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1.
Article in Chinese | WPRIM | ID: wpr-885795

ABSTRACT

Objective:To summarize our clinical experience in the treatment of aortic root aneurysm by aortic valve sparing root replacement.Methods:From May 2017 to October 2019, a total of 20 patients with aortic root aneurysm underwent aortic valve sparing root replacement by reimplantation method. There were 17 males and 3 females, with an average age of(35.6±15.8) years(12-63 years). There were 11 cases of Marfan syndrome, 5 cases of bicuspid aortic valve, and 1 case of redo operation. The preoperative diameter of ascending aorta was(40.6±9.7)mm, the diameter of aortic sinus was(52.2±9.2)mm, and the diameter of aortic valve ring was(27.1±3.6)mm. There were 10 cases of no or mild regurgitation, 5 cases of moderate regurgitation and 5 cases of severe regurgitation. In the whole group of patients, the root replacement of aortic valve was retained by reimplantation, and the artificial graft were selected as: 26, 28 and 30mm straight vessels, 1, 3 and 6 cases, respectively, 26 and 28mm artificial graft with valsalva sinus, 4 and 6 cases, respectively. During the operation, aortic valve cusp repair was performed in 6 cases, such as plication of the free margin( 4 cases), decalcification(1 case) and raphe release(1 case).Results:None of the patients died in hospital or underwent rethoracotomy for hemostasis. During the operation, the duration of CPB time was(171.0±25.6) minutes and the duration of cross-clamp time was(134.0±23.2) minutes. There were 12 cases of aortic valve regurgitation and 8 cases of mild regurgitation. The mean follow-up was(15.1±9.8) months(4-33 months). During the follow-up period, there were 2 cases with moderate aortic regurgitation no need reoperation, while the rest of the patients had no or mild regurgitation. There are no patients undergoing reoperation. During the follow-up, 1 patient suffered coronary artery embolism in left circumflex artery and recovered after medicine treatment.Conclusion:Reimplantation with aortic valve sparing root replacement is safe and effective in the treatment of aortic root aneurysm, and the early and mid-term follow-up results are satisfactory, which can avoid anticoagulation-related complications and is suitable for young patients.

2.
Article in Chinese | WPRIM | ID: wpr-885786

ABSTRACT

Objective:Comparing the different effects between using electrotome and ultrasonic scalpel in segmentectomy for separating intersegmental plane.Methods:The ex vivo porcine lungs were chosen for experiments, the a segment of the cranial lobe of the right lung(RS1a) was removed by using electrotome(coagulation mode) or ultrasonic scalpel, the values of minimum air leak pressure among them were compared, and also the hematoxylin and eosin staining for evaluating the injury degree of incision edge.Results:The mean values of minimum air leak pressures for the intersegmental plane after segmentectomy were(17.3±1.0)cmH 2O by electrotome, (16.4±2.9) cmH 2O by ultrasonic scalpel, the differences did not reach significance between electrotome and ultrasonic scalpel( P=0.17). When focused on heat injury degree of incision edge, electrotome caused a heavier damage than ultrasonic scalpel[(819.70±158.00)μm vs.(354.35±98.81)μm, respectively, P<0.01]. Conclusion:Electrotome and ultrasonic scalpel presented different merits and defects, and we should opt energy devices rationally for separating inter-segmental plane.

3.
Chinese Journal of Digestion ; (12): 171-176, 2021.
Article in Chinese | WPRIM | ID: wpr-885742

ABSTRACT

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

4.
Article in Chinese | WPRIM | ID: wpr-885671

ABSTRACT

Objective:To investigate the mechanism of PE_PGRS60 protein in the pathogenesis of Mycobacterium tuberculosis infection. Methods:The cloned and purified PE_PGRS60 protein from Mycobacterium tuberculosis was used to stimulate RAW264.7 cells. The expression of cyclooxygenase 2(COX2) mRNA and protein was detected by qRT-PCR and Western blot, respectively. The signal pathways that may regulate the expression of COX2 were screened, and the expression of inflammatory cytokines induced by PE_PGRS60 was detected by ELISA. The level of cell death was measured by lactate dehydrogenase(LDH) release test and flow cytometry PI staining. Western blot was used to detect the expression of COX2 in Peripheral blood mononuclear cell(PBMC) from active tuberculosis patients. Results:PE_PGRS60 protein was found to promote the expression of COX2 in RAW264.7 cells and activate the three major members of the mitogen-activated protein kinase(MAPK) family: extracellular regulated protein kinase(ERK), p38 and c-Jun N-terminal kinase(JNK). Interestingly, only JNK-IN-7, the inhibitor of JNK was observed to suppress the up-regulation expression of COX2 induced by PE_PGRS60. This up-regulated expression of COX2 was also found in PBMCs from active tuberculosis patients. The COX2 inhibitor celecoxib can effectively block the expression of the inflammatory factors IL-1β, TNF-α and IL-6 induced by PE_PGRS60 and promote macrophage death.Conclusions:PE_PGRS60 can promote macrophages to release inflammatory factors by activating JNK/COX2 signal axis. Some macrophages still die under the protection of COX2.

5.
Article in Chinese | WPRIM | ID: wpr-885595

ABSTRACT

Objective:To explore the regulatory effect of miR-873-5p micro-RNA targeting voltage-dependent anion channel protein 1 (VDAC1) in neurons and its mechanism.Methods:Murine nerve cells were randomly divided in vitro into a control group, a model group, a mimetic negative carrier (miR-con) group and an miR-873-5p group. The epileptiform hippocampal nerve cell model was induced in all of the cells except those in the control group using magnesium-free medium. The control group was normally cultured, while the miR-con and miR-873-5p groups were transfected with miR control and miR-873-5p RNA respectively. Real-time fluorescent quantitative polymerase chain reactions were used to detect the expression of miR-873-5p and VDAC1 mRNA. Western blotting was employed to detect VDAC1, B-cell lymphoma/leukemia-2 protein (Bcl-2), Bcl-2 associated X protein (Bax) and cleared caspase-3 in the neurons. The levels of reactive oxygen species (ROS), malondialdehyde (MDA) and glutathione (GSH) were measured using the DCFH-DA fluorescent probe, the thiobarbituric acid method and enzyme-linked immunosorbent assay respectively. Any apoptosis was detected using flow cytometry, while the targeting of miR-873-5p on VDAC1 was verified using the double fluorescence zymase reporter gene method.Results:Compared with the control group, a significant decrease in the average expression of miR-873-5p, Bcl-2 and in GSH and MDA levels was observed in the model group, but there was a significant increase in the average level of VDAC1, Bax, cleaved caspase-3 and ROS and in the rate of apoptosis. Compared with the miR-con group, a significant decrease in the average expression of Bax, cleaved caspase-3, ROS and in the apoptosis rate was observed in the miR-873-5p group, but there was a significant increase in the average level of Bcl-2, GSH and MDA. Moreover, it was verified that miR-873-5p reduced the expression of VDAC1.Conclusion:miR-873-5p protects damaged neurons by inhibiting their apoptosis through negatively regulating the target gene VDAC1 and the oxidative stress response.

6.
Article in Chinese | WPRIM | ID: wpr-885383

ABSTRACT

Clinical data of 289 patients aged 60 years old and above with acute intestinal obstruction operated in Drum Tower Hospital during June 2010 to December 2020 were analyzed retrospectively. Among 289 cases, 97 cases(33.6%)had tumor, 66(22.8%)had external hernias, 44(15.2%)had adhesions, 36(12.5%)had volvulus, 20(6.9%)had internal hernias, 8(2.8%)had intussusception and 18(6.2%)had other causes. Of 156 strangulated intestinal obstruction cases, 51 cases(32.7%)had external hernias,36(23.1%)had volvulus, 26(16.7%)had adhesions, 18(11.5%)had internal hernias, 14(9.0%)had tumor, 8(5.1%)had intussusception, and 3(1.9%)had other causes. There was a history of abdominal surgery in 88.6%(39/44)cases of adhesion, 85.0% (17/20) cases of internal hernia and 61.1%(22/36)cases of volvulus. For patients with acute intestinal obstruction caused by intestinal tumor, the cases of small bowel obstruction, strangulated intestinal obstruction and the strangulated large bowel were significantly less than those of large bowel obstruction, the non-strangulated intestinal obstruction and the non-strangulated large bowel obstruction (5 vs. 92, 14 vs. 80, 12 vs. 83, respectively; all P<0.05). For patients with strangulated intestinal obstruction caused by external hernias, volvulus, internal hernias and intussusception were significantly more than those with non-strangulated intestinal obstruction groups(51 vs.15, 36 vs. 0, 18 vs. 2, 8 vs. 0, respectively; P<0.05). The patients with strangulated large bowel obstruction caused by external hernias( n=4) and volvulus( n=9)were significantly more than those with non-strangulated large bowel obstruction( n=1 and 0, respectively; P<0.05). The patients with strangulated small bowel obstruction caused by adhesions( n=26)and volvulus( n=27)were significantly more than those with non-strangulated small bowel obstruction( n=18 and 0,respectively; P<0.05).The study showed that the principal causes of emergency operation for acute intestinal obstruction and strangulated intestinal obstruction are intestinal tumor and external hernias in elderly patients.

7.
Chinese Journal of Urology ; (12): 365-369, 2021.
Article in Chinese | WPRIM | ID: wpr-885023

ABSTRACT

Objective:To explore the clinical effects of penile ventral Z-shaped cross flap and penile dorsal pedicled transfer flap in penoplasty for concealed penis.Methods:From January 2017 to June 2019, the data of 151 patients with concealed penis admitted to our hospital was retrospectively reviewed. The patients were divided into 2 groups according to the surgical method. 69 cases were treated with penis ventral Z-shaped cross flap to form penis and 82 cases were treated with dorsal penis pedicled flaps to form the penis. In Z-shaped flap group, the penis length of 33 patients with tight scrotum was (3.06±0.25)cm before surgery and the penis length of 36 patients with relaxed scrotum was (2.99±0.28) cm before surgery. In flap with transfer group, the penis length of 39 patients with tight scrotum was (3.04±0.30)cm before surgery and the penis of 43 patients with relaxed scrotum was (3.04±0.24)cm before surgery. The length of the penis after surgery and incidence of postoperative complications were compared between Z-shaped flap group and flap with transfer group. Common complications included penile body retraction, foreskin edema, foreskin stenosis and penile wound splitting.Results:151 patients were followed up for 6-12 months, and all patients were satisfied with penis appearance. There was no penile necrosis or urinary fistula. In Z-shaped flap cross group, the penis length of 33 patients with tight scrotum extended (2.47±0.22)cm after surgery.The penis length of 36 patients with scrotum relaxation extended (2.61±0.27)cm after surgery, 39 patients was adopted the penile dorsal pedicled transfer flap with scrotum tight had extended penis (2.90± 0.16)cm, which significantly different from the Z-shaped flap group( P<0.05). In flap with transfer group, 43 patients with relaxed scrotum extended (2.79±0.18)cm after surgery, which was significantly different from the Z-shaped flap group ( P<0.05). In Z-shaped flap group, 33 patients with scrotum tight, there were 2 cases of penile retraction, 1 case of stenosis of the foreskin, 2 cases of foreskin edema, 2 cases of penile wound rupture. In transfer flap group, of 39 patients with scrotum tight, there was 1 case of foreskin edema. The incidence of complications that adopted the penile dorsal pedicled transfer flap with scrotum tight was lower than those adopted penile ventral Z-shaped cross flap [2.56%(1/39) vs. 21.21%(7/33), P=0.033]. In transfer flap group, of the 43 patients with scrotum relaxation, there were 3 cases of penile retraction, 3 cases of foreskin stenosis, 2 cases of penile ventral foreskin edema, and 1 case of penile wound rupture. Z-shaped flap group: 36 patients was scrotum relaxation was 1 case of foreskin edema. The incidence of complications that adopted the penile dorsal pedicled transfer flap was higer than those adopted penile ventral Z-shaped flap [20.93%(9/43) vs. 2.78%(1/36), P =0.038]. Conclusions:In terms of children with tight scrotum or loose scrotum, the effect of the transfer flap method to extend the penis is better than that of the Z-shaped flap method. However, the transfer flap method has a low complication rate for children with tight scrotum, while the Z-shaped flap method has a low complication rate for children with loose scrotum.

8.
Chinese Journal of Urology ; (12): 185-191, 2021.
Article in Chinese | WPRIM | ID: wpr-884986

ABSTRACT

Objective:To explore the clinicopathological characteristics and prognostic factors of bladder squamous cell carcinoma (SqCC)and bladder adenocarcinoma.Methods:A retrospective analysis of the clinical data of 107 patients with nonurothelial carcinoma of the bladder admitted to the First Affiliated Hospital of Zhengzhou University from October 2011 to January 2019 was performed. Among the 107 patients, 78 were males and 29 were females(ratio 2.69∶1), and the median age of onset was 62.0 years. According to histological types, patients were divided into SqCC group, urachal adenocarcinoma group and non-urachal adenocarcinoma group. There were 55 cases in the SqCC group, including 40 males and 15 females. Their mean age was 69.0(58.0, 75.0) years. 14 cases had the history of smoking. The clinic manifestation included hematuria in 35 cases, bladder irritation in 13 cases, dysuria in 2 cases and pain in 5 cases .Tumors located at the anterior and posterior walls in 18 cases, at the lateral wall in 27 cases, at the triangular area in 8 cases and at the apical wall in 2 cases. The average diameter of tumor was 4.5(3.0, 6.0) cm. 37 cases suffered with single tumor and 18 cases suffered with multiple tumors. The surgical method was radical cystectomy in 38 cases, partial cystectomy in 4 cases, TURBT in 9 cases, interventional surgery in 2 cases, and no operation in 2 cases. There were 20 cases in the urachal adenocarcinoma group, including 14 males and 6 females; age 53.5(43.5, 57.8) years; 6 cases with a history of smoking. The clinic manifestation included hematuria in 16 cases, bladder irritation in 1 case, pain in 2 cases and asymptomatic in 1 case. Tumors located at anterior and posterior walls in 4 cases and at apical wall in 16. The average diameter of tumor was 3.0(2.0, 4.8) cm. Single tumor was present in 18 cases, multiple tumors were present in 2 cases. The surgical method was partial cystectomy in 16 cases, radical cystectomy in 1 case, TURBT in 1 case and no operation in 2 cases. There were 32 cases in the non-urachal adenocarcinoma group, including 24 males and 8 females. Their mean age was 55.0(46.3, 70.8) years.11 cases had a history of smoking. The clinic manifestation included hematuria in 16 cases, bladder irritation in 3 cases, dysuria in one case and pain in 7 cases. Tumor located at anterior and posterior walls in 17 cases, at lateral wall in 7 cases, at triangular area in 5 cases and at apical wall in 3 cases. The average diameter of tumor was 3.6(2.0, 4.5) cm. 23 cases suffered with single tumor, 9 cases suffered with multiple tumors.The surgical method was radical cystectomy in 11 cases, partial cystectomy in 9 cases, TURBT in 9 cases , and no operation in 3 cases. The preoperative data of the three groups of tissue types were compared, the differences of age of onset, tumor diameter, tumor location, reason for treatment, operation method ( P<0.05)among the 3 groups were statistically significant. The clinicopathological characteristics and prognosis of the 3 groups of tissue types were compared, and the Cox proportional regression risk model was used to analyze the clinical factors affecting the prognosis. Results:91 patients were followed up, the overall follow-up rate was 85.1%, the median follow-up time was 26(7, 48) months. The 3-year and 5-year overall survival rates were 54.1% and 42.2%, respectively. In the SqCC group, 11 cases received chemotherapy; 3 cases received postoperative radiotherapy; 12 cases received postoperative perfusion.10 cases had recurrence; 17 cases had lymph node metastasis; 19 cases had distant metastasis; 5 cases were pT x in pT stage, 36 cases were pT 1-pT 2, 14 cases were pT 3-pT 4. 19 cases had unknown tumor differentiation, 4 cases had well differentiated, 24 cases had moderately differentiated and 8 cases had poorly differentiated. In the urachal adenocarcinoma group, 7 cases received chemotherapy, 3 cases had recurrence, 2 cases had lymph node metastasis, 2 cases had distant metastasis; 1 case was pT x in pT stage, 16 cases were pT 1-pT 2, 3 cases were pT 3-pT 4. 9 cases had unknown tumor differentiation, 3 cases had well differentiated, and 5 cases had moderately differentiated, 3 cases had poorly differentiated. In the urachal adenocarcinoma group, 3 cases received chemotherapy, 1 case received postradiotherapy, 11 cases received postoperative perfusion; 10 cases had recurrence. 5 cases had lymph node metastasis, 4 cases had distant metastasis, 6 cases were pT x, 21 cases were pT 1-pT 2 and 5 cases were pT 3-pT 4. 14 cases had unknown tumor differentiation, 8 cases had moderately differentiated and 10 cases had poorly differentiated.The postoperative general data of the three groups of tissue types were compared. There was statistically significant difference between whether there was postoperative perfusion and whether there was distant metastasis (all P<0.05). The univariate analysis results showed gender, age, surgical method, lymph node metastasis, distant metastasis, pT staging, tumor differentiation and histological type were risk factors that affect the prognosis(all P<0.05). Cox multivariate analysis showed that women ( HR=2.604, P=0.032) and distant metastases ( HR=2.571, P=0.026) were independent risk factors affecting the prognosis of patients. Conclusions:SqCC and adenocarcinoma are clinically rare and have poor prognosis. They often present with hematuria. Surgical treatment is the first choice. Radical cystectomy is the first choice for SqCC and non-urachal adenocarcinoma, and extended partial cystectomy is the first choice for urachal adenocarcinoma. Female and distant metastasis are independent risk factors affecting the prognosis of patients.

9.
Chinese Journal of Urology ; (12): 137-143, 2021.
Article in Chinese | WPRIM | ID: wpr-884973

ABSTRACT

Objective:To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method:The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively. There were 42 males and 47 females and patients’median age was 53 (26-78). Sixty-five cases were treated by operation in our hospital, and 24 cases were primarily treated by the operation in another hospital. The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases, abdominal distension in 12 cases, abdominal pain in 10 cases, fever in 11 cases, nausea, vomiting and poor appetite in 8 cases, frequent urination and dysuria in 6 cases, and bilateral lower limb edema in 1 case. Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases, while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases. There were 55 single cases and 34 multiple cases. The median tumor length was 20(3-52) cm. Among the primarily treated 65 patients, 47(72.3%) were considered as primary retroperitoneal liposarcoma by preoperative imaging examination. Among the 89 patients treated by surgery, 78 underwent endoscopic surgery, among which 21 underwent laparoscopic surgery, 38 cases of retroperitoneal laparoscopic surgery, 19 cases of Da Vinci robot-assisted laparoscopic surgery. Open operation was performed in 11 cases. There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection. Forty-two patients underwent intraoperative combined resection of the adjacent organs. The recurrence and survival status of patients were followed up.Results:All the 89 patients underwent the operation successfully, with the median operative blood loss of 200 (10-2000) ml. There were 23 cases being diagnosed of well differentiated liposarcoma, 40 cases of dedifferentiated, 20 cases of myxoid/round, 5 cases of myxoid liposarcoma, and 1 cases of mixed type. Pathologically, there 42 cases with low grade histology and 47 cases with high grade histology. In this study, 89 patients were followed up for 3 to 108 months, and the median follow-up time was 28 months. The 5-year recurrence free survival rate, disease-free survival rate and overall survival rate of the patients were 16.7%, 16.1% and 52.6%, respectively. There were 57 patients presenting local recurrence, 1 patient of lung metastasis, and 1 patient of liver metastasis, and the median disease-free survival time was 24 months. There were 42 patients died of the disease, with a median survival time of 64 months. Univariate analysis showed that intraoperative blood loss( P<0.01), whether multiple cases( P<0.01), pathologic types( P<0.01), and histological grades ( P<0.01) were related to disease-free survival.The intraoperative blood loss( P<0.01), multiple cases( P<0.05), pathologic types ( P<0.05), and recurrence ( P<0.01)were related with overall survival. Gender, age, tumor size, tumor location, whether primary surgery, radical resection or combined resection of adjacent organ had no effect on the prognosis of patients ( P>0.05). Cox regression model multivariate analysis revealed that surgical bleeding ( RR=2.360, 95% CI 1.313-4.241, P=0.004), multiple tumor ( RR=1.899, 95% CI 1.068-3.375, P=0.029), and pathological type ( RR=4.976, 95% CI 1.622-15.264, P=0.005) were independent factors affecting disease-free survival. The recurrence was an independent factor affecting the overall survival of patients ( RR=31.495, 95% CI 1.062-933.684, P=0.046). Conclusions:Retroperitoneal liposarcoma is a rare disease with high recurrence rate. The intraoperative blood loss, whether multiplicity and pathological type are independent factors affecting the disease-free survival, and recurrence is independent factors affecting the overall survival.

10.
Chinese Journal of Urology ; (12): 127-131, 2021.
Article in Chinese | WPRIM | ID: wpr-884971

ABSTRACT

Objective:To discuss the diagnosis and treatment of urothelial carcinoma of the prostate.Methods:The clinical data of 25 patients with prostate urothelial carcinoma from January 2011 to November 2019 were retrospectively analyzed.Among the 25 patients, the age of onset was 39 to 85 years old, with an average of (63.4±11.2) years old, 13 patient presented with gross hematuria, 9 patients presented with dysuria, and 3 presented with bladder irritation. The PSA of 25 patients was within the normal range (less than 4 ng/ml). 17 cases of pelvic MRI showed abnormal signals in the bladder and prostate area, 3 cases indicated that prostate cancer had invaded the bladder, and 14 cases considered bladder cancer Invasion of the prostate suggests a cauliflower-like abnormal signal in the bladder area. 6 of this 14 patients have a history of bladder cancer. All 25 patients underwent surgical treatment, and 14 underwent transurethral diagnostic resection, of which 6 cases accepted radical cystectomy later. One patient underwent radical cystectomy combined with pelvic lymph node dissection 15 days after the first operation.9 cases received radical cystectomy.2 cases undergoing transurethral palliative resection due to multiple metastases before the operation.Results:The postoperative pathological diagnosis of 25 cases were all prostate urothelial carcinoma, 13 cases were accompanied by bladder urothelial carcinoma, secondary prostate urothelial carcinoma, and 12 cases were primary prostate urothelial carcinoma. After the operation, 13 patients were further treated. Among the patients with secondary prostate urothelial carcinoma, 7 patients received bladder perfusion, 2 patients received GC chemotherapy, 1 patient received local pelvic radiotherapy.25 patients were followed up for 2 to 36 months with an average of (21.5±10.1) months. Among them, lymph node metastasis were seen in 17/25 patients. lymph node metastasis were found in 7/25 before surgery, and 1/25 found lymph node metastasis during surgery. Among the patients with distant metastases afterwards, multiple metastases throughout the body (4/14), lung metastases only (6/14), and bone metastases only (4/14), the 1-year survival rate was 88% (22/25), the 2-year survival rate was 40% (10/25), and the 3-year survival rate was 28% (7/25).Conclusions:The diagnosis depends on histopathological examination. Early diagnosis may help improve prognosis. The first choice is a comprehensive treatment based on radical surgery.

11.
Chinese Journal of Urology ; (12): 110-115, 2021.
Article in Chinese | WPRIM | ID: wpr-884968

ABSTRACT

Objective:To explore the clinical features and prognosis of urachal carcinoma.Methods:The clinical data of 35 patients with urachal carcinoma admitted to the First Affiliated Hospital of Zhengzhou University from August 2011 to November 2019 were analyzed retrospectively. There were 23 males and 12 females, with a male to female ratio of 1.92∶1. The average age was (52.1±13.9) years old, and the median age was 55 years old. There were 8 patients with a history of smoking and 3 patients with a history of drinking. There were 5 cases of hypertension, 5 cases of diabetes, 2 cases of coronary heart disease, and 1 case of cerebral infarction. The first symptoms were hematuria in 25 cases, lower abdominal pain in 4 cases, abdominal mass in 2 cases, umbilical discharge in 1 case, and asymptomatic in 4 cases.Preoperative CT examination showed that the tumor was located on the top wall of the bladder in 24 cases and the front wall of the bladder in 11 cases. There were 25 solid tumors and 10 cystic tumors. The maximum diameter of the tumor was 1.5 to 11.0 cm, and the median maximum diameter of the tumor was 4.0 cm. Preoperative cystoscopy detected masses on the anterior or top wall of the bladder and urachal carcinoma was suspected in 35 cases. All 35 cases underwent enlarged partial cystectomy (conventional resection of the umbilical part), and 3 cases underwent pelvic lymph node dissection at the same time. Among them, 19 cases underwent open surgery, 14 cases underwent laparoscopic surgery, and 2 cases underwent Da Vinci robot assisted laparoscopic surgery.Results:According to Mayo staging, there were 10 cases of stage Ⅰ, 18 cases of stage Ⅱ, 1 case of stage Ⅲ, and 6 cases of stage Ⅳ. The overall follow-up rate was 91.4% (32/35), and the median follow-up time was 41 (3-103) months. The 1-year survival rate was 82.5%, the 3-year survival rate was 59.3%, and the 5-year survival rate was 53.9%. Univariate analysis showed that age ( P=0.033), maximum tumor diameter ( P=0.011), lymph node metastasis ( P=0.002), distant metastasis ( P=0.011), pathological grade ( P=0.001), Mayo staging ( P=0.026) were ralated prognostic factors (all P<0.05). Cox multivariate analysis showed that the pathologically poor differentiation ( HR=1.640, 95% CI 1.112-2.418, P=0.013), and the largest tumor diameter ≥4cm were ( HR=5.000, 95% CI 1.099-22.755, P=0.037). Independent factors affecting patient prognosis. Conclusions:Urachal carcinoma is a malignant bladder tumor with insidient onset. Most of the first diagnosis symptoms are hematuria. When diagnosed, most patients are in the middle and late stages of clinical grading, and the prognosis is poor.Pathological grade and maximum tumor diameter are independent factors that affect the prognosis of patients with urachal carcinoma. The higher was the pathological grade, and the larger was the maximum tumor diameter, the worse was the prognosis.

12.
Article in Chinese | WPRIM | ID: wpr-884619

ABSTRACT

Objective:To review our experience in the use of "Full right-Full left" split liver transplantation in adult-to adult or adult-to adult-size child.Methods:The clinical data of liver donors to 4 recipients of full right-full left split liver transplantation performed at Beijing Friendship Hospital of Capital Medical University from January to December 2019 were reviewed. The surgical methods of split liver transplantation, cold ischemia time, operation time, intraoperative blood transfusion, and postoperative complications and prognosis were analyzed.Results:The 4 recipients of complete right hepatic-left hepatic split liver transplantation included 3 adults and 1 heavy child (45 kg). Their ages ranged from 14 to 48 years, and body weight ranged from 45 to 61 kg. The end-stage liver disease model score were 21, 12, 41, and 30 points. The ratios of graft mass to recipient's body mass ranged from 0.85% to 1.35%. The cold ischemia time was 457-650 min, and the operation time was 460-575 min. Early liver function recovered smoothly in all the 4 patients after transplantation, and no small liver syndrome occurred. Patients were followed up to 6 months after operation. One patient developed anastomotic biliary leak, which was cured by endoscopic retrograde cholangiopancreatographic treatment. Another patient developed biliary stricture presenting with repeated biliary tract infection despite percutaneous transhepatic puncture biliary drainage. A third patient died six months from lung infection.Conclusion:In properly selected patients, using full right-full left hemiliver by split liver transplantation increased organ utilization and provided patients with increased treatment opportunities.

13.
Article in Chinese | WPRIM | ID: wpr-884607

ABSTRACT

Objective:To study the hepatic hemodynamics changes and pathophysiological mechanisms of the use of a functional shunt after auxillary liver transplantation to treat portal hypertension associated with a small-for-size graft.Methods:A retrospective analysis of the clinical data of patients with portal hypertension treated with functional shunting of small-volume grafts from a living donor liver at the Beijing Friendship Hospital, Capital Medical University from July 2014 to December 2018, and a total of 6 patients were included as the research objects, including 4 males and 2 females, with a median age of 35.5 (29.0-52.0) years old. Blood flow monitoring data were collected during and after operation, and the characteristics of liver hemodynamics were analyzed.Results:The portal venous blood flow of the remnant native liver gradually decreased to no flow. As a buffer response, the flow velocity of hepatic artery increased. The portal venous blood flow of the graft gradually increased in the early postoperative period and then gradually decreased from post-operation Day 5 to 10 due to gradual increase in portal venous resistance. However, the portal venous perfusion gradually increased from Day 10 after the operation, reached to a level and declined to a stable level about 1 month after the operation. The volume of abdominal drainage slowly decreased after the peak level at Day 5-10 after the operation, and disappeared completely at Day 30 after operation.Conclusions:When using auxiliary liver transplantation for functional shunting to treat portal hypertension, autologous residual liver can act as a guide buffer for the pressure gradient of portal vein hyperperfusion in liver transplantation, and reach a steady state of blood flow distribution about 1 month after surgery, while relying on autologous remnant liver hepatic artery buffer response prevents small liver syndrome.

14.
Journal of Chinese Physician ; (12): 189-192, 2021.
Article in Chinese | WPRIM | ID: wpr-884029

ABSTRACT

Objective:To explore the distribution of pelvic lymph node (PLN) metastasis and the correlative dangerous factors in early cervical cancer patients.Methods:The medical records of 508 patients who underwent extensive hysterectomy and lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰb-Ⅱb cervical cancer in Guizhou Provincial People`s Hospital were reviewed retrospectively.Results:There were 278 patients with stage Ⅰb cervical cancer, 204 patients with stage Ⅱa cervical cancer and 26 patients with stage Ⅱb cervical cancer; the positive rate of lymph node metastasis was 16.7%(85/508), and obturator lymph node metastasis was the most common (56.6%); there were 19 patients with bilateral lymph node metastasis, accounting for 22.35%(19/85); lymph node metastasis occurred 104 times (two times for bilateral simultaneous transfer), and jumping lymph node metastasis accounted for 37.5%(39/104); common iliac lymph node metastasis accounted for 18.3%(19/104). The metastasis rate of patients with stage Ⅱa and Ⅱb (including parametrial, lymph node, ovarian and oviduct metastasis) was higher than that of patients with stage Ⅰb, and the odd ratio ( OR) was 2.30 and 2.48 respectively ( P<0.05); the metastasis rate of patients with moderately differentiated tumors was significantly higher than that of patients with well differentiated and poorly differentiated tumors ( P<0.05). There was no significant difference in the positive rate of pelvic lymph node metastasis among patients with different ages and histological types ( P>0.05); the positive rate of pelvic lymph node metastasis in patients with stage Ⅱa and Ⅱb was higher than that in patients with stage Ⅰb with statistically significant difference ( P<0.05); the positive rate of pelvic lymph node metastasis in patients with moderately differentiated tumors was higher than that in patients with well differentiated and poorly differentiated tumors, with statistically significant difference ( P<0.05). Conclusions:Obturator lymph node metastasis is the most common in cervical cancer. The risk of lymph node metastasis is increased in patients with stage Ⅱa or moderately differentiated tumors. Jumping metastasis is also a common way of metastasis, which suggests that standard and complete lymph node resection is an important measure to ensure the curative effect.

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Chinese Critical Care Medicine ; (12): 223-228, 2021.
Article in Chinese | WPRIM | ID: wpr-883862

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Objective:To study the dynamic changes of cellular immune function in peripheral blood of trauma patients and its role in the evaluation of traumatic complications.Methods:A prospective cohort study design was conducted. Patients with blunt trauma admitted to Chongqing Emergency Medical Center from November 2019 to January 2020 were consecutively enrolled. The peripheral blood samples were collected at 1, 3, 5, 7, and 14 days after injury. The expressions of CD64, CD274, and CD279 on the surface of neutrophils, lymphocytes, and monocytes as well as CD3 +, CD4 + and CD8 + T lymphocyte subsets were measured by flow cytometry. The trauma patients were divided into different groups according to the injury severity score (ISS) and sepsis within 28 days after injury, respectively. The dynamic changes of cellular immune function in different time points after injury and differences between different groups were compared. Furthermore, the correlation with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), sequential organ failure assessment (SOFA), and ISS were evaluated by Pearson correlation analysis. Results:A total of 42 patients with trauma were finally enrolled, containing 8 severe trauma patients with ISS greater than 25 scores, 17 patients with ISS between 16 and 25 scores, and 17 patients with ISS less than 16 scores. The sepsis morbidity rates were 14.3% (n = 6) within 28 days after injury. CD64 index and CD4 +T lymphocyte subsets were significantly increased at different time points after trauma (H = 15.464, P = 0.004; F = 2.491, P = 0.035). The CD64 index and positive rates of CD279 in neutrophils, lymphocytes, and monocytes were increased with the severity of injury at day 1 and day 3 after injury, respectively. At the first day after injury, CD64 index were 2.81±1.79, 1.77±0.92, 3.49±1.09; positive rate of CD279 in neutrophils were 1.40% (0.32%, 2.04%), 0.95% (0.44%, 2.70%), 12.73% (3.00%, 25.20%); positive rate of CD279 in lymphocytes were 3.77% (3.04%, 5.15%), 4.71% (4.08%, 6.32%), 8.01% (4.59%, 11.59%); positive rate of CD279 in monocytes were 0.57% (0.24%, 1.09%), 0.85% (0.22%, 1.25%), 6.74% (2.61%, 18.94%) from mild to severe injury groups, respectively. The CD64 index in severe injury group was significantly higher than that in moderate group, and the positive rates of CD279 in neutrophils, lymphocytes and monocytes of severe injury patients were higher than those in other two groups (all P < 0.05). At 3rd day after injury, compared to moderate group, severe injury patients had significantly higher CD64 index and positive rate of CD279 in lymphocytes [4.58±2.41 vs. 2.43±1.68, 7.35% (5.90%, 12.28%) vs. 4.63% (3.26%, 6.06%), both P < 0.05]. Compared with the non-sepsis patients, the sepsis patients had significantly higher CD64 index and positive rate of CD279 in monocytes at day 1 after injury [4.06±1.72 vs. 2.36±1.31, 3.29% (1.14%, 12.84%) vs. 0.67% (0.25%, 1.48%), both P < 0.05], and positive rate of CD279 in lymphocytes significantly higher at 3rd day after injury [8.73% (7.52%, 15.82%) vs. 4.67% (3.82%, 6.21%), P < 0.05]. In addition, correlation analysis showed that positive rate of CD279 in lymphocytes was positively correlated with SOFA and ISS, respectively (r values were 0.533 and 0.394, both P < 0.05), positive rate of CD279 in monocytes was positively correlated with APACHEⅡ, SOFA and ISS scores, respectively (r values were 0.579, 0.452 and 0.490, all P < 0.01), positive rate of CD279 in neutrophils was positively correlated with APACHEⅡ and ISS, respectively (r values were 0.358 and 0.388, both P < 0.05). Conclusions:CD64 index and CD279 expression in neutrophils, lymphocytes, and monocytes are significantly related to the severity and prognosis of trauma. Dynamic monitoring the cellular immune function may be helpful for assessing the prognosis of trauma patients.

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Article in Chinese | WPRIM | ID: wpr-883779

ABSTRACT

Objective:To correlate N-terminal pro-B-type natriuretic peptide (NT-proBNP) and heart type fatty acid binding protein (H-FABP) levels with the prognosis of patients with heart failure.Methods:Forty-nine patients with severe heart failure who received treatment in Tongde Hospital from December 2017 to June 2019 were included in the observation group. Forty-nine healthy subjects who concurrently received health examination were included in the control group. The heart function of the 49 patients was graded by the New York Heat Association (NYHA) classification. The levels of NT-proBNP and H-FABP were measured in different NYHA grades of patients and the healthy controls. The value of NT-proBNP and H-FABP levels in the diagnosis of heart failure was investigated and NT-proBNP and H-FABP levels were correlated with prognosis of heart failure.Results:In the observation group, NT-proBNP and H-FABP levels were (341.52 ± 12.74) pg/mL and (69.01 ± 11.45) ng/mL, respectively, which were significantly higher than (189.60 ± 12.73) pg/mL and (37.25 ± 11.44) ng/mL, respectively, in the control group ( t = 59.047 and 13.735, both P < 0.001). In patients with NYHA III grade severe heart failure, NT-proBNP and H-FABP levels were (295.62 ± 42.38) pg/mL and (75.09 ± 19.15) ng/mL, respectively, which were significantly higher than (120.43 ± 21.69) pg/mL and (21.76 ± 5.22) ng/mL, respectively in patients with NYHA I grade severe heart failure, (203.51 ± 42.77) pg/mL and (44.92 ± 10.85) ng/mL in patients with NYHA Ⅱ grade severe heart failure ( F = 55.100, 46.040, both P < 0.001). NT-proBNP and H-FABP levels in patients with NYHA I grade severe heart failure were significantly lower than those in patients with NYHA Ⅱ grade severe heart failure ( t = 7.231, 8.130, both P < 0.001). The sensitivity and accuracy of detecting NT-proBNP and H-FABP levels alone in the diagnosis of heart failure (76.92%, 78.85%, 84.69%, 86.73%) were significantly lower than those of detecting NT-proBNP and H-FABP levels in combination (98.08%, 97.96%, χ2 = 75.760, 10.913, both P < 0.001). NT-proBNP and H-FABP levels were positively correlated with the prognosis of heart failure ( r = 0.362, 0.611, both P < 0.05). Conclusion:NT-proBNP and H-FABP levels are positively correlated with the prognosis of severe heart failure in older adult patients. Detecting NT-proBNP and H-FABP levels in combination can increase the sensitivity and accuracy in the diagnosis of severe heart failure.

17.
Article in Chinese | WPRIM | ID: wpr-883170

ABSTRACT

Objective:To study the relationship between the level of high mobility group protein 1(HMGB1)and the severity of hand, foot and mouth disease (HFMD).Methods:A total of 150 children with enterovirus 71(EV71) HFMD admitted to Xi′an Children′s Hospital from April 2018 to December 2019 were selected as the study objects, including 100 mild cases(normal group) and 50 severe cases(severe group). Meanwhile, 50 healthy children during the same period were selected as control group.The level of HMGB1 in plasma was detected by ELISA.The clinical data and laboratory examination of the case group were collected.The factors that may affect the conversion of HFMD to severe were analyzed by single factor and multi-factor Logistic regression analysis.The risk factors of conversion of HFMD to severe and the correlation between the level of HMGB1 in plasma and the severity of HFMD were discussed.Results:The level of HMGB1 in EV71 HFMD children in the acute stage[(13 700±3 036)pg/mL] was significantly higher than that in the control group[(10 116±2 435) pg/mL]( t=5.913, P<0.05). After treatment, the level of HMGB1 decreased in the convalescence period[(10 658±2 349) pg/mL], and the difference was not statistically significant compared with the control group ( t=2.515, P>0.05). Blood glucose, white blood cell count and HMGB1 level in the severe group were all higher than those in the normal group (all P<0.05). Multivariate Logistic regression analysis found that the levels of blood glucose >8.3 mmol/L, peripheral blood leukocyte >15×10 9/L, and HMGB1≥ 13 110 pg/mL were the risk factors for severe aggravation of HFMD in children.The receiver operating characteristic curve analysis showed that when HMGB1 was 13 110 pg/mL, the Yoden index was the highest, with a sensitivity of 81.6% and a specificity of 72.0%. Conclusion:WBC>15×10 9/L, blood glucose>8.3 mmol/L and HMGB1≥13 110 pg/mL are the risk factors of HFMD.When HMGB1 is higher than, it suggests that HFMD may develop to severe.

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Article in Chinese | WPRIM | ID: wpr-883151

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Objective:In this study, the clinical data of biliary atresia(BA) and infant intrahepatic cholestasis(IHC) was reviewed, and the utility of gamma-glutamyl transpeptidase(GGT) and liver Young′s modulus in the differential diagnosis of BA and IHC in infants was discussed.Methods:Based on the clinical data of 120 infants with cholestasis treated in the Children′s Hospital Affiliated to Xi′an Jiaotong University, from September 2017 to December 2019, the infants were divided into two groups according to the results of intraoperative cholangiography and follow-up: BA group( n=50); IHC group( n=70). The age, clinical manifestations, laboratory examination results, gallbladder contraction rate, hepatobiliary scintigraphy, liver Young′s modulus, and medical treatment effects were compared between the two groups.The utility of GGT and liver Young′s modulus in the differential diagnosis of BA and IHC was analyzed. Results:The age, alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bile acid, fasting blood glucose, blood ammonia and splenomegaly between the two groups were compared and the results showed no statistical significance( P>0.05). In contrast, there were statistically significant differences( P<0.001) in stool color, liver size, total bilirubin(TB), direct bilirubin(DB), GGT, liver Young′s modulus, positive hepatobiliary scintigraphy, gallbladder contraction rate at 1 hour after meal, and medical treatment effect between the two groups.TB, DB, GGT, liver Young′s modulus and GGT combined with liver Young′s modulus were analyzed using ROC curves, and the area under the curve(AUC) were 0.820, 0.809, 0.906, 0.876 and 0.926, respectively.When GGT exceeded the cut-off value of 198.85 U/L, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 82.0%, 84.3%, 78.8%, 86.8% and 83.3%, respectively.When liver Young′s modulus exceeded the cut-off value of 8.6 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BA were 88.0%, 80.0%, 75.9%, 90.3% and 83.3%, respectively.The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of GGT combined with liver Young′s modulus in diagnosing BA were 98.0%, 68.6%, 69.0%, 98.0% and 80.8%, respectively.Multivariate logistic regression analysis found that DB>115.55 μmol/L, GGT>198.85 U/L, and liver Young′s modulus>8.6 kPa were risk factors for BA( OR=9.510, P=0.001; OR=24.634, P<0.001; OR=21.469, P<0.001). Conclusion:GGT and liver Young′s modulus are useful in the differential diagnosis of BA and IHC.If GGT and liver Young′s modulu sexceed the threshold values of 198.85 U/L and 8.6 kPa respectively, it can effectively indicate that the child is BA.

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Article in Chinese | WPRIM | ID: wpr-882868

ABSTRACT

Dopa-responsive dystonia(DRD) is a clinical syndrome characterized by childhood dystonia and dramatic and sustained response to low-dose levodopa.The deficiency of any link in dopamine synthesis pathway can lead to DRD that is caused by TH gene mutation and is autosomal recessive, which results in the reduction of tyrosine hydroxylase(TH) synthesis and extensive deficiency of dopamine and catecholamine.However, DRD presents atypical clinical manifestations.Mild patients mainly present with dystonia.Some of them might progressively develop into spastic paraplegia and some may have parkinsonian features.Most of them display good response to levodopa.Severe patients present with progressively complex infantile encephalopathy, and badly response to levodopa and remnant intellectual development problems.Most of them manifest with declining homovanillic acid(HVA) in cerebrospinal fluid.However, due to the noncharacteristic clinical course and nonspecific laboratory tests of TH DRD, gene detection still is the only reliable criterion of diagnosis so far.Low-dose levodopa is effective to most mild patients and can improve symptoms to severe patients to some extent.

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Article in Chinese | WPRIM | ID: wpr-882643

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Objective:To investigate the effects of different lipid-lowering regimens on blood lipids, endothelial function and safety in patients with unstable angina.Methods:Patients who admitted to Henan Provincial People's Hospital for unstable angina from September 2018 to May 2019 were randomly (random number) divided into the conventional treatment group, intensive statin group and intensive lipid-lowering group. Follow-up was performed at 1, 3, and 6 months after treatment according to the predetermined lipid-lowering regimen. Assessments included lipid profile, liver function, muscle enzymes, hypersensitive C-reactive protein (hs-CRP), endothelial function (reactive hyperemia index, RHI), ischemic events, myalgia, and discontinuation. The differences of the follow-up indicators among the three groups were analyzed.Results:A total of 375 patients were enrolled and randomly divided into three groups, 125 patients in each group. There were no significant differences in demographic data and medication among the three groups. At the 1st month, the low density lipoprotein cholesterin (LDL-C) compliance rate of the intensive statin group was significantly higher than those in the conventional treatment group ( χ2=3.939, P=0.047) and the intensive lipid-lowering group ( χ2=4.63, P=0.031). At the 3rd month, the reductions of LDL-C in the intensive statin group and the intensive lipid-lowering group were significantly better than that in the conventional treatment group( P<0.01). At the 6th month, the reduction rate of LDL-C in the intensive lipid-lowering group was higher than that in the intensive statin group ( q=4.332, P<0.01). At the 1st month, the improvement of hs-CRP and RHI in the intensive statin group was significantly better than that in the conventional treatment group( q=4.133, P<0.05). From the 3rd month of treatment, the incidence of cardiovascular events in the intensive statin group and the intensive lipid-lowering group showed a tendency to decrease compared with the conventional treatment group, but no statistically significant difference was found. At the 6th months of treatment, the withdrawal rates were significantly higher in the intensive statin group and the intensive lipid-lowering group than that in the conventional treatment group (χ 2=4.488, P=0.03 and χ2=5.039, P=0.02). There were no significant differences in the ratio of liver enzyme and muscle enzyme elevation and the incidence of myalgia among the three groups (all P>0.05). Conclusions:Intensive statin therapy can make LDL-C reach the standard in patients with unstable angina pectoris as soon as possible, significantly improve inflammation indicators and endothelial function, and has good safety.

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