Postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder / 中华泌尿外科杂志

Objective To investigate postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder.Methods Retrospective analysis of 79 cases of local progression bladder cancer (cT2-3 N0-2 Mo) in our hospital from September 2014 to September 2018.79 cases were confirmed by pathology as high-grade uroepithelium cell carcinoma of bladder.Posterior urethra and bladder neck biopsy did not see tumor invasion.The urodynamic examination for all patients before surgery showed no significant decrease in urinary control function.Preoperative International urinary Incontinence Advisory Committee urinary Incontinence Questionnaire summary confirmed that there was no obvious urinary incontinence symptoms.All patients underwent radical bladder resection and in situ Ushaped ileum new bladder surgery.40 cases in the experimental group were treated with complete robot assisted radical bladder resection and in situ U-shaped ileum new bladder.39 cases in control group were treated with laparoscopic surgery.There was no statistically significant difference between the two groups of general data (both P ＞ 0.05).The operation time,bleeding volume,positive rate of postoperative incision,postoperative hospitalization time,new bladder capacity,residual urine volume,maximum urinary flow rate,bladder internal pressure,unilateral ureteral reflux and stenosis incidence,as well as immediate urinary control rate after extraction of catheter and 1,3,6 and 12 months of urinary control recovery were compared.Results 79 cases of this study were successfully completed.The operation time of the two groups [(286.5 ±37.2) min vs.(288.5 ±32.9) min,P =0.801],intraoperative blood loss[(185.1±41.6) ml vs.(189.3 ±54.2) ml,P =0.700].There was no significant difference in the average postoperative hospital stay [(14.3 ± 1.6)d vs.(14.9 ±2.2)d,P =0.168].The margins of the pathological examinations in both groups were negative.New bladder volume after surgery [(300 ± 10) ml vs.(245 ± 10) ml,P ＜ 0.001].Urodynamic examination of residual urine volume [(20 ± 10) ml vs.(50 ± 10) ml,P ＜0.001],maximum urine flow rate [(16 ±4) m1/s vs.(13 ±2) m1/s,P =0.006].Intravesical pressure [(22.5 ±3.0) cmH2Ovs.(17.5 ± 2.5) cmH2O,P ＜ 0.001] (1 cmH2O =0.098 kPa).The two groups of postoperative cystoscopy showed that unilateral ureteral reflux was 5％ (2/40) and 20.5％ (8/39),respectively,and the unilateral ureteral anastomotic stenosis was 2.5％ (1/40) and 15.4％ (6/39) after operation,and the difference was statistically significant (P =0.038,P =0.044).The urine control rate of the observation group and the control group immediately after removal of the catheter was 37.5％ (15/40) and 15.4％ (6/39),respectively.The urine control rate in 1 month was 62.5％ (25/40) and 38.5％ (15/39),respectively.The urine control rate in 3 month was 82.5％ (33/40)and 56.4％ (22/39),the difference was statistically significant (P =0.026,P =0.033,P =0.012).At other follow up time points,there was no significant difference in point-controlled urine rate (P ＞ 0.05).Conclusions Complete robot-assisted radical cystectomy and in situ U-shaped ileal neobladder surgery are more advantageous than standard laparoscopic surgery in time of the early recovery urinary function.

Finite element analysis of fixation of U-shaped sacral fractures / 生物医学工程学杂志

Finite element method (FEM) was used to investigate the biomechanical properties of three types of surgical fixations of U-shaped sacral fractures. Based on a previously established and validated complete lumbar-pelvic model, three models of surgical fixations of U-shaped sacral fractures were established: ① S1S2 passed through screw (S1S2), ② L4-L5 pedicle screw + screw for wing of ilium (L4L5 + IS), and ③ L4-L5 pedicle screw + S1 passed through screw + screw for wing of ilium (L4L5 + S1 + IS). A 400 N force acting vertically downward, along with torque of 7.5 N·m in different directions (anterior flexion, posterior extension, axial rotation, and axial lateral bending), was exerted on the upper surface of L4. Comparisons were made on differences in separation of the fracture gap and maximum stress in sitting and standing positions among three fixation methods. This study showed that: for values of separation of the fracture gap produced by different operation groups in different positions, L4L5 + S1 + IS was far less than L4L5 + IS and S1S2. For internal fixators, the maximum stress value produced was: L4L5 + IS > L4L5 + S1 + IS > S1S2. For the intervertebral disc, the maximum stress value produced by S1S2 is much larger than that of L4L5 + S1 + IS and L4L5 + IS. In a comprehensive consideration, L4L5 + S1 + IS could be prioritized for fixation of U-shaped sacral fractures. The objective of this research is to compare the biomechanical differences of three different internal fixation methods for U-shaped sacral fractures, for the reference of clinical operation.

Comparison of three kinds of catheterization in the treatment of lacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the therapeutic effects of lacrimal duct retrograde catheterization, double loop antegrade catheterization, and lacrimal duct U-shaped catheter for patients with lacrimal duct obstruction.<p>METHODS: Totally 108 patients with lacrimal duct obstruction who were treated in our hospital from July 2015 to June 2018 were selected as subjects and prospectively studied. They were randomly divided into three groups: A(36 cases), B(36 cases), and C(36 cases). In group A, lacrimal duct retrograde catheterization was performed. Group B was treated with double-loop antegrade catheterization. Group C was treated with lacrimal duct U-shaped catheterization. All patients were followed up for 6mo. The intraoperative basic conditions(Lntraoperative blood loss, operation time, hospital stay), treatment efficacy, and the occurrence of complications and recurrence of lacrimal duct obstruction of the three groups were compared. <p>RESULTS: There were significant differences in the amount of intraoperative blood loss, operation time and hospital stay between the three groups(<i>P</i><0.05). The total effective rate of treatment in group A was 91.7%, which was lower than 94.4% in group B and 97.2% in group C, but the difference in total effective rate between the three groups was statistically significant(<i>P</i>>0.05). The complication rate was 11.1% in group A, 5.6% higher than that in group B, and higher than 2.8% in group C(<i>P</i>=0.010). The recurrence rate of lacrimal duct obstruction in group A was 9.1%, higher than 5.9% in group B, higher than that in group C(<i>P</i>=0.029).<p>CONCLUSION: Retrograde catheterization of the lacrimal duct, double-loop antegrade catheterization, and lacrimal duct U-shaped tube for the treatment of patients with lacrimal duct obstruction have higher therapeutic effects, postoperative complications and less recurrence of lacrimal duct obstruction, but lacrimal passage Retrograde catheterization can reduce the amount of intraoperative blood loss, operation time, and U-shaped catheterization of the lacrimal duct can reduce the length of hospital stay, and can be widely used in clinical practice.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome / 华中科技大学学报（医学）（英德文版）

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries.These fractures are highly unstable and frequently cause neurological deficits.The majority of surgeons have limited experience in management of U-shaped sacral fractures.No standard treatment protocol for U-shaped sacral fractures has been available till now.This study aimed to examine the management of U-shaped sacral fractures and the early outcomes.Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed.Demographics,fracture classification,mechanism of injury and operative treatment and deformity angle were assessed.All the patients were treated with lumbopelvic fixation or (and) sacral decompression.EQ-5d score was applied to evaluate the patients' quality of life.Of the 15 consecutive patients with U-shaped sacral fracture,the mean age was 28.8 years (range:15-55 years) at the time of injury.There were 6 females and 9 males.The mean followup time was 22.7 months (range:9-47 months) and mean full weight-bearing time was 9.9 weeks (range:8-14 weeks).Ten patients received lumbopelvic fixation and sacral decompression,one lombosacral fixation,and 4 merely sacral decompression due to delayed diagnosis or surgery.The post-operation deformity angle (mean 27.87°,and range:8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67;range:15-90) with no significance difference noted.At the latest follow-up,all patients obtained neurological recovery with different extents.Visual analogue score (VAS) was reduced from preoperative 7.07 (range:5-9) to postoperetive 1.93 (range:1-3).All patients could walk without any aid after treatment.Eight patients were able to care for themselves and undertook some daily activities.Five patients had returned to work full time.In conclusion,lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed.Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery.Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures: Surgical Management and Early Outcome / 华中科技大学学报（医学）（英德文版）

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries.These fractures are highly unstable and frequently cause neurological deficits.The majority of surgeons have limited experience in management of U-shaped sacral fractures.No standard treatment protocol for U-shaped sacral fractures has been available till now.This study aimed to examine the management of U-shaped sacral fractures and the early outcomes.Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed.Demographics,fracture classification,mechanism of injury and operative treatment and deformity angle were assessed.All the patients were treated with lumbopelvic fixation or (and) sacral decompression.EQ-5d score was applied to evaluate the patients' quality of life.Of the 15 consecutive patients with U-shaped sacral fracture,the mean age was 28.8 years (range:15-55 years) at the time of injury.There were 6 females and 9 males.The mean followup time was 22.7 months (range:9-47 months) and mean full weight-bearing time was 9.9 weeks (range:8-14 weeks).Ten patients received lumbopelvic fixation and sacral decompression,one lombosacral fixation,and 4 merely sacral decompression due to delayed diagnosis or surgery.The post-operation deformity angle (mean 27.87°,and range:8°-90°) of the sacrum was smaller than that pre-operation (mean 35.67;range:15-90) with no significance difference noted.At the latest follow-up,all patients obtained neurological recovery with different extents.Visual analogue score (VAS) was reduced from preoperative 7.07 (range:5-9) to postoperetive 1.93 (range:1-3).All patients could walk without any aid after treatment.Eight patients were able to care for themselves and undertook some daily activities.Five patients had returned to work full time.In conclusion,lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed.Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery.Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Surgical correction of grade III hypertelorism

Orbital hypertelorism is an increased distance between the bony orbits and can be caused by frontonasal malformations, craniofacial clefts, frontoethmoidal encephaloceles, glial tumors or dermoid cysts of the root of the nose, and various syndromic or chromosomal disorders. We report a series of 7 cases of hypertelorism that were treated in our hospital. The underlying causes in our series were craniofacial clefts 0 to 14 (4 cases), craniofacial clefts 1 to 12 (1 case), and frontonasal encephalocele (2 cases), all congenital. Surgical techniques used to correct the deformity were box osteotomy and medial wall osteotomy with or without calvarial and rib grafts. A few of our cases were reoperations with specific challenges.

Application of the two-paths double U-shaped fixer in the intravenous indwelling needle / 中国实用护理杂志

Objective To study the application of the two-paths double U-shaped fixer in clinical intravenous indwelling needle fixation. Methods A total of 420 cases using of intravenous indwelling needle from January to June 2015 were involved and divided into experimental group(210 cases) and control group(210 cases) by random digits table method. The two-paths double U-shaped fixer was applied in experimental group and the control group were used tape by Y type to fix. The incidence of returning-blood, blocking, phlebitis, slippage and the comfort between two groups were observed and compared. Results The incidence of returning-blood, blocking, phlebitis, slippage in experimental group were 6.2%(13/210), 0.5%(1/210), 0 , which were lower than those in control group 48.6%(102/210), 5.7%(12/210), 1.4%(3/210) seperately, the differences were statistically significant (χ2=117.895, P<0.01). The incidence of phlebitis levelⅠ,Ⅱ,ⅢandⅣin experimental group were 3.3%(7/210), 1.4%(3/210), 0.9%(2/210), 0, which were lower than those in control group 11.9%(25/210), 9.0%(19/210), 3.8%(8/210), 2.4%(5/210), the differences were statistically significant(Z=-5.960, P<0.01). The incidence of the comfort level 1, 2, 3 and 4 in experimental group were 92.4%(194/210), 6.2%(13/210), 1.4%(3/210), 0 individually, which were higher than those in control group 36.7%(77/210), 46.7%(98/210), 12.4%(26/210), 4.3%(9/210), the differences were statistical significant (Z=-16.228, P < 0.01). Conclusions Two-paths double U-shaped fixationis is better than Y-shaped tape fixation. To compare the venous indwelling needle fixation, two-paths double U-shaped fixer could fix more effectively and safety. At the same time, it also has advantages in convenient, observation and appearance. It could be widely used in clinical practice.

A U-shaped Association between Body Mass Index and Psychological Distress on the Multiphasic Personality Inventory: Retrospective Cross-sectional Analysis of 19-year-old Men in Korea

Objective personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), might be more sensitive to reflect subclinical personality and be more state-dependent in an individual's lifetime, so they are good scales to predict the psychological distress regarding certain states. The aim of this study was to identify the specific pattern between body mass index (BMI) and psychological distress using the objective personality test. For this study, we investigated BMI and the Korean Military Multiphasic Personality Inventory (MPI). A retrospective cross-sectional study was conducted with 19-yr-old examinees who were admitted to the Military Manpower Administration in Korea from February 2007 to January 2010. Of 1,088,107 examinees, we enrolled 771,408 subjects who were psychologically apparent healthy possible-military-service groups. Afterwards, we reviewed and analyzed directly measured BMI and MPI results. In terms of the validity scales, the faking-good subscale showed an inverted U-shaped association, and faking-bad and infrequency subscales showed a U-shaped association with BMI groups. In terms of the neurosis scales, all clinical subscales (anxiety, depression, somatization, and personality disorder) also showed a U-shaped association with BMI groups. For the psychopath scales, the schizophrenia subscale showed a U-shaped association, and the paranoia subscale showed a near-positive correlation with BMI. In conclusion, a specific U-shaped pattern was observed between BMI and the MPI in 19-yr-old men in Korea. Underweight and obesity are related to psychological distress, so supportive advice and education are needed to them.

Study of reducing adverse drug reactions and resistance by gold zone method / 中国药学杂志

OBJECTIVE: To reduce adverse drug reactions and resistance of cefamandole nafate for injection and ceftriaxone sodium for injection by gold zone method. METHODS: The relationships between doses and effects were studied. Using gold zone as the middle range and dividing empirical range into three sections are the keypoints to the study design. RESULTS: The incidences of drug adverse reactions of both drugs complied with U-shaped rule, i.e, with the increase of doses (mg·kg-1·d-1), the adverse reaction rates first decreased and then rose, and the bottom of the U-shaped curve was in the gold zone. Central limit theorem and normal distribution demonstrated that the appropriate doses existed in the gold zone, which was less than 1/4 of the empirical range but covered nearly 70% of the probability. The relationship between the resistance and dose also followed U-shaped rule, and the bottom of the U-shaped curve was also in the gold zone. CONCLUSION: Abuse, adverse reactions and resistance are the three major problems in antibiotics use today. Using gold zone method to determine dose may be a special breakthrough in solving these problems. Copyright 2012 by the Chinese Pharmaceutical Association.

Three-dimensional finite element analysis of the stress distribution pattern in the design modifications of U-shaped palatal major connector.

Background: The U-shaped maxillary major connector is considered to be the least-desirable design by many prosthodontists as it lacks rigidity, which is a primary requisite for a major connector. Aims and Objectives: Design modifications in the U-shaped palatal major connector are desired because it lacks rigidity. The study also aimed to determine the best design when a U-shaped palatal major connector is indicated for clinical use. Materials and Methods: The normal design and the design-modified models (modification 1, 2, 3, 4) were loaded at the functional cusps of the premolars and the molars with a magnitude of 200 N, 250 N and 300 N at angulations of 60 o and 90 o on both sides of the maxillary arch. Results for each loading were obtained as stress distribution colored images and numerical values were recorded. A three-dimensional finite element analysis study of the design-modified models was performed using two finite element softwares, namely PRO-E and IDEAS. Results: The least stress value of 7.86 Megapascals (MPa) at 200 N, 60 o was recorded for the double-thickness design, followed by design 1, which was 8.03 MPa. The least stress value for the palatal mucosa and ligament was provided by design modification 1 (0.5 mm-thick U-shaped connector, 9 mm anteroposteiorly, 14.6 mm laterally), which was 9.78 MPa and 2.98 MPa, respectively. Conclusion: The double-thickness group exhibited the least internal stress for the U-shaped major connector. However, it delivered the greatest stress to the palatal mucosa and the periodontal ligaments.

Post-Operative Skeletal Stability of the Maxilla Treated with Le Fort I and U-Shaped Osteotomies in Simultaneous Maxillomandibular Orthognathic Surgery

Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report

BACKGROUND: U-shaped sacral fractures are highly unstable, can cause significant neurological deficits, lead to progressive deformity and chronic pain if not treated appropriately. OBJECTIVE: To report a case of a U-shaped sacral fracture treated with lumbopelvic fixation and decompression of sacral roots in a 23-years-old man. METHOD: Decompression of the sacral roots combined with internal reduction and lumbopelvic fixation using iliac screws. RESULTS: Restitution of lumbosacropelvic stability and recovery of sphincter function. CONCLUSION: Lumbopelvic fixation is effective in restoring lumbosacralpelvic stability and allows full mobilization in the postoperative period. Good neurological recovery can be expected in the absence of discontinuity of the sacral roots.

INTRODUÇÃO: As fraturas sacrais em U são instáveis e podem causar significativa lesão neurológica, deformidade progressiva e dor crônica se não tratadas apropriadamente. OBJETIVO: Relatar caso de um homem de 23 anos com fratura em U do sacro tratada com fixação lombopélvica e descompressão das raízes sacrais. MÉTODO: Descompressão da cauda equina associada a redução interna e fixação lombopélvica usando parafusos ilíacos. RESULTADOS: Reconstituição da estabilidade lombosacropélvica e recuperação da continência esfincteriana CONCLUSÃO: A fixação lombopélvica é eficaz em restaurar a estabilidade lombo-sacro-pélvica e permite mobilização imediata no pós-operatório. Recuperação neurológica pode ser esperada na ausência de neurotmese das raízes sacrais.

Gambee Anastomosis Using U-shaped Suturing Needle in Surgery of Lower Gastrointestinal Tract

BACKGROUND: It is commonly accepted that the Gambee suture is a precise and reliable suturing method in the anastomosis of the intestine, especially in the aspect of the exact apposition of the submucosal layer. Generally, Gambee suturing technique requires much time and effort, as well as complicated actions and skills. For this reason, the Gambee suture is avoided by many surgeons. PURPOSE: Nahm-gun Oh has devised a U-shaped needle, which can prevent submucosal tearing of the posterior bowel wall, owing to the short distance between its both ends. As a result, an operator to perform a Gambee stitch more easily, safely. This study was undertaken to evaluate the usefulness, reliability of the U-shaped needle. METHODS: The clinical analysis was made on 104 cases with Gambee anastomosed colo rectal disease who have been admitted and operated at the Department of Surgery, Pusan National University Hospital, from January, 1996 to December, 1997 and the disease and patients status, operative procedure, postoperative complication, needle holder grasping count according to anastomosis level of 104 cases were analyzed. RESULTS: Gambee anastomosis was performed in 71 cases(68.3%) of colorectal cancers and 33 cases(31.7%) of nonmalignant colorectal diseases. Postoperative complication was 20 cases(19.2%) and 2 cases(1.9%) of anastomotic site leaks were observed. In aspect of needle holder grasping according to anastomosis level, U-shaped needles allow for an entire Gambee suture from one fixed grasp, while the common half-circled suturing needle requires at least 2 or 3 different grasping positions of the needle holder. In case of anterior bowel wall anastomosis, undesirable slipping-off of the submucosal tissue was founded. Authors also suggest a hook-style barb tip so that barb tip should prevent the slipping-off. CONCLUSION: The half-ellipsed or half-track needle can prevent submucosal tearing of the posterior bowel, owing to the short distance between its both ends. Barb feature on the suturing needle tips will be able to prevent slipping-off of the submucosa contralateral from the needle holder during an entire Gambee stitch on the anterior bowel wall. We recommended, based on our results, with U-shaped suturing needle, as well as barb-tip needle feature, operators can save a lot of time and effort formerly required by other common needle in Gambee suture.

Clinical Observation on Hydrargyrum Oxydatum Crudum Medicinal Twist Filling-Extubation plus Hanley Technique for Treating 69 Cases of High Position U-shaped Anus Fistula / 中医杂志

Objective To observe the therapeutic effect of hydrargyrum oxydatum crudum medicinal twist filling-extubation plus Hanley technique for high position u-shaped anus fistula.Methods hydrargyrum oxydatum crudum medicinal twist filling-extubation plus Hanley technique was adopted for 69 cases,and the control group(68 cases)was treated with Hanley technique only.Observed were therapeutic effect,changes of symptoms and signs after operation,score of complications,healing time of both groups.Results The clinical curative rate of treatment group and control group was 94.20% and 82.35% respectively.The difference was of signifi- cance(P