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【Objective】 To explore the efficacy of transurethral columnar balloon dilation of prostate (TUCBDP) and transurethral bipolar plasmakinetic resection of prostate (TUPKP) for patients with small volume (≤30 mL) benign prostatic hyperplasia (BPH) and the effects on urinary control and sexual function. 【Methods】 Clinical data of BPH patients who underwent surgical treatment during Jun.2021 and Jan.2022 were reviewed. A total of 95 patients with prostate volume ≤30 mL and regular sexual life were selected as subjects, including 45 patients who received TUCBDP as the TUCBDP group and 50 patients who received TUPKP as the TUPKP group. The patients were followed up for 12 months, and the perioperative data and follow-up results were analyzed. 【Results】 The TUCBDP group had shorter operation time, less intraoperative blood loss, less postoperative hemoglobin loss and sodium concentration loss, shorter bladder irrigation time, lower pain score, shorter urinary tube indwelling time and shorter hospital stay than the TUPKP group (P0.05). The TUPKP group had worse ejaculation function score and ejaculation disturbance score after surgery (P0.05), and the two indexes were superior in the TUCBDP group than in the TUPKP group. The TUCBDP group had significantly lower complication rate than the TUPKP group (P<0.05). 【Conclusion】 TUCBDP is safe and effective in the treatment of small volume (≤30 mL) BPH, less trauma, less biochemical interference, less pain, fewer complications, and shorter course of disease. It has little effect on the ejaculation function and erectile function, and is more suitable for patients requiring retention of sexual function. It has a good application prospect in the treatment of small volume BPH.
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Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.
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OBJECTIVE：To study the repa ir effect and mechanism of Taohong siwu decoction on rotator cuff injury in rabbits. METHODS：New Zealand rabbits were randomly divided into blank control group ，model group ，Taohong siwu decoction low-dose，medium-dose and high-dose groups （2.75，5.5，11 g/kg），and Taohong siwu decoction+LY 294002 group [ 5.5 g/kg Taohong siwu decoction+ 6.4 μg/kg LY294002（pathway inhibitor ）]，with 11 rabbits in each group. Except for blank control group ， other groups underwent right subscapularis muscle detachment to establish rotator cuff injury model. After modeling ，blank control group and model group were given normal saline intragastrically ；Taohong siwu decoction groups were given relevant medicine intragastrically；Taohong siwu decoction+LY 294002 group was given Taohong siwu decoction intragastrically ，and then injected with LY 294002 at the ear edge ，once a day ，for 12 weeks. After last intragastric administration （injection），the pathological changes of tendon-bone interface was observed ；the levels of TNF-α，IL-10 and IL- 6 in serum were detected ；mRNA and protein expressions of PI 3K，Akt and mTOR in tendon-bone interface were detected ；the expression of autophagy related protein （Beclin1， LC3Ⅱ）were detected. RESULTS ：Compared with blank control group ，the tendon-bone interface was uneven and the intima was swollen in model group. Serum levels of TNF-α and IL-6，mRNA and protein expressions of PI 3K，Akt and mTOR in tendon-bone interface were increased significantly （P＜0.05 or P＜0.01），while the level of IL- 10 and protein expression of Beclin 1 and LC 3Ⅱ were decreased significantly （P＜0.01）. Compared with model group ，the tendon-bone interface of rabbits in Taohong siwu decoction low-dose and medium-dose groups still had certain intimal damage ，while the tendon-bone interface of rabbits in high-dose group was smooth and flat without an obvious intimal tear ；the levels of most indexes in serum and tendon-bone interface of rabbits were significantly reversed in each dose group （P＜0.05 or P＜0.01）. Swollen tendon-bone interface and obvious intimal tear were obse rved in Taohong siwu decoction + LY group；compared with model group ，there w as no significant difference in above indexes of serum and tendon-bone interface （P＞0.05）. CONCLUSIONS ：Taohong siwu decoction may repair the rotator cuff injury of rabbits ，the mechanism of which may be associated with inhibiting PI3K/Akt/mTOR signaling pathway，activating autophagy and inhibiting inflammatory response.
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Radiotherapy plays an important role in the treatment of cervical cancer. The radiosensitivity of cervical cancer is closely related to genes, RNA regulation, tumor microenvironment, drugs and other factors. Recently, many studies have been conducted to continuously explore the mechanisms of these factors in radiotherapy sensitization, and progress has been made in radiotherapy sensitization of cervical cancer at basic or clinical level.
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OBJECTIVE：To study the effect of total flavonoids of Epimedium brevicornu on postmenopausal osteoporosis （PMOP）model rats based on BMP/Runx 2/Osx signaling pathway so as to confirm the mechanism of preventing and treating osteoporosis（OP）. METHODS ：By body mass stratification ，50 rats were randomly divided into sham operation group ，model group，E. brevicornu total flavonoids low-dose and high-dose groups [265，530 mg/（kg·d）]，estradiol group [0.09 mg/（kg·d）]， with 10 rats in each group. Except that sham operation group underwent sham operation ，PMOP model was established by ovariectomy and castration in other groups. After modeling ，they were given normal diet for 2 months and then given relevant medicine intragastrically for consecutive 84 d，once a day ；rats in sham operation group and model group were given equal volume of normal saline. After last medication ，bone mineral density （BMD）of femur and vertebrae of the right lower limb ，the number of trabecular bone （Tb.N），trabecular bone thickness （Tb.Th）and trabecular separation （Tb.Sp）of femur were determined in each group. The serum levels of Ca 2+，OC and P 1NP in serum were detected by ELISA. HE staining was used to observe pathological changes of femur. mRNA and protein expressions of BMP ，Runx2 and OSX in bone tissue were detected by RT-PCR and Western blotting. RESULTS ：Compared with sham operation group ，BMD of femur and vertebrae ，serum levels of Ca 2 +，OC and P 1NP， Tb.N and Tb.Th of femur ，mRNA and protein expression of BMP ，Runx2 and Osx in femur were decreased significantly in model group，while Tb.Sp of femur was increased significantly （P＜0.01）；the structure of trabecular bone was disordered and the fracture was obvious. Compared with model group ，above indexes of rats in administration groups were improved significantly （P＜ 0.05 or P＜0.01），and the effect of E. brevicornu total flavonoids was dose-dependent （P＜0.05）；the number of trabecular bone increased， arranged orderly and the structure was more brevicornu total flavonoids can improve OP ，the mechanism of which may be associated with com promoting the activity of BMP/Runx 2/Osx signaling pathway.
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Objective@#To analyze the clinical effect of modified standard traumatic craniectomy and standard large trauma craniectomy in the treatment of severe craniocerebral trauma.And to evaluate the clinical value of modified standard traumatic craniectomy in the treatment of severe craniocerebral trauma.@*Methods@#Ninety-two patients with severe craniocerebral trauma treated in Rugao Bo′ai Hospital (GCS3-8, acute subdural hematoma) from January 2015 to January 2017 were divided into two groups using random envelope drawing method, with 46 cases in each group.The control group was treated by standard large trauma craniectomy, and the observation group was treated by modified standard traumatic craniectomy.The intracranial pressure levels and activity of daily living scale (ADL) were compared between the two groups.@*Results@#At 1 d, 5 d, 10 d after operation, the intracranial pressure levels of the observation group were (23.19±2.82)mmHg, (15.26±2.77)mmHg and (11.22±2.75)mmHg, respectively, which were lower than those of the control group[(28.12±2.32)mmHg, (19.14±2.17)mmHg and (14.23±2.17)mmHg](t=47.544, 37.922, 29.504, all P<0.05). At 6 months after operation, according to ADL, the good rate of postoperative recovery in the observation group (67.39%, 31/46) was significantly higher than the control group (45.65%, 21/46), the difference was statistically significant(χ2=4.423, P<0.05).@*Conclusion@#The modified standard traumatic craniectomy has a certain value in the treatment of patients with severe craniocerebral trauma.
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Objective To investigate the CT findings of primary orbital lipid prolapse. Methods The CT data of 13 patients with primary orbital lipid prolapse in Jiaxing Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University from January 2012 to June 2018 were retrospectively analyzed. Results In all of the 13 cases of primary orbital lipid prolapse, there were 12 cases of bilateral orbital lipid prolapse and 1 case of unilateral orbital lipid prolapse. The CT images showed that the fat density masses in the posterior orbital septum were herniated from the outer quadrant of the orbit. The tumor was crescent shaped and connected with the orbital adipose tissue. The mass and the orbital adipose tissue were natural and homogeneous. Conclusions CT has distinctive imaging findings in the diagnosis of primary orbital lipid prolapse, and it is helpful for the diagnosis and differential diagnosis of this disease.
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Objective To analyze the clinical effect of modified standard traumatic craniectomy and standard large trauma craniectomy in the treatment of severe craniocerebral trauma.And to evaluate the clinical value of modified standard traumatic craniectomy in the treatment of severe craniocerebral trauma.Methods Ninety-two patients with severe craniocerebral trauma treated in Rugao Bo'ai Hospital (GCS3-8,acute subdural hematoma)from January 2015 to January 2017 were divided into two groups using random envelope drawing method,with 46 cases in each group.The control group was treated by standard large trauma craniectomy,and the observation group was treated by modified standard traumatic craniectomy.The intracranial pressure levels and activity of daily living scale (ADL) were compared between the two groups.Results At 1 d,5 d,10 d after operation,the intracranial pressure levels of the observation group were (23.19 ± 2.82) mmHg,(15.26 ± 2.77) mmHg and (11.22 ± 2.75) mmHg,respectively,which were lower than those of the control group[(28.12 ± 2.32) mmHg,(19.14 ± 2.17) mmHg and (14.23 ±2.17) mmHg] (t =47.544,37.922,29.504,all P ＜ 0.05).At 6 months after operation,according to ADL,the good rate of postoperative recovery in the observation group (67.39％,31/46) was significantly higher than the control group (45.65 ％,21/46),the difference was statistically significant (x2 =4.423,P ＜ 0.05).Conclusion The modified standard traumatic craniectomy has a certain value in the treatment of patients with severe craniocerebral trauma.
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Objective@#This study aims to analyze the relationship among the clinical features, radiologic characteristics and pathological diagnosis in patients with solitary pulmonary nodules, and establish a prediction model for the probability of malignancy.@*Methods@#Clinical data of 372 patients with solitary pulmonary nodules who underwent surgical resection with definite postoperative pathological diagnosis were retrospectively analyzed. In these cases, we collected clinical and radiologic features including gender, age, smoking history, history of tumor, family history of cancer, the location of lesion, ground-glass opacity, maximum diameter, calcification, vessel convergence sign, vacuole sign, pleural indentation, speculation and lobulation. The cases were divided to modeling group (268 cases) and validation group (104 cases). A new prediction model was established by logistic regression analying the data from modeling group. Then the data of validation group was planned to validate the efficiency of the new model, and was compared with three classical models(Mayo model, VA model and LiYun model). With the calculated probability values for each model from validation group, SPSS 22.0 was used to draw the receiver operating characteristic curve, to assess the predictive value of this new model.@*Results@#112 benign SPNs and 156 malignant SPNs were included in modeling group. Multivariable logistic regression analysis showed that gender, age, history of tumor, ground -glass opacity, maximum diameter, and speculation were independent predictors of malignancy in patients with SPN(P<0.05). We calculated a prediction model for the probability of malignancy as follow: p=ex/(1+ ex), x=-4.8029-0.743×gender+ 0.057×age+ 1.306×history of tumor+ 1.305×ground-glass opacity+ 0.051×maximum diameter+ 1.043×speculation. When the data of validation group was added to the four-mathematical prediction model, The area under the curve of our mathematical prediction model was 0.742, which is greater than other models (Mayo 0.696, VA 0.634, LiYun 0.681), while the differences between any two of the four models were not significant (P>0.05).@*Conclusions@#Age of patient, gender, history of tumor, ground-glass opacity, maximum diameter and speculation are independent predictors of malignancy in patients with solitary pulmonary nodule. This logistic regression prediction mathematic model is not inferior to those classical models in estimating the prognosis of SPNs.
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Objective To investigate the effect of anisodamine on air repair of intussusception in children,to improve the success rate of air enema reduction in children with acute intussusception.Methods Based on the clinical symptoms and ultrasound diagnosis,582 children who were diagnosed with intussusception and needed air enema reduction were divided into two groups according to the modified method of operation.Children in the control group were not injected 654-2 before the air enema;the experimental group received intramuscular injection of 654-2 before air enema.The success rate and total success rate of the first reduction were observed and compared between the two groups.Results In the control group,229 cases was successfully repaired,and the success rate was 83.9%;17 cases were successfully reset by two times after intramuscular injection of 654-2;the overall success rate was 90.1%.In the experimental group, 295 cases were successfully repaired for the first time,and the success rate was 95.5%;3 cases were successfully reset by two times;the overall success rate was 96.4%.The successful rate and the total success rate of the experimental group were higher than those of the control group.χ2=22.71,P<0.001,was statistically significant.Conclusion Air enema before intramuscular injection of 654-2 is helpful to improve the success rate of air enema reduction in children with acute intussusception.
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Recent studies find that the expression of hepatoma-derived growth factor (HDGF) is closely correlated with the tumorigenesis,progression,metastasis,therapy and prognosis of various malignancies.Though the mechanism of the interaction of HDGF and tumors is still unclear,the research of HDGF serving as a tumor marker in malignancies and a new target for tumor treatment has become a hotspot in the research of tumor.
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Objective To investigate the effect of bone cement distribution on efficacy of vertebroplasty.Methods From January 2013 to June 2016,a total of 132 cases (132 vertebrae) with single segment osteoporotic thoracolumbar vertebral fractures underwent parallel vertebroplasty surgery,and there were 57 male,75 female,with an average age of (71.6±2.2) years old (ranged from 65 to 86 years old).On the basis of the postoperative X-ray films of bone cement distribution were divided into 3 groups.The bone cement was biased to the lateral side of the vertebral body (partial group,35 cases),the bone cement was over the vertebral midline,but not completely filled with contralateral vertebral body (near midline group,46 cases),and the bone cement was filled with bilateral vertebral body (bilateral group,51 cases).There were 15 males and 20 females in the partial group,aged (70.3±5.3) years old;20 males and 26 females in the proximal midline group,aged (72.1±3.2) years old;22 males and 29 females in the bilateral group,aged (71.2±4.6) years old.Local anesthesia was used to make the patient prone to operate on the operating bed.The head and tail of the bed were increased at the same time slightly and vertebral compression fractures reduction was performed.Bone cement was injected into the vertebral body through partial or bilateral transpedicular approach.The visual analogue scores (VAS) were measured of preoperation,postoperation and 3,6,12 months after surgery.Analysis of variance for each group and VAS before and after operation,and postoperative complications were observed too.Results All the 132 cases were followed up for 1-12 months,with an average of (11±0.3) months.There were statistically significant differences in the immediate effect of postoperation among partial group,near middle group and the bilateral group (F=90.472,P=0.000),VAS score in partial group was lower than that in bilateral group (t=11.433,P=0.000),but higher than that in near midline group (t=11.106,P=0.000),and the differences were statistically significant,but there was no significant difference between near midline group and bilateral group (t=0.581,P=0.563).VAS score showed no statistically difference among the three groups 3 months,6 months and 1 year follow-up after operation (F=0.892,P=0.413;F=0.342,P=0.713;F=0.834,P=0.441).In 3 eases of partial group,the pain was not relieved due to unfilled cement until the contralateral bone was injected into the bone cement.However,there were 11 cases of cement leakage in partial group,13 cases in near midline group,and 3 cases in bilateral group.Conclusion The distribution of bone cement is one of the main factors affecting the clinical efficacy after vertebroplasty,and the clinical effect of distributing the midline of vertebral body is better than the one side.
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Objective To investigate the efficacy of permanent left ventricular epicardial pacing through left lateral thoracotomy in children with complete atrioventricular block (CAVB)or complete left bundle branch block (CLBBB)as well as its effects on heart synchronization.Methods Permanent left ventricular epicardial pacemakers were implanted through left lateral thoracotomy in 26 children with CAVB or CLBBB in Heart Center,the First Affiliated Hospital of Tsinghua University.These children aged (2.3 ±2.1 )years old (1 month -9 years old),weight (1 1 .2 ± 5.8)kg (5 -32 kg),among them 1 5 cases were male and 1 1 cases were female.Among the 26 patients,24 patients had CAVB and 2 patients had dilated cardiomyopathy secondary to CLBBB.Fifteen children who visited the Pediatrics Department for acute upper respiratory tract infection were chosen as control group.The efficacy of left ventricular epi-cardial pacemakers was analyzed and its effects on heart synchronization were observed by using tissue Doppler imaging (TDI).Results Implantations of pacemakers were successfully conducted in all the 26 patients with no complications associated with operations.Left atrial and ventricular dual chamber epicardial pacemakers were implanted in 21 patients and left ventricular single chamber epicardial pacemakers were implanted in 5 patients.Within the follow -up period of (28.2 ±1 5.1 )months (1 month -51 months),atrial and ventricular leads were 1 00% effective.No significant diffe-rence was found in atrial electrode sensing,ventricular electrode threshold and ventricular electrode impedance com-pared with those during implantation(P >0.05).For the 6 patients with preoperative cardiac insufficiency,their left ventricular diastolic diameters decreased from (48.50 ±1 1 .1 0)mm to (40.67 ±6.40)mm after operation,and the difference was significant (t =2.96,P =0.030);but left ventricular ejection fraction increased from 0.27 ±0.08 to 0.53 ±0.08 after operation,and the difference was significant (t =-5.02,P =0.004).Two patients with right ven-tricular pacing developed pacemaker syndrome and were switched to left ventricular epicardial pacing.Their cardiac function returned to normal 1 .5 and 2.0 years later,respectively.Fifteen patients received evaluation of heart synchroni-zation by TDI.No significant difference was found in LVEF,septal -to -lateral wall motion delay,septal -to -posterior wall motion delay and standard deviation of Standard deviation of the peak tissue velocity between these 2 groups(all P >0.05).Conclusions For children requiring epicardial pacing,left ventricular epicardial pacing is safe and effec-tive,which can protect left ventricular systolic synchronization,prevent or reverse the pacemaker syndrome.
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Fibrinogen (Fib) is one of the most common coagulation proteins,plays an important role in the coagulation cascade,and has a closed relationship with tumor.Studies indicate that the level of Fib has elevated in many kinds of cancer,and Fib is also closely correlated with the progression,metastasis and prognosis of tumor.Though the mechanism of the interaction of Fib and tumor is still unclear,Fib as a tumor marker and new therapy for these malignancies has been a new hotspot.
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Background & objectives: With the ethical concern about the dose of CT scan and wide use of CT in protocol of suspected renal colic, more attention has been paid to low dose CT. The aim of the present study was to make a comparison of unenhanced low-dose spiral CT localization with unenhanced standard-dose spiral CT in patients with upper urinary tract calculi for minimally invasive percutaneous nephrolithotomy (MPCNL) treatment. Methods: Twenty eight patients with ureter and renal calculus, preparing to take MPCNL, underwent both abdominal low-dose CT (25 mAs) and standard-dose CT (100 mAs). Low-dose CT and standard-dose CT were independently evaluated for the characterization of renal/ureteral calculi, perirenal adjacent organs, blood vessels, indirect signs of renal or ureteral calculus (renal enlargement, pyeloureteral dilatation), and the indices of localization (percutaneous puncture angulation and depth) used in the MPCNL procedure. Results: In all 28 patients, low-dose CT was 100 per cent coincidence 100 per cent sensitive and 100 per cent specific for depicting the location of the renal and ureteral calculus, renal enlargement, pyeloureteral dilatation, adjacent organs, and the presumptive puncture point and a 96.3 per cent coincidence 96 per cent sensitivity and 93 per cent specificity for blood vessel signs within the renal sinus, and with an obvious lower radiation exposure for patients when compared to standard-dose CT (P<0.05). The indices of puncture depth, puncture angulation, and maximum calculus transverse diameter on the axial surface showed no significant difference between the two doses of CT scans, with a significant variation in calculus visualization slice numbers (P<0.05). Interpretation & conclusions: Our findings show that unenhanced low-dose CT achieves a sensitivity and accuracy similar to that of standard-dose CT in assessing the localization of renal ureteral calculus and adjacent organs conditions and identifying the maximum calculus transverse diameter on the axial surface, percutaneous puncture depth, and angulation in patients, with a significant lower radiation exposure, who are to be treated by MPCNL, and can be used as an alternative localization method.
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Sperm associated antigen 9(SPAG9),a new member of the c-Jun NH2-terminal kinase (JNK)interacting protein(JIP)family. plays a role in sperm-egg fusion and mitogen-activated protein kinase (MAPK)signaling pathway.Researches have shown that SPAG9 is closely related to the biological behavior of human malignant tumors, and plays an important role in the development of tumor.
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Objective To discuss the clinical value of dynamic monitoring the copies of human cytomegalovirus(HCMV)-DNA in prophylaxis of HCMV pneumonia after renal transplantation.Methods There were 242 cadaveric renal transplantation recipients including 144 males and 98 females,with the average age of 41(from 17 to 71).They were divided into 2 groups(experimental group 127 cases,control group 115 cases).Recipients in experimental group were routinely monitored by blood preparation and urine aliquot FQ-PCR.The therapy was initiated when HCMC-DNA>1×103 copies/ml by blood preparation and/or urine aliquot FQ-PCR with intravenous ganciclovir for 4 weeks.The dosage was calculated according to creatinine clearance rate.FQ-PCR monitoring and Preemptive therapy was not performed in the control group.The pneumonia rate, death rate and survival between the two groups were compared. Results In experimental group, the HCMV pneumonia incidence rate was 6.3 % (8/127), onset time was 46-167 d, median time was 84 d, hospitalization time was 30-57 d,median time was 36 d, death rate was 12.5 % (1/8), breathing machine using rate was 12.5 % (1/8),concurrent other pathogen infection rate was 25 % (2/8), and + year renal graft survival rate was 98.4% (125/127).One was dead with graft function and the other dysfunction was because of acute rejection.In control group, the HCMV pneumonia incidence rate was 14.8%(17/115), onset time was 34-138 d,median time was 51 d, hospitalization time was 21-67 d,median time was 40 d,breathing machine using rate was 29.4% (5/17),concurrent other pathogen infection rate was 41.2%(7/17), death rate was 23.5% (4/17), and 1 year renal graft survival rate was 93.0% (107/115).Three was dead with graft function and the other one was dead of DGF.The other 4 cases of renal dysfunction were because of acute rejection.Significant difference existed between the 2 groups (P<0.05) except for hospitalization time (P> 0.05). Conclusion The preemptive therapy of CMV pneumonia after renal transplantation by dynamic monitoring the copies of HCMV-DNA in recipients could have a good effect, and the 1 year renal graft survival rate could be higher.