Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. Methods: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Results: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ2=5.13, P=0.03; χ2=7.53, P=0.01). Conclusion: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

Intermittent abdominal pain and abdominal distension with fatigue and massive ascites in a 13-year-old boy / 中国当代儿科杂志

A 13-year-old boy was admitted due to intermittent abdominal pain for one year with massive ascites. The purified protein derivative (PPD) test after admission yielded positive results (3+), and ascites examination revealed a yellow color. There were 634×10 nucleated cells/L in the ascites, among which 82.2% were mononuclear cells and 17.8% were multinuclear cells. The Rivalta test yielded a positive result and revealed that the ascites was exudate, suggesting the possibility of tuberculosis infection. The symptoms were not relieved after isoniazid-rifampicin anti-tuberculosis therapy and symptomatic/supportive treatment. Plain CT scan of the abdomen and contrast-enhanced CT showed that the lesion was located at the left wall of the transverse colon, with uneven thickening of the peritoneum and heterogeneous enhancement. Colonoscopic biopsy found signet ring cells in the mucosa and immunohistochemical examination revealed Syn (-), CgA (-), CD56 (-), CK(pan) (+), CDX-2 (+), CK20 (+), Muc-1 (+) and Ki-67 (+, about 80%). PET-CT scan showed an abnormal increase in fluorodeoxyglucose metabolism, which was shown as a mass near the splenic flexure of the transverse colon, with a maximum standard uptake value of 9.9, indicating a highly active lesion; this was consistent with the metabolic changes of malignant tumors. Surgical operation was performed and intraoperative exploration revealed massive ascites, a hard mass located at the hepatic flexure of the colon, involvement of the serous coat and surrounding tissues, stenosis of the bowel, lymph node enlargement around the superior mesenteric vessels and the gastrocolic ligament, and multiple metastatic nodules in the greater omentum, the abdominal wall and the pelvic cavity. The results of postoperative pathology were consistent with those of colonoscopic biopsy, i.e., poorly differentiated mucinous adenocarcinoma of the transverse colon and partly signet-ring cell carcinoma. Therefore, the boy was diagnosed with colon signet-ring cell carcinoma with peritoneal metastasis and tuberculosis infection. When a child is suffering from intractable abdominal pain, unexplained intestinal obstruction and massive intractable ascites, the possibility of malignancy should be considered. Abdominal plain CT scan as well as contrast-enhanced CT scan should be performed as early as possible, and enteroscopy should be performed when necessary.

Clinico-pathologic analysis of 12 cases of epithelioid hemangioendothelioma / 临床与实验病理学杂志

Purpose To study the clinicopathologic features,immunophenotypes,diagnosis and differential diagnosis of epithelioid hemangioendothelioma (EHE).Methods Histopathology,clinical features and immunophenotypes of 12 cases of EHE which diagnosed by resection and core needle biopsy were analyzed retrospectively.These patients were followed-up.Results There were 9 males and 3 females,aged from 30 to 69 years,with an average age of 43.5 years.Among 12 EHEs,there were 8 cases in liver,3 cases in bone,and 1 case in lung.Histopathologically,the tumor cells were round and oval epithelioid arranged in single,nests,and cords.Tumor cells had abundant eosinophilic cytoplasm that contained vacuoles and erythrocyte in the tumor cytoplasm.The stroma showed myxoid change.Sparse calcification could be seen in some EHEs.Immunophenotype,tumor cells showed strong positive for CD34,CD31 and factor Ⅷ related antigen (FⅧRAg).Most EHEs are alive with tumor.1 case recurred in 6 months after surgery.1 patient died at 100 months postoperation.3 cases were lost follow-up.Conclusion EHE is a very rare low-grade malignant vascular neoplasm especially for arising from solid organ.Precise diagnosis must depend on surgical histopathology and molecular biology test of WWTR1-CAMTA1 fusion gene.

Effect of authentic leadership and job engagement on turnover intention among civil servants on tax system / 中国职业医学

OBJECTIVE: To explore the relationship of authentic leadership,job engagement and turnover intention in civil servants of tax system. METHODS: A total of 414 tax system civil servants were selected from 8 local tax bureaus and 6national tax bureaus by convenience sampling as the study subjects. They were investigated by the questionnaires of Authentic Leadership Scale,Job Engagement Scale and Turnover Intention Scale. RESULTS: The average scores of authentic leadership,job engagement and turnover intention in the 414 tax system civil servants were( 3. 28 ± 0. 76),( 3. 56 ±0. 68) and( 2. 50 ± 0. 90) respectively. There were 69 servants( 16. 7 %) and 77 servants( 18. 6 %) in the high turnover intention group and low turnover intention group respectively. Authentic leadership was positively related to job engagement[correlation coefficient( r) = 0. 376,P < 0. 01] but negatively correlated with turnover intention( r =- 0. 357,P <0. 01). The job engagement was negatively correlated with turnover intention( r =- 0. 425,P < 0. 01). Job engagement was the intermediate( 41. 7 % of the total effect) variable between authentic leadership and turnover intention. CONCLUSION: The job engagement of civil servants in the tax system partially mediated the relationship between authentic leadership and turnover intention.

Analgesic and Sedative Effect of Acupuncture Combined with Medicine on Patients Undergiong Cardiac Surgery / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe analgesic and sedative effect of acupuncture combined with medicine (ACM) on patients undergiong cardiac surgery.</p><p><b>METHODS</b>A total of 50 patients with cardiac surgery from January 2012 to October 2014 were randomly assigned to the conventional analgesia group (group A) and the ACM analgesia group (group B), 25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine, while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA, Shenting (GV24); Yintang (EX-HN3)] combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed, such as static and dynamic VAS scores, SAS scores, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2). The injection dosage of dexmedetomidine and morphine hydrochloride, analgesia satisfaction rate, sedation satisfaction rate, the incidences of adverse reactions during treatment such as bradycardia and low blood pressure, mechanical ventilation time, ICU time, and hospitalization expense were observed and recorded in the two groups.</p><p><b>RESULTS</b>There was no statistical difference in static and dynamic VAS scores, SAS score, MAP, HR and SpO2 between the two groups at different time points (P > 0.05). The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A (P < 0.05). The analgesia satisfaction rate of patients in group B was much higher than that in group A (P < 0.05). The incidence of bradycardia also obviously decreased more in group B than in group A (P < 0.05). There was no statistical difference in patients' sedation satisfaction rate, incidences of low blood pressure, delirium, vomiting; mechanical ventilation time, ICU time, or hospitalization expense between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>The analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.</p>

The effect of ulinastatin on blood gas analysis in rabbits with acute lung injury following a blast / 中华急诊医学杂志

Objective To study the effect of ulinastatin (UTI) on blood gas analysis in rabbits with acute lung injury (ALI) after an explosion.Methods A total of 24 healthy New Zealand white rabbits were made to be ALI models by an explosion at a distance of 11 cm.The rabbits met the criteria of ALI,and were randomly (random number) divided into A and B groups.In group B,rabbits received UTI injected at 0.5 h,6 h,12 h,24 h after modeling.In group A,an equal volume of saline was given to rabbits instead at the same intervals after modeling.Arterial blood pH,carbon dioxide partial pressure (PaCO2) and partial pressure of blood oxygen (PaO2) were determined by a portable blood gas analyzer before modeling and at given intervals after modeling.All rabbits were sacrificed after 48 h later.The pathological changes of lung tissue were observed with naked eye and extent of lung injury with HE staining.Results Compared with group A,pulmonary edema and infiltration of inflammatory cells in the lungs of rabbits in group B were less significant.The blood gas analysis showed there were significant difference in pH at 24 h after injury between group A (7.24 ± 0.07) and group B (7.35 ± 0.06),P ＜ 0.05.There was significant difference in PaO2 at 24 h after injury between group A (50.5 ± 9.9) mmHg and group B (78.1 ± 8.4) mmHg,P ＜ 0.05.And there was significant difference in PaCO2 at 24 h after injury between group A (52.4 ± 5.5) mmHg and group B (42.8 ± 4.5) mmHg,P ＜ 0.05.Conclusion UTI can significantly reduce acidosis,PaCO2 and increase PaO2 in rabbits with ALI following a blast,improving oxygenation and mitigating lung histopathological changes.

Exploration of ALK fused gene expression in non-small cell lung cancer patients by immuno-histochemistry / 临床与实验病理学杂志

Purpose To explore the accuracy of ALK fused gene expression by immunohistochemistry ( IHC) in non-small cell lung cancer ( NSCLC) patients, and to investigate the clinical and pathological features of ALK-positive NSCLC patients. Methods By u-sing rabbit monoclonal D5F3 antibody, ALK IHC was performed on 234 NSCLC patients. ALK positive cases were confirmed by reverse transcription-polymerase chain reaction ( RT-PCR) . Results The positive incidence of ALK by IHC in 234 NSCLC specimens was 8. 97% (21/234), the positive rate of ALK fused gene verificated by RT-PCR was 5. 98% (14/234). There was significant difference with histological type, age, stage (P120, the consistency rate was 100%. Conclusion Although immunohistochemical expres-sion of ALK fused gene may have a certain false positive, IHC or immunohistochemical score> 120 show very high value for ALK fused gene RT-PCR followed by ALK immunohistochemistry in lung cancer is a economical and feasible method for the valuation of ALK fused gene.

Identification of a novel NOTCH3 mutation in a family featuring cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze potential mutations of NOTCH3 gene in a Chinese family featuring cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL) in order to facilitate genetic counseling and prenatal diagnosis.</p><p><b>METHODS</b>The proband and related family members and 100 healthy controls were recruited. The NOTCH3 gene was screened for mutations by polymerase chain reaction and direct DNA sequencing. PolyPhen-2 and SIFT software were used to predict the protein function.</p><p><b>RESULTS</b>The proband and two affected individuals from the family were adult-onset, with main clinical manifestations including recurrent transient ischemic attacks and(or) strokes, cognitive impairment, memory decline, and depression. MRI findings suggested multiple cerebral infarcts and severe leukoencephalopathy. A novel heterozygous missense mutation c.3043T> A (p.Cys1015Ser) located in exon 19 of NOTCH3 gene was identified not only in the proband and two patients, but also in an asymptomatic relative from the family. The same mutation was detected in none of the 100 unrelated healthy controls. Function analysis suggested that this mutation can severely affect the functions of this protein. Multiple sequence alignment revealed that the mutation site was extremely conserved in various species.</p><p><b>CONCLUSION</b>A novel heterozygous Cys1015Ser mutations in exon 19 of the NOTCH3 gene probably underlies the CADASIL in this family.</p>

Feasibility of radical laparoscopy-assisted gastrectomy for patients with chronic obstructive pulmonary disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the effect of radical laparoscopy-assisted gastrectomy(LG) for patients with chronic obstructive pulmonary disease (COPD).</p><p><b>METHODS</b>Clinical data of 340 gastric cancer patients with COPD undergoing radical gastrectomy with lymphadenectomy at Southwest Hospital, Third Military Medical University between January 2010 and October 2013 were analyzed retrospectively. The clinical outcomes for the 262 patients with COPD who underwent LG(LG group) were compared with those of 78 patients with COPD who underwent open gastrectomy(OG group). During LG, pneumoperitoneum was maintained at an insuffiation pressure of 8 mmHg to 10 mmHg. The primary endpoint was postoperative pulmonary complication(PPC). To predict factors related to PPC, univariate and multivariate logistic analyses were carried out.</p><p><b>RESULTS</b>Intraoperative blood loss was significantly less in the LG group [(131.2±14.7) ml] than in the OG group [(246.7±49.0) ml; t=-13.445, P=0.000], but operation time was significantly longer [(220.4±19.1) min vs. (194.2±31.5) min; t=6.877, P=0.000]. The findings showed PPC to be significantly less frequent in the LG group(5.3%,14/262) than in the OG group (15.4%, 12/78)(χ(2)=8.581, P=0.003). The severity of COPD was independent risk factor for PPC(P=0.031, HR=1.456, 95%CI:1.306-1.789). No independent predictor of PPCs was found in type of operative approach (open vs laparoscopic; P=0.126).</p><p><b>CONCLUSION</b>The LG procedure with insuffiation pressure of pneumoperitoneum is tolerated for gastric cancer patients with mild or moderate COPD.</p>