizing pancreatitis (ANP) model and perforative peritonitis (PP) model were established in 120 rats,from which the PAAF and PPAF were collected.Forty-eight rats were randomly divided into three groups:normal saline (NS) group,PAAF group,and PPAF group.Within each group,they were randomly sacrificed at 7h and 12h of surgery.The pathological severity of the lung injury,wet/dry ratio,MPO (myeloperoxidase) in lung,and apoptosis rate of pneumocytes were evaluated and analyzed.Results Lung injury,wet/dry ratio,MPO in lungs,and cell apoptosis were significantly higher in the PAAF group and PPAF group than in the NS group (P＜0.01).However,there was no significant difference between PAAF group and PPAF group (P＞0.05).Conclusions Both PAAF and PPAF can induce acute lung injury in rats by intraperitoneal injection.However,the acute hung injury induced by PAAF has limited specificity.

A preliminary study on the radiologic findings in the major Wenchuan earthquake / 中华放射学杂志

Objective To analyze the injury types and radiologic findings of the wounded in the major Wenchuan earthquake of May 12, 2008. Methods Radiologic results of 1013 victims admitted to MianYang Central Hospital from May 13, 2008 to May 19, 2008 were studied retrospectively, including X-ray of 854 cases (about 2900 local exam positions) and CT scan of 259 cases (about 300 local exam positions). Results 733 cases showed radiologic abnormalities, including 527 cases of single region injury (accounting for 52. 0%) and 206 cases of multi-region injury (accounting for 20. 3%), the overall positive rate was 72. 4%. The results were in the following order on the basis of the incidence, 288 cases of lower extremity injuries (28.4%), 151 cases of thoracic injuries(14. 9%), 136 cases of upper extremity injuries(13.4%), 133 cases of spine fracture(13.1%), 114 cases of pelvic fracture and dislocation(11.3%),88 cases of craniocerebral injuries (8. 7%), 25 cases of maxillofacial fracture (2. 5%) and 8 cases of abdominal tranma(0. 1%). Thoracic injuries included: rib fracture in 136 cases, pulmonary injury in 59 cases, and sternal fracture in 3 cases. Spinal fracture included: cervical vertebrae involved in 12 cases,thoracic vertebrae involved in 43 cases, lumbar vertebrae involved in 93 cases, and Sacrococcygeal vertebraeinvolved in 12 cases. Craniocerebral injuries included: skull fracture in 41 cases, endocranial abnormalities in 72 cases. Abdominal trauma included: intestinal obstruction in 4 cases, renal contusion in 3 cases and abdominal wall hematoma in 1 case. Conclusion Most parts of the body can be injured by earthquake.Bone fracture and dislocation of lower extremity are the most common manifestations.

Whether preventive drainage is needed or not after abdominal surgery / 中华消化外科杂志

Abdominal drainage is the most common technique applied in the abdominal surgery. According to the aim of drainage, it can be divided into curative drainage and preventive drainage, but there is no obvious difference between the 2 drainages. Abdominal drainage is not necessary after parenchymal viscera operation, but necessary after spleenectomy in preventing infection. For cavity viscera operation, abdominal drainage is applied according to the infectious condition, but scholars at home and abroad have different opinions on this point. Surgeons should pay attention to the placement of the drainage tube in patients who received preventive drainage.

The application value of ultrasonography in the victims of Wenchuan earthquake ZHANG Hai-feng, / 中华超声影像学杂志

Objective To investigate the application value of uItrasonography in the classifying patients,preventing and treating the major earthquake-induced complications.Methods Seven hundred and forty-three patients were divided into four sorts by region of injuries:thoracic cavity,abdominal cavity,blood vessels of limbs and crush.According to the admission time,there were two phases and the data was analyzed respectively.Results Abnormal ultrasonic image was found in 218 of all patients,with positive ratio 29.3%.In the first phase,the morbidity of crush-induced hematoma was the highest,followed by pleural effusion,spleen rupture,liver fracture,injury of blood vessels,renal damage,intestinal rupture and crush syndrome with renal failure.Compared with that of the first phase,the morbidity of the injury of blood vessels and crush syndrome with renal failure increased in the second phase.Conclusions It was important to analyze the earthquake-induced injury because the major earthquake often cause the damage of multiple organs.

Significance of CYP3A5 in Individualized Immunosuppressive Treatment with Tacrolimus after Liver Transplantation / 中国普外基础与临床杂志

Objective To summarize the significance of CYP3A5 in individualized immunosuppressive treatment with tacrolimus (FK506) after liver transplantation. Methods Relevant literatures about the effect of CYP3A5 polymorphisms on the pharmacokinetics of tacrolimus in liver transplant recipients,which were published recently domestic and abroad,were reviewed and analyzed. Results Tacrolimus was used effectively to prevent allograft rejection after liver transplantation. Narrow therapeutic range and individual variation in pharmacokinetics made it difficultly to establish a fixed dosage for all patients. Genetic polymorphism in drug metabolizing enzymes and in transporters influenced the plasma concentration of tacrolimus. CYP3A5 genotype had an effect on the tacrolimus dose requirement in liver transplant recipients. Conclusion Genotyping for CYP3A5 may help optimal individualization of immunosuppressive drug therapy for patients undergoing liver transplantation

Intraoperative Study of 1988 Recurrent Laryngeal Nerves / 昆明医科大学学报

Objective To study the anatomical relationship between the recurrent laryngeal nerve(RLN)and the inferior thyroid artery,to investigate the prophylactic measures on how to avoid iatrogenic injures while exposing the RLN during thyroid operation.Methods Retrospectively reviewed the clinical data of 1 345 patients accepted thyroid operation with RLN exposing.Results A total of RLN 1 988 were observed,874 on the left and 1 114 on the right(including 2 non-recurrent laryngeal nerve).On the left side,the nerve passed anterior to the artery in 32.8%,posterior to it in 26.7%,and between the branches of the artery in 41.6%.On the left side,the nerve was found coursing anterior to the artery in 36.2%,posterior to it in 28.2%,and between the branches in 35.3%.6 nerves were iatrogenic injured,4 cases were temporary injured and 2 were permanent.Conclusions Although the anatomical relationship between the RLN and the inferior thyroid artery are variable,iatrogenic injures of the nerve can be avoid by exposing it,and an experienced surgeon with good knowledge of RLN anatomical characteristics and skilled surgical techniques was needed.

The Cause and Management of Anastomotic Leakage Following Low Anterior Excision of Rectal Cancer / 昆明医科大学学报

Objective To investigate the cause and diagnosis of anastomotic fistula following low anterior excision of rectal cancer,and its management and prevention measures.Methods Retrospectively analyzed the clinical data of 6 patients with anastomotic leakage underwent anterior excision of rectal cancer.Results 115 patients accepted anterior excision of rectal cancer,6 patients developed anastomotic fistula.5 patients are cured with effective pelvic drainage and 1 case with ileostomy and pelvic drainage.Conclusions Anastomotic fistula is one of the most serious complications related to pre-operative preparation,blood supply and anastomotic tension,intra-operative technigues and effective of drainage.It can be avoided or reduced by different prophylactic measures.

The Study on Improvement of the Technology of Intravenous Pyelography under PACS System / 实用放射学杂志

Objective To study the applied value of the improved pyelographic technique under PACS system.Methods The pyelography in 200 cases(including the traditional pyelography in 92,the traditional big dose pyelography in 8 and the improved pyelography in 100) were retrospectively analysed in groups.Results The improved pyelography in comparison with the traditional pyelography,compressing time reduced 9~11 minute during radiography and the contrast medium amount was the same in both.Conclusion The improved pyelography is superior to the traditional or the traditional big dose pyelography.

Non-drainage in Peritoneal Cavity after Appendectomy on 112 Patients with Perforating Appendicitis / 昆明医科大学学报

Objective To study the clinical value of peritoneal cavity non-drainage after the operation of acute perforating appendicitis.Methods 196 patients with perforating appendicitis were randomly divided into drainage group and non-drainage group.The incidence rates of wound infection and ankylenteron and hospital durations in the two groups were observed and compared with each other.Results The incidence rate of wound infection and ankylenteron were 19.0%,10.7% in the drainage group and 8.0%,4.5% in the non-drainage group respectively(P0.05).The mean postoperative hospital stay of the drainage group was(9.3?2.7)days,which was significantly longer that of the non-drainage group(5.1?1.9)days,P