Modular repairing strategy of penile skin defect after multiple hypospadias operations / 中华泌尿外科杂志

Objective:To evaluate the safety and effectiveness of the model repair strategy for preputial defect in hypospadias surgery.Methods:From February 2017 to December 2022, 59 children in our hospital with an average age of (6.9±3.2) years were retrospectively analyzed. All of them were children with multiple failed hypospadias operations. According to the condition of penile scrotum skin, different methods of penile skin reconstruction were selected. Among them, 20 patients underwent penile skin flap reconstruction with simple foreskin and multiple small incision reduction, 22 patients with penile and scrotal transposition underwent penile lateral scrotum flap to complete ventral penis coverage, and 12 patients underwent middle scrotum flap with pedicled flap to cover ventral urethra. The penis was covered by inferior epigastric artery perforator flap in 5 patients.Results:The wound healed completely one week after the operation and no obvious scar formation was observed. The ventral flap of the penis was covered by the lateral scrotal flap of the penis, and no flap necrosis and wound infection were observed. The ventral urethra was covered with pedicled skin flap in the middle scrotal suture. The flap survived without scrotal hematoma. The inferior epigastric artery perforator flap was used to cover the patients with penile defect, all the flaps survived, and no complications such as wound infection and abdominal hernia occurred. No urethral fistula or urethral diverticulum was reported in all the patients. Urethral stricture occurred in 1 case of scrotal suture pedicled flap group and 1 case of lateral penis scrotal flap group, which was cured after expansion. One case with small incision and one case with lateral scrotal skin were cured after secondary repair by Mathieu method.Conclusions:For children with a history of multiple hypospadias operations, coverage of ventral skin defects of the penis is essential to reduce complications and obtain good appearance. This study summarized four effective strategies for covering penile defect from simple to complex. The small incision was used to reduce the expansion of all flaps. The lateral penile scrotal flap is more suitable for patients with penile scrotal transposition. The pedicled flap of scrotal suture and inferior superficial artery perforator flap are suitable for the repair of larger defect area.

The effect analysis of systematic diagnosis and treatment model based on new classification on primary hypospadias / 中华泌尿外科杂志

Objective:To explore the effect of systematic diagnosis and treatment model based on new classification on primary hypospadias.Methods:The data of 689 patients with primary hypospadias admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2010 to June 2021 were retrospectively analyzed. Of all, 349 cases from March 2010 to June 2016 were treated with traditional treatment methods, and 340 cases from July 2016 to June 2021 were treated with systematic diagnosis and treatment model based on new hypospadias classification. Traditional treatment group of patients according to the European Society of Urology (EAU) guide classification, were divided into the distal-anterior type (located on the glans or distal shaft of the penis), intermediate-middle type (penile) and proximal-posterior type (penoscrotal, scrotal, perineal). For distal type, tubularized incised plate (TIP) or dorsal inlay urethroplasty (Inlay) was performed. Patients with intermediate-middle type underwent Inlay, and patients with proximal-posterior type underwent Bracka staging. In the systematic diagnosis and treatment group, hypospadias was reclassified into distal type (located on the glan or in the first third of the shaft of the penis), junctional type (the back two-thirds of the shaft of the penis and the base of the penis), and proximal type (scrotum or perineum). For distal type, TIP or Inlay was used. Patients with junctional type were treated with urethroplasty with union free graft and local flap method (Montage). Patients with proximal type were treated with Montage or Bracka staging. Patients with testicular volume <0.8 ml and glans width <1.0 cm were treated with human chorionic gonadotropin (HCG) before surgery. There were 349 patients in the traditional group, with an average age of (18.58±7.59) months. There were 157 cases of distal-anterior type, 47 cases of intermediate-middle type and 145 cases of proximal-posterior type. There were 181 cases with penile curvature < 30° and 168 cases with penile curvature ≥30°. There were 340 cases in the systematic diagnosis and treatment group, with an average age of (18.94±6.05) months. According to EAU classification, 160 cases were distal-anterior type, 42 cases were intermediate-middle type and 138 cases were proximal-posterior type. There were 197 cases with penile curvature < 30° and 143 cases with penile curvature ≥30°. There was no significant difference in the above indicators between the two groups ( P>0.05). The surgical methods, incidence of postoperative complications and the time of hospital stay between the two groups compared. The changes in penis size and testis volume before and after the use of hormones in the systematic treatment group were compared. Results:In the traditional group, 139 patients underwent TIP, 65 patients underwent Inlay, and 145 patients underwent Bracka staging. In the systematic diagnosis and treatment group, 187 cases were reclassified as distal type (153 cases underwent TIP and 34 cases underwent Inlay). Of the 69 cases of junctional type, 10 cases underwent Inlay, and 59 cases underwent Montage. Of the 84 cases of proximal type, 77 cases underwent Montage, and 7 cases underwent Bracka staging. There was significant difference between the two groups ( P<0.01). In the traditional group, there were 31 cases of urinary fistula (8.9%), 43 cases of urethral stricture (12.3%), 21 cases of urethral diverticulum (6.1%), 45 cases of penile recurvature (12.9%), and the total incidence of complications was 40.1% (140/349). There were 19 cases of urinary fistula (5.6%), 28 cases of urethral stricture (8.2%), 15 cases of urethral diverticulum (4.4%) and 24 cases of penile recurvature (7.1%) in the systematic diagnosis and treatment group. The total incidence of complications was 25.3%(86/340). There were statistically significant differences in the incidence of the above complications between the two groups ( P<0.05). There was a significant difference in the duration of hospital stay between the traditional group and the systematic diagnosis and treatment group [(4.3±1.2) d vs. (1.5±0.5) d, P=0.01]. The width of glans penis after HCG treatment was (1.35±0.14) cm, which was significantly higher than that before HCG treatment [(0.96±0.24) cm, P=0.03]. The length of penis [(2.55±0.19) cm vs. (2.29±0.16) cm] and the volume of testis [(0.76±0.24) ml vs. (0.64±0.15) ml] were not significantly different from those before treatment ( P>0.05). Conclusions:The new classification has clarified the choice of surgical methods, avoiding the amplification of surgical indications. The systematic diagnosis and treatment model based on new classification has significantly improved the treatment effect of hypospadias and effectively reduced postoperative complications. It provides an optional diagnosis and treatment model for hypospadias.

Application of free skin graft or auricle composite tissue in the correction of nasal flange retraction / 中华医学美学美容杂志

Objective:To investigate the clinical effect and application value of free skin or auricle composite tissue transplantation in the correction of nasal alar retraction.Methods:From August 2019 to January 2023, a total of 45 patients with nasal retraction (7 males and 38 females) were treated in Shanghai United Regal Medical Cosmetology Hospital. Age ranged from 18 to 46 years, with a mean of 26.6 years. All patients had retroalar margin retraction caused by insufficient alar lining to varying degrees, with a retraction distance between 2-5 mm, with an average retraction distance of 3.3 mm. 11 cases of nasal flange retraction were corrected by free transplantation of composite tissue of auricle directly. The remaining 34 patients were corrected by alar border cartilage graft and free skin graft.Results:During 2-18 months of follow-up, 41 patients had satisfactory results and no obvious complications. Partial necrosis of free skin was observed in 2 patients, ischemic necrosis of complex flap of auricle was observed in 1 patient, and necrosis of free skin was observed in 1 patient. In addition to the above complications, 3 patients reported that the correction of alar retraction did not achieve the expected effect, but indicated that they were satisfied with the surgical effect, which was considered to be caused by skin contracture and other factors. The overall satisfaction rate of all patients was 91.1%. After follow-up and statistics, 41 patients in this group were satisfied with the results, with an overall satisfaction rate of 91.12%.Conclusions:The application of free skin graft (or auricle composite tissue) to correct nasal alar retraction has the advantages of simple operation, wide indications and accurate efficacy, and is worthy of clinical promotion.

Preimplantation genetic testing for a couple where the husband is affected by osteogenesis imperfecta combined with balanced translocation using karyomapping technique / 中华医学遗传学杂志

OBJECTIVE@#To carry out preimplantation genetic testing (PGT) for a couple where the husband was affected by osteogenesis imperfecta combined with balanced translocation using the karyomapping technique.@*METHODS@#Blastocysts were detected using karyomapping, the carrier status of COL1A1 c.760G>A (p.Gly254Arg) variant and the carrier status of the translocated chromosome were analyzed simultaneously.@*RESULTS@#For a total of 10 blastocysts, two euploid blastocysts were found to not carry the COL1A1 c.760G>A (p.Gly254Arg) variant but a balanced translocation. After transplanting one of the blastocysts, clinical pregnancy was achieved. Amniocentesis at 18th gestational week and prenatal genetic testing was in keeping with the result of PGT.A healthy female was born at 40+4 weeks gestation.@*CONCLUSION@#For patients simultaneously carrying genetic variant and balanced chromosomal translocation, PGT can be performed with efficiency by the use of karyomapping method.

Up-regulated SUMO1 expression by inhibition of miRNA-548m as a potential cause of congenital orofacial cleft in a fetus / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology for a fetus with congenital orofacial cleft.@*METHODS@#Single nucleotide polymorphism microarray (SNP array) was carried out on skin tissues sampled from the fetus following induced abortion for the detection of copy number variation (CNVs). Pathogenicity of the candidate gene was validated through experiment.@*RESULTS@#SNP array revealed that the fetus has carried a hemizygous 9.23Mb deletion at Xq21.31-q22.1(91 063 807-100 293 555), which was inherited from its mother. The region contained 13 OMIM genes and 1 ncRNA coding gene(MIR548M). Inhibiting of the expression of the MIR548M gene in oral epithelial celllines has resulted in up-regulation of the expression of SUMO1 gene which was known to involve in the pathogenesis of orofacial cleft.@*CONCLUSION@#Dosage insufficiency of the MIR548M gene may underlie the etiology of orofacial cleft in this fetus.

The complications of strategic urethrostomy in the treatment of complicated hypospadias / 中华泌尿外科杂志

Objective To evaluate if strategic urethrostomy could reduce complications in complicated hypospadias repair.Methods From January 2016 to August 2018,165 patients of complicated hypospadias were reviewed according to inclusion criteria.They were divided into three groups of one-stage repair (group A,n =86),two-stage repair using Bracka procedure (group B,n =49) and strategic urethrostomy (group C,n =30).The median age was 26 months in group A,24 months in group B and 28 months in group C.The median length of urethral defect was 3.0 (2.0-10.0) cm,4.0 (2.5-10.0) cm and 3.8(2.5-11.0) cm in the different three groups,respectively.No difference showed in age or length of urethral defect among 3 groups.Three groups were compared with rates of urethral fistula,urethral stricture and urethral diverticulum.Results After average of 20.0 months follow-up,the urethral stricture incidence of group C [3.3％ (1/30)] was significantly lower than that of group A [22.0％ (19/86),P =0.023] and group B[24.5％ (12/49),P =0.032].The complications were found in 7 patients with urethral fistula and 11 patients with urethral diverticulum in group A,4 patients with urethral fistula and 3 patients with urethral diverticulum in group B,none patient with urethral fistula nor urethral diverticulum in group C,respectively.The incidence of urethral fistula was 8.1％ (7/86),8.2％ (4/49) and 0 in the three groups,and the rate of urethral diverticulum was 12.8％ (11/86),6.1％ (3/49) and 0,respectively.None difference was shown neither in the incidence of urethral fistula nor urethral diverticulum among the three groups(P ＞ 0.05).Conclusions Strategic urethrostomy is a novel and effective method for complicated hypospadias repair.Application of strategic urethrostomy can significantly decrease urethral stricture and improve success rate in complicated hypospadias repair.

Appliance of microsurgery in the treatment of male infertility / 中华泌尿外科杂志

Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.

Analysis of vascular injury in lumbar spine surgery

To investigate the incidence of vascular injury in lumbar spine surgery and determine the strategy for its diagnosis and treatment. We retrospectively reviewed 1159 patients in our institution treated with lumbar spine surgery from September 2003 to November 2009. Primary outcomes measured included intraoperative vascular complications, operative blood loss and operative mortality. The incidence of vascular injury is significantly higher in anterior exposure [9.1%] than posterior exposure [0.29%] [p < 0.05] and 84.4% of vascular injury involved in L4-5 segment. Nineteen patients experienced vascular injury in two-level or multi-level exposure and 26 in one-level exposure, no significant difference between two groups was found [p > 0.05]. One patient died and others got favourable results. L4-5 segment has high incidence of vascular injury especially when anterior exposure is performed, and spine surgeons should pay more attention to the fatal complication.

Effects of diet-induced obesity on the development of testicle in Sprague Dawley rats / 中华临床营养杂志

ObjectiveTo investigate the effects of diet-induced obesity on the developmental process of testes in pubertal Sprague Dawley (SD) rats and explore the possible reversibility. MethodsSixty one-month-old male SD rats were randomly divided into a control group ( n =10) and a model group ( n =50 ), which were fed on a normal diet and a high-fat diet, respectively. After 8 weeks, all the rats in the control group and 10 rats randomly picked out from the model group were killed. The serum testosterone and estradiol levels were measured by enzymelinked inununosorbent assay. Their left testes sections were stained by HE method, and the histology was observed under optical microscope and the spermatogenic activity was evaluated by Johnsen scoring system. The remaining 40 rats in the model group were further randomly divided into 3 subgroups: continued high-fat diet subgroup ( n =13), resume normal diet subgroup (n =13), and weight-loss subgroup (n =14). The continued high-fat diet subgroup was fed by high-fat diet, while the other two subgroups were fed by normal diet. Rats in weight-loss group took normal diet with running 20 min/d. After 6 weeks, the same parameters were assessed using the same methods. ResultsAfter 8 weeks, compared with the control group, the testosterone level of the model group significantly decreased (P =0.024) and the estradiol level significantly increased ( P =0. 017). The result of HE staining showed that the spermatogenic cell layers decreased, with part of seminiferous tubule experiencing atrophy.The number of Leydig cell also decreased and lipo vacuole was seen in the interstitial tissue of testis. The Johnsen score of the model group was significantly lower than that of the control group (P =0.000). The testosterone level was significantly lower in the continued high-fat diet subgroup than that in resume normal diet subgroup ( P =0.001 ) and weight-loss subgroup ( P =0.000), and was significantly lower in resume normal diet subgroup than that in weight-loss subgroup ( P =0.001 ). The estradiol level was significantly higher in continued high-fat diet subgroup than that in resume normal diet subgroup ( P =0.001 ) and weight-loss group ( P =0.000 ), and was significantly higher in resume normal diet subgroup than that in weight-loss group ( P =0.001 ). HE staining showed that, pathological changes aggravating and worsening compared with the control group, the model group had significantly decreased seminiferous tubule cell layers, with some seminiferous tubules experiencing atrophy.The Johnsen score was significantly higher in weight-loss subgroup than that in the other two subgroups ( P =0.000and 0.001, respectively). The Johnsen score was negatively correlated with body weight ( r =- 0.962, P =0.000), and positively correhted with the serum testosterone level ( r =0.916, P =0.000 ). Conclusions High-fat diet can induce pubertal obesity in male SD rats, which is featured by testicular hypoplasia, decreased spermatogenesis, and endocrine dysfunction. Physical exercise may improve the conditions. The degree of obesity may be negatively correlated with the spermatogenic function.

A clinical analysis of inlay buccal mucosal urethroplasty for hypospadias repair / 中华泌尿外科杂志

ObjectiveTo evaluate the effect of inlay buccal mucosa graft with tubularized incised urethral plates (TIP) urethroplasty for hypospadias repair. MethodsFrom January 2005 to December 2010,a total of 343 cases of hypospadias underwent a buccal mucosa graft with TIP urethroplasty.The patients aged from 6 months to 61 years,mean 7 years.One hundred and forty-seven were primary surgery cases,and 196 cases had a history of failed surgery.In primary cases,124 were distal type and 23 were proximal type.There were 137 distal type cases and 59 proximal types in failed case group.A buccal mucosa graft was harvested from lower lip,fixed into the incised urethral plates in primary cases.In re-do cases,open urethral and remove scar tissue were necessary. ResultsThe width of the buccal mucosa ranged 0.5 - 2.5 cm,length ranged 1.0 - 8.5 cm.All the patients were followed up for 6 - 36 months,average 16 months.In primary group,fistula occurred in 14 cases (9.5％ ),and urethral stricture in 2 cases (1.4％),in which 1 proximal case occurred both with urethral stricture and fistula; the overall success rate was 89.8％.In re-do group,fistula occurred in 32 cases ( 16.3％ ),and stricture in 13 cases (6.6％),in which 1 distal and 5 proximal cases occurred with both urethral stricture and fistula; the overall success rate was 80.1％. ConclusionsInlay buccal mucosal graft with TIP technique is an effective instrumentality for hypospadias repair because of its high successful rate,good cosmetic effect and without affecting on oral appearance and function in donor site.

The effectiveness of intervention intergrated health education, positive reinforcement behavioral therapy,music therapy and exercise on negative symptoms in inpatient with schizophrenia / 中华行为医学与脑科学杂志

Objective To explore the effectiveness of intervention measure intergrated health education, positive reinforcement behavioral therapy, music therapy and exercise on the negative symptoms in the inpatient with schizophrenia. Methods Sixty waning inpatients with schizophrenia were randomly divided into intergral in-tervention group(30 cases) and control group (30 people). The intergral intervention group were treated with health education, positive reinforcement behavioral therapy, music therapy and exercise, that lasted 8 weeks, and control group received ordinary rehabilitation treatment. The effectiveness of the measures were evaluated by scale for the Assessment of Nagative Symptoms (SANS) and IPROS scales before and after the intergral intervention. Results The scores of SANS and IPROS in the intergral intervention group were significant lower than those in the control group after the intergral intervention[43.68±20. 11,61.37±29.43;18.09±7.60,26.62±13.48; P<0.01], while the scores showed no difference before the intergral intervention [60.42±20.83,64.47±29.45;36.81±10.47,36.67±10.84; P>0.05]. Conclusions The intervention intergrated health education, positive reinforcement behavioral therapy, music therapy and exercise could improve negative symptoms and social function of the inpatient with schizophrenia.

Stereotactic aspiration combined with gamma knife radiosurgery for cystic brain metastasis / 中国微创外科杂志

Objective To evaluate the outcome of stereotactic aspiration combined with gamma knife radiosurgery in the treatment of cystic brain metastasis.Methods The study included 21 cases of cystic brain metastasis.There were 16 males and 5 females,with their age ranged 45～78 years old(mean,64.5 years old).Nineteen patients had a solitary tumor and 2 patients had two lesions.The mean diameter of tumors was 36 mm.The Karnofsky Performance Score(KPS) was ≥50%.A stereotactic aspiration was performed under CT guidance to drain the cystic fluid.Then the MASEP-SRRS gamma knife radiosurgery was performed.All brain metastasis were averagely enclosed within the 40%～65%(mean,50%) isodose shells of the radiosurgical fields with a peripheral dose of 16～22 Gy(mean,19.5 Gy).Results All the cases were followed for 1～3 months(mean,2.3 months) with CT or MRI scanning.Tumors completely disappeared in 12 lesions,subsided in 9 lesions,changed less than 10% in 1 lesion,and enlarged in 1 lesion.Cerebral necrosis and edema adjacent to lesions respectively developed in 1 case.No other severe complications were seen.The control rate of tumor was 95.7%(22/23).Twenty-one patients were followed for 6～36 months(mean,23.5 months).The followed-up results showed improvement of symptoms in 18 cases,no change in 2 cases,and exacerbation in 1 case.The survival rate at 6 months was 90.5%(19/21).And the 1-and 2-year survival rates were 62.5%(10/16) and 25%(3/12),respectively.One case survived beyond 3 years.The median survival time was 14.1 months.Conclusions Stereotactic aspiration combined with gamma knife radiosurgery is an ideal treatment for cystic brain metastasis.

Endoscopic treatment of ureteral calculi accompanied with polyps: A report of 35 cases / 中国微创外科杂志

Objective To evaluate the curative effect of endoscopic treatment of ureteral stones accompanied with polyps. Methods A total of 35 cases of ureteral stones complicated with polyps were treated under ureteroscope by using electrocauterization and pneumatic lithotripter. Results All polyps were successfully cauterized. Stones were fragmented in 88.6% (31 of 35) of the cases.Because the stones moved into renal pelvis, ESWL was adopted after the intubation of double-J catheter in 2 cases. Conclusions After polyps have been cauterized by electrocauterization in advance, the treatment for ureteral stones by using ureteroscopy and pneumatic lithotripter is safe and effective.