A prospective study of super-thin anterolateral thigh flap harvesting assisted by high-frequency color Doppler ultrasound in detecting perforators in deep adipose layers / 中国修复重建外科杂志

OBJECTIVE@#To investigate the clinical application of high-frequency color Doppler ultrasound (HFCDU) in detecting perforators in the deep adipose layers for harvesting super-thin anterolateral thigh flap (ALTF).@*METHODS@#Between August 2019 and January 2023, 45 patients (46 sides) with skin and soft tissue defects in the foot and ankle were treated, including 29 males and 16 females, aged from 22 to 62 years, with an average of 46.7 years. The body mass index ranged from 19.6 to 36.2 kg/m 2, with an average of 23.62 kg/m 2. The causes of injury included traffic accident injury in 15 cases, heavy object crush injury in 20 cases, mechanical injury in 8 cases, heat crush injury in 1 case, and chronic infection in 1 case. There were 20 cases on the left side, 24 cases on the right side, and 1 case on both sides. After thorough debridement, the wound size ranged from 5 cm×4 cm to 17 cm×11 cm. All patients underwent free super-thin ALTF transplantation repair. HFCDU was used to detect the location of the perforators piercing the deep and superficial fascia, as well as the direction and branches of the perforators within the deep adipose layers before operation. According to the preoperative HFCDU findings, the dimensions of the super-thin ALTF ranged from 6 cm×4 cm to 18 cm×12 cm. The donor sites of the flaps were directly sutured.@*RESULTS@#A total of 55 perforators were detected by HFCDU before operation, but 1 was not found during operation. During operation, a total of 56 perforators were found, and 2 perforators were not detected by HFCDU. The positive predictive value of HFCDU for identifying perforator vessels was 98.2%, and the sensitivity was 96.4%. Among the 54 perforators accurately located by HFCDU, the orientation of the perforators in the deep adipose layers was confirmed during operation. There were 21 perforators (38.9%) traveled laterally and inferiorly, 12 (22.2%) traveled medially and inferiorly, 14 (25.9%) traveled laterally and superiorly, 5 (9.3%) traveled medially and superiorly, and 2 (3.7%) ran almost vertically to the body surface. Among the 54 perforators accurately located by HFCDU, 35 were identified as type 1 perforators and 12 as type 2 perforators (HFCDU misidentified 7 type 2 perforators as type 1 perforators). The sensitivity of HFCDU in identifying type 1 perforators was 100%, with a positive predictive value of 83.3%. For type 2 perforators, the sensitivity was 63.2%, and the positive predictive value was 100%. The surgeries were successfully completed. The super-thin ALTF had a thickness ranging from 2 to 6 mm, with an average of 3.56 mm. All super-thin ALTF survived, however, 1 flap experienced a venous crisis at 1 day after operation, but it survived after emergency exploration and re-anastomosis of the veins; 1 flap developed venous crisis at 3 days after operation but survived after bleeding with several small incisions; 3 flaps had necrosis at the distal edge of the epidermis, which healed after undergoing dressing changes. All 45 patients were followed up 6-18 months (mean, 13.6 months). Three flaps required secondary defatting procedures, while the rest had the appropriate thickness, and the overall appearance was satisfactory.@*CONCLUSION@#Preoperative application of HFCDU to detect the perforator in the deep adipose layers can improve the success and safety of the procedure by facilitating the harvest of super-thin ALTF.

Exploration and reform on education of applied talent in clinical laboratory technology in Guizhou Medical University under the background of "New Medicine" / 中华检验医学杂志

Objective:To explore the reform path of clinical laboratory technical talents training in local universities under the background of "New Medicine".Methods:The present situation of medical laboratory technical personnel training under the background of "New Medicine" was analyzed, and the teaching mode, teaching platform and practical teaching were reformed according to the reality of Guizhou Medical University.Results:An open education system of "healthcare-education collaboration and academia-industry alliances" and the talent training mode of "three-oriented drive, four-sided integration" had been formed, which improved the training quality and provided a large number of qualified medical laboratory technical undergraduate talents to the grass-roots of Guizhou Medical System.Conclusion:The reform and practice of applied talent training in Guizhou Medical University can be used as a reference for local colleges and universities to educate applied medical laboratory technical talents.

Efficacy analysis of Allium ureteral stent in semisupine-lithotomy position for treatment of pelvic tumour-induced ureteral stricture / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of semisupine-lithotomy position placement of Allium ureteral stent to treat ureteral stricture caused by pelvic tumours.Methods:The clinical data of 29 patients who received Allium ureteral stent(URS) placement for ureteral stricture in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between April 2020 and March 2022 were retrospectively analyzed. There were 3 males and 26 females, with the median age of 56(54, 61) years old. All patients had a pathology confirmation of carcinoma before the treatment, including 26 patients with gynaecological tumours, two with urinary system tumours, and one with rectal carcinoma. A preoperative imaging examination confirmed the diagnosis of ureteral stricture. There were 15 patients with unilateral and 14 with bilateral stenosis, median stenosis length was 3.6(2.0, 4.9)cm. Preoperative median urine white blood cell count was 62(21, 354) U/L, median serum creatinine (SCR) was 170.0(85.5, 273.5) μmol/L, and renal pelvis separation was (32.98±6.64) mm. The median time of long-term indwelling double J (D-J)ureteral stent before surgery was 12.0 (6.5, 35.5) months. Seven patients had mild hydronephrosis, 18 had moderate hydronephrosis, and four had severe hydronephrosis. In all patients, Allium URS were placed in the way of the semisupine-lithotomy position (Galdakao-modified supine Valdivia position). Anterograde flexible ureteroscope was inserted into the percutaneous nephrostomy channel, and the retrogradel rigid ureteroscope were advanced simultaneously, looking for location of strictures. Allium URS were inserted retrogradely with transureteroscope when the two ureteroscope were connected. Perioperative conditions and postoperative follow-up for the last examination of SCR, renal pelvis width under ultrasound, and plain abdominal film (KUB). Allium URS patency and complications, hydronephrosis and renal function were evaluated.Results:A total of 61 Allium URS were successfully placed. Seven patients were placed in stages, and 18 patients were placed in series with multiple stents. The mean follow-up period was (12.1±5.8) months. At last follow-up, median SCR was 124.0(81.5, 193.0)μmol/L and renal pelvis separation was(14.96±5.18)mm, which were significantly decreased compared with preoperative(all P<0.01). There were 24 cases of hydronephrosis disappeared and 5 cases of mild hydronephrosis in the last follow-up. Postoperative follow-up, urinary tract infection occurred in 3 patients after operation, such as hematuria and fever within one week, and the symptoms were relieved after anti-infective and symptomatic treatment. One case had mild urine leakage, and 4 patients had occasional low back pain, which may be related to the activity. One case occurred stent displacement due to stent migration to the bladder after eight months, the URS was replaced and a D-J stent was inserted .The patency rate was 96.6%(28/29). Conclusions:Allium URS was placed in the semisupine-lithotomy position for treating pelvic tumour-induced ureteral stricture, with low incidence of complications, high patency and good curative effect.

The interpretation of urothelial carcinoma at the 2023 ASCO-GU / 中华泌尿外科杂志

The 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium (ASCO-GU) reported several advancements in the field of urothelial carcinoma. Multiple new treatment options for non-muscle invasive bladder cancer (NMIBC) were introduced, providing more choices for bladder preservation in BCG-resistant/failed NMIBC cases. In muscle invasive bladder cancer (MIBC) perioperative treatment, the updated 3-year follow-up data from the CheckMate 274 study demonstrated a clear advantage in disease-free survival for the nivolumab monotherapy adjuvant treatment group. For metastatic urothelial carcinoma (mUC), the final overall survival (OS) report from the IMvigor130 study was published, prompting further considerations for future first-line treatment options in mUC. Additionally, the conference highlighted research progress in upper tract urothelial carcinoma (UTUC).

Sodium alginate coating simultaneously increases the biosafety and immunotherapeutic activity of the cationic mRNA nanovaccine

The extraordinary advantages associated with mRNA vaccines, including their high efficiency, relatively low severity of side effects, and ease of manufacture, have enabled them to be a promising immunotherapy approach against various infectious diseases and cancers. Nevertheless, most mRNA delivery carriers have many disadvantages, such as high toxicity, poor biocompatibility, and low efficiency in vivo, which have hindered the widespread use of mRNA vaccines. To further characterize and solve these problems and develop a new type of safe and efficient mRNA delivery carrier, a negatively charged SA@DOTAP-mRNA nanovaccine was prepared in this study by coating DOTAP-mRNA with the natural anionic polymer sodium alginate (SA). Intriguingly, the transfection efficiency of SA@DOTAP-mRNA was significantly higher than that of DOTAP-mRNA, which was not due to the increase in cellular uptake but was associated with changes in the endocytosis pathway and the strong lysosome escape ability of SA@DOTAP-mRNA. In addition, we found that SA significantly increased the expression of LUC-mRNA in mice and achieved certain spleen targeting. Finally, we confirmed that SA@DOTAP-mRNA had a stronger antigen-presenting ability in E. G7-OVA tumor-bearing mice, dramatically inducing the proliferation of OVA-specific CLTs and ameliorating the antitumor effect. Therefore, we firmly believe that the coating strategy applied to cationic liposome/mRNA complexes is of potential research value in the field of mRNA delivery and has promising clinical application prospects.

Free PSA performs better than total PSA in predicting prostate volume in Chinese men with PSA levels of 2.5-9.9 ng ml-1 / 亚洲男科学杂志(英文版)

This study investigated whether free prostate-specific antigen (fPSA) performs better than total PSA (tPSA) in predicting prostate volume (PV) in Chinese men with different PSA levels. A total of 5463 men with PSA levels of <10 ng ml-1 and without prostate cancer diagnosis were included in this study. Patients were classified into four groups: PSA <2.5 ng ml-1, 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1. Pearson/Spearman's correlation coefficient (r) and receiver operating characteristic (ROC) curves were used to evaluate the ability of tPSA and fPSA to predict PV. The correlation coefficient between tPSA and PV in the PSA <2.5 ng ml-1 cohort (r = 0.422; P < 0.001) was markedly higher than those of the cohorts with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1 (r = 0.114, 0.167, and 0.264, respectively; all P ≤ 0.001), while fPSA levels did not differ significantly among different PSA groups. Area under ROC curve (AUC) analyses revealed that the performance of fPSA in predicting PV ≥40 ml (AUC: 0.694, 0.714, and 0.727) was better than that of tPSA (AUC = 0.545, 0.561, and 0.611) in men with PSA levels of 2.5-3.9 ng ml-1, 4.0-9.9 ng ml-1, and 2.5-9.9 ng ml-1, respectively, but not at PSA levels of <2.5 ng ml-1 (AUC: 0.713 vs 0.720). These findings suggest that the relationship between tPSA and PV may vary with PSA level and that fPSA is more powerful at predicting PV only in the ''gray zone'' (PSA levels of 2.5-9.9 ng ml-1), but its performance was similar to that of tPSA at PSA levels of <2.5 ng ml-1.

Feasibility analysis and nail planning ofS2 iliac crest screw placement in children / 中国骨伤

OBJECTIVE@#To evaluate the feasibility of S2 alar iliac screw insertion in Chinese children using computerized three-dimension reconstruction and simulated screw placement technique, and to optimize the measurement of screw parameters.@*METHODS@#A total of 83 pelvic CT data of children who underwent pelvic CT scan December 2018 to December 2020 were retrospectively analyzed, excluding fractures, deformities, and tumors. There were 44 boys and 39 girls, with an average age of (10.66±3.52) years, and were divided into 4 groups based on age (group A:5 to 7 years old;group B:8 to 10 years old;group C:11-13 years old;group D:14 to 16 years old). The original CT data obtained were imported into Mimics software, and the bony structure of the pelvis was reconstructed, and the maximum and minimum cranial angles of the screws were simulated in the three-dimensional view with the placement of 6.5 mm diameter S2 alar iliac screws. Subsequently, the coronal angle, sagittal angle, transverse angle, total length of the screw, length of the screw in the sacrum, width of the iliac, and distance of the entry point from the skin were measured in 3-Matic software at the maximum and minimum head tilt angles, respectively. The differences among the screw parameters of S2 alar iliac screws in children of different ages and the differences between gender and side were compared and analyzed.@*RESULTS@#In all 83 children, 6.5 mm diameter S2 iliac screws could be placed. There was no significant difference between the side of each screw placement parameter. The 5 to 7 years old children had a significantly smaller screw coronal angle than other age groups, but in the screw sagittal angle, the difference was more mixed. The 5 to 7 years old children could obtain a larger angle at the maximum head tilt angle of the screw, but at the minimum cranial angle, the larger angle was obtained in the age group of 11 to 13 years old. There were no significant differences among the age groups. The coronal angle and sagittal angle under maximum cephalic angle and minimum cranial angle of 5 to 7 years old male were (40.91±2.91)° and (51.85±3.75)° respectively, which were significantly greater than in female. The coronal angle under minimum cranial angle was significantly greater in girls aged 8-10 years old than in boys. For the remaining screw placement angle parameters, there were no significant differences between gender. The differences in the minimum iliac width, the screw length, and the length of the sacral screws showed an increasing trend with age in all age groups. The distance from the screw entry point to the skin in boys were significantly smaller than that of girls. The minimum width of the iliac in boys at 14 to 16 years of age were significantly wider than that in girls at the same stage. In contrast, in girls aged 5 to 7 years and 11 to 13 years, the screw length was significantly longer than that of boys at the same stage.@*CONCLUSION@#The pelvis of children aged 5 to 16 years can safely accommodate the placement of 6.5 mm diameter S2 alar iliac screws, but the bony structures of the pelvis are developing and growing in children, precise assessment is needed to plan a reasonable screw trajectory and select the appropriate screw length.

Analysis of global mRNA drug industrialization dynamics / 药学学报

The successful development and application of mRNA COVID-19 vaccine fully illustrated the great potential and application prospect of mRNA technology in the field of biomedicine. Currently, many companies worldwide are developing drugs and vaccines based on mRNA technology for the prevention and treatment of various diseases. It can be foreseen that with the continuous launch of mRNA drugs, commercial GMP production capacity matching them is also urgent. The optimization of production processes, intelligent manufacturing and other risk control strategies, as well as the control of industrialization costs, will help improve the core competitiveness of mRNA innovative drug development. In view of this, this article will provide an overview of the global production process of mRNA drugs and the progress of related GMP production dynamics, sort out the key chain points of the mRNA industry chain, explore the construction of the mRNA pharmaceutical enterprise value chain and the formation of core competitiveness, and provide reference and reference for the research and development of innovative mRNA drugs and high-quality development in China.

Treatment of pelvic fractures complicated with urethral rupture via lateral-rectus approach and Pfannenstiel approach / 中华创伤骨科杂志

Objective:To investigate the safety and clinical efficacy of the lateral-rectus approach combined with the Pfannenstiel approach in the treatment of pelvic fractures complicated with urethral rupture.Methods:From January 2013 to June 2021, 20 patients with pelvic fracture complicated with urethral rupture were surgically managed through the lateral-rectus approach and the Pfannenstiel approach at Department of Traumatic Surgery, Center for Orthopaedic Surgery, the Third Hospital Affiliated to Southern Medical University. They were 15 males and 5 females, with an average age of 42 years (from 18 to 55 years). By the Tile classification, there were 11 cases of type B and 9 cases of type C. The first-stage urethral realignment was performed via the Pfannenstiel approach in the supine position after general anesthesia in conjunction with an urologist; at the second-stage, the lateral-rectus approach was used to reduce and fixate the acetabular or pelvic fractures. The operation time, intraoperative blood loss, fracture reduction quality, pelvic functional recovery and complications were documented.Results:In this cohort, the operation time ranged from 80 to 240 min, averaging 140.5 min; the time for simple urethral convergence ranged from 20 to 30 min; the intraoperative blood loss ranged from 400 mL to 2,000 mL, averaging 730 mL. According to the Mears andVelyvis evaluation for fracture reduction quality, anatomical reduction was achieved in 13 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in one. The 20 patients were followed up for 12 to 68 months (mean, 37 months) after surgery. One fracture got nonunited but the other fractures got united after 3.0 to 4.5 months (mean, 3.5 months). According to the Majeed scoring system, the pelvic function at 12 months after surgery was excellent in 12 cases, good in 6 and fair in 2, giving an excellent and good rate of 90% (18/20). Screw loosening was found in one patient, traction injury to the lumbosacral trunk nerve in another patient, varying degrees of dysuria which responded to periodic urethral dilation in 8 patients, urethral stricture in 3 patients and erectile dysfunction in 5 patients. No abdominal hernia or pelvic infection was observed.Conclusions:The lateral-rectus approach combined with the Pfannenstiel approach can be used effectively to reduce and fixate the pelvic and acetabular fractures, and to repair the urethral rupture in one stage as well. They are also safe due to a low incidence of such complications as abdominal wall hernia and pelvic infection.

Role of microenvironment in the pathogenesis of benign prostatic hyperplasia / 中华泌尿外科杂志

Benign prostatic hyperplasia (BPH) is a progressive disease causing male lower urinary tract symptoms. The incidence of BPH increases with age. Studies have revealed that the prostate microenvironment is closely related to occurrence and development of BPH. This article reviews the mechanisms of cell components, such as lymphocytes and fibroblasts, inflammatory mediators, such as interleukins and growth factors, hypoxia and oxidative stress in the microenvironment that promote prostate hyperplasia.

TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation in unstable pelvic fracture surgery / 中华骨科杂志

Objective:To investigate the role of TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation in unstable pelvic fracture surgery.Methods:Twelve patients with unstable pelvic fractures, 7 males and 5 females, aged 39.41±12.56 years (range 25-60 years), admitted from January 2020 to January 2021, were retrospectively analyzed. The duration between injury and surgery was 9.67±5.81 d (range 4-24 d). The following are the causes of injury, namely traffic injury in 6 cases, fall from height injury in 4 cases, crush injury in 2 cases. Tile type of pelvic fractures were 3 cases of type B (2 cases of type B2, 1 case of type B3), 9 cases of type C (4 cases of type C1, 3 cases of type C2, 2 cases of type C3). Sacral fractures with Denis division were 5 cases of zone I, 7 cases of zone II. Seven patients were repositioned by intraoperative traction on the injured side of the limb and maintained by fixation with a Starr frame. Two cases were repositioned by intraoperative longitudinal bone traction on each lower limb for fracture displacement. The other 3 B-type fractures were repositioned by inserting Schanz nails into the anterior inferior iliac spine bilaterally. Then, the fractures were maintained with external pelvic fixators. The fractures were assessed by O-arm fluoroscopy. Hollow screws were placed with the aid of orthopedic robotic guidance, and the screw positions were verified by O-arm fluoroscopy again after the nail placement. The duration of each screw placement and operation were recorded. The quality of fracture repositioning, hip function and postoperative complications were observed at the follow-up.Results:All patients were followed up for 8.17±1.99 months (range, 6-12 months). There were 27 screws inserted in 12 patients, with a single screw insertion duration of 19.9±1.8 min (range, 9-31 min). In all patients, one O-arm fluoroscopy was performed in each row after closed reduction and after completion of nail placement. The operative duration was 257.78±80.63 min (range, 160-450 min). The O-arm fluoroscopy after nail placement verified that 23 screws were placed in a satisfactory position at one time, with satisfactory rate of 85% (23/27) for the first nail placement. Two patients with preoperative grade II sacral plexus nerve injury recovered to grade I in one case and grade II in one case. However, the numbness was reduced after operation. No further aggravation of nerve injury occurred after surgery. The quality of fracture repositioning was evaluated according to the Matta score, including excellent in 9 cases, good in 2 cases, and acceptable in 1 case, with an excellent rate of 92% (11/12). At the last follow-up, the Majeed pelvic fracture quantitative assessment system scored 85.75±5.82 (range, 74-96). There were 8 cases in excellent and 4 cases in good. Twelve patients had one-stage wound healing. No complications, such as incision infection, nerve injury, loosening and breaking of the internal fixation occurred during the follow-up.Conclusion:TiRobot combined with O-arm assisted closed reduction and percutaneous screw fixation for unstable pelvic fractures has some advantages, including safety, precision, convenient nail placement, and less fluoroscopic radiation.

Chinese expert consensus on diagnosis, treatment and prevention of venous thrombus embolism associated with chest trauma (2022 version) / 中华创伤杂志

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Observational study of macular capillary perfusion with branch retinal vein occlusion by using DART-OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA)in macular-involved branch retinal vein occlusion(BRVO)and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA)and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.

Research progress in the diagnosis and treatment of urothelial carcinoma at the 2022 ASCO-GU / 中华泌尿外科杂志

In 2022, ASCO genitourinary cancer symposium reported the latest progress in the diagnosis and treatment of urothelial carcinoma. Perioperative treatment progress include prediction of the effect of neoadjuvant chemotherapy for muscle invasive bladder cancer (MIBC) and upper urinary tract epithelial carcinoma (UTUC). The matched cohort study of bladder-sparing treatment showed that the effect of trimodality therapy (TMT) and radical cystectomy was equivalent in oncologic outcome. Immunotherapy showed promising effects in the circumstance of advanced urothelial carcinoma, neoadjuvant therapy and non muscle invasive bladder cancer (NMIBC) treatment. Poly-adenosine diphosphate ribose polymerase (PARP) inhibitors and antibody coupled drugs (ADC) show antitumor activity in the treatment of advanced urothelial carcinoma. The meeting also reported a series of progress in biomarkers related to the prediction of curative effect of urothelial carcinoma.

The application of pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury / 中华骨科杂志

Objective:To investigate the clinical effect assistant with pelvic unlocking reduction frame for the treatment of old Denis I or II sacral fractures combined with sacral plexus nerve injury.Methods:From January 2013 to October 2020, 37 patients diagnosed with old sacral fractures with sacral plexus nerve injury which Gibbons classification was grade III were divided into the use group and the non-use group according to whether assisted with pelvic unlocking reduction frame. Eighteen patients (11 males, 7 females, mean age 38±6.4, range from 13-56) were selected into the use group and nineteen patients (14 males, 5 females, mean age 42±10.7, range 19-59) were selected into the non-use group. The three-dimensional (3D) pelvic model (1∶1) was printed before operation. The operation time, intraoperative bleeding, Matta score, visual analogue scale (VAS), Majeed score and gibbons sacral nerve injury grade of the two groups were compared. The healing time and complications of each group was recorded.Results:The average operation time of the use group and the non-use group was 121.0±16.2 min and 182.6±16.2 min, respectively, with significant difference ( t=11.54, P<0.001). The mean operative bleeding was 686±382 ml of the use group and 963±348 ml of the non-use group ( t=2.38, P=0.003). The quality of fracture reduction was evaluated according to Matta scoring standard: the excellent and good rate of the use group was 94% (17/18), and that of the non-use group was 68% (13/19) ( P=0.039). The curative effect was evaluated according to the Majeed score: the use group was 88.72±7.03 points, and that of the non-use group was 72.00±9.75 points ( t=5.96, P<0.001) at 1 year post-operative. One year after operation, the VAS scale of the use group was 0.83±0.71 points, and that of the non-use group was 1.00±0.82 points ( t=0.66, P=0.512). According to Gibbons classification, 15 patients were grade I, 1 patient was grade II and 2 patients were grade III in the use group and 11 patients were grade I, 3 patients were grade II and 5 patients were grade III in the non-use group one year after operation ( Z=-1.04, P=0.401). One patient in the use group presented rupture of plate without symptoms. In the non-use group, 1 case with internal iliac vein rupture which treated with gelatin sponge and no obvious bleeding after operation. 4 cases with unequal length of lower limbs, walking claudication. The complication rate of the use group was 6% (1/18), and that of the non-use group was 26% (5/19) ( P=0.042) . Conclusion:The lateral rectus abdominis approach combined with pelvic unlocking reduction frame can reduce the operation time and bleeding, improve the fracture reduction in the treatment of old Denis type I and II sacral fractures with sacral plexus injury.

Cytokine Profiles and Virological Marker Monitoring during 48 Weeks Peginterferon Alfa Treatment for HBeAg-Positive Chronic Hepatitis B / 生物医学与环境科学（英文）

Objective@#This study aimed to investigate whether cytokine profiles and virological markers might add value in monitoring the effects of peginterferon (PEG-IFN) therapy for hepatitis B e-antigen (HBeAg) positive chronic hepatitis B (CHB).@*Methods@#HBeAg positive patients with CHB were treated with PEG-IFN for 48 weeks. Clinical biochemical, and HBV serological indexes, as well as cytokines, were detected at baseline and every 12 weeks.@*Results@#A total of 116 patients with CHB were enrolled in this study; 100 patients completed the 48-week treatment and follow-up, of whom 38 achieved serum HBeAg disappearance, 25 achieved HBeAg seroconversion, 37 showed HBsAg decreases ≥ 1 log 10 IU/mL, 9 showed HBsAg disappearance, and 8 became HBsAb positive. The cytokine levels at baseline and during treatment were similar between the HBeAg disappearance group and non-disappearance group. The disappearance of HBeAg was independently associated with HBeAg levels at weeks 12 and 24, and with the HBeAg decline at week 24 ( P < 0.05). The HBsAg response was independently associated with HBsAg, the HBsAg decline, HBeAg, the HBeAg decline at week 12, and HBsAg at week 24 ( P< 0.05).@*Conclusion@#There was no significant correlation between the response to interferon (IFN) and cytokines during PEG-IFN treatment. The changes in virological markers predicted the response to IFN after 48 weeks.

Early functional and oncological outcomes of lateral prostate capsule sparing robot-assisted radical cystectomy-Orthotopic ileal neobladder / 中华泌尿外科杂志

Objective:To investigate the experience and results of the modified lateral prostate capsule sparing robot-assisted radical cystectomy-orthotopic ileal neobladder (LPCS-RARC-OIN).Methods:From December 2018 to November 2020, 19 patients received LPCS-RARC-OIN by a single surgeon in Sun Yat-sen Memorial Hospital, Sun Yat-sen University. LPCS-RARC-OIN was performed on male patients with high-risk non-muscle-invasive bladder cancer or muscle-invasive bladder cancer cT 2N 0M 0 without tumour in the bladder neck or urethra, and prostate cancer was ruled out by MRI and serum PSA<2.5ng/ml. The average age was 57.6 years, the average IIEF-5 score was 20.4. Separating the prostatic adenoma and the lateral prostate capsule from the base to the apex of the prostate, and retaining the lateral prostate surgical capsule or lateral prostate capsule about 1-2mm thickness. Patients were followed up and urinary function, sexual function and oncological outcomes were recorded. Results:All 19 operations were finished successfully. The average operation time was 279.9 (225-345) min and average estimated blood loss was 88.9 (30-200) ml. The average postoperative hospital stays was 15.8 (9 -23) days. The average lymph node yields was 23.3 (11-42). All surgical margins were negative and no incidental prostate cancer was found. 2 weeks, 1 month, 3 months and 6 months after catheter removal, the daytime and nighttime continence were 42.1% (8/19)and 36.8% (7/19), 63.2% (12/19)and 63.2% (12/19), 78.9% (15/19) and 73.7% (14/19), 94.7% (18/19) and 89.5% (17/19), respectively. 3 months and 6 months after operation, the average IIEF-5 score was 7.2 and 10.1 points respectively. The average follow-up was 10.6 months (5.4-26.1 months)and no recurrence or distant metastasis was found in this study.Conclusions:LPCS-RARC-OIN could improve the urinary and sexual function in selected patients. However, the long-term follow up is needed for functional and oncological outcomes.

The effects of weight-bearing area compression injury of the femoral head on the outcomes of elderly acetabular fractures after open reduction and internal fixation / 中华骨科杂志

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Treatment of pelvic fragility factures in the elderly patients via lateral-rectus approach / 中华骨科杂志

Objective:To explore the surgical method and clinical efficacy of lateral-rectus approach (LRA) in the treatment of fragility fractures of the pelvis (FFP) in the elderly.Methods:A retrospective study was conducted for elderly FFP patients from January 2011 to December 2019. All the pelvic fractures should be exposed and reduced through LRA and fixed with pelvic reconstruction plates and channel screws. Then, a total of 30 elderly patients were included in the study, including 9 males and 21 females, with an average age of 72.5 years (range, 60-87 years). Fractures were caused by car accident in 5 cases, by falling from high places in 8 cases and by tumbling in 17 cases. According to the FFP classification, there were 6 cases of type IIc (6/30, 20%), 22 cases of type III (22/30, 73.33%, of which 13 cases were type IIIa, 7 cases were type IIIb, and 2 cases were type IIIc), 2 cases of type IVa (2/30, 6.67%). Among that, 2 cases suffered ipsilateral acetabular fractures, 17 suffered medical diseases such as hypertension, coronary heart disease, diabetes, etc., and none suffered extremities fractures or other types of injuries. Surgical field was exposed retroperitoneally through LRA, combined with lower limb traction to reduce the anterior and posterior pelvis ring fractures. Then, the reductions were done in direct visions and verified through X-ray fluoroscopy. After that, the posterior ring was fixed with reconstruction plate and/or sacroiliac screws, and the anterior ring was fixed with reconstruction plate or INFIX. The quality of fracture reduction was evaluated by Matta score and the postoperative function was evaluated by Majeed score.Results:All the 30 patients were surgical treated through LRA. The time from injury to operation was 5 to 20 days, with an average of 9.9 days. The operating time ranged from 35 to 150 min (mean, 73.5 min) and the intraoperative bleeding ranged from 220 to 2 400 ml (mean, 586.7 ml). Fractures were successfully reduced under direct vision and the positions of the plates and screws were monitored through X-ray fluoroscopy during the operation. Postoperative X-rays and CT scans showed satisfactory reduction of the pelvic ring. According to Matta criteria, the quality of fracture reduction was evaluated as excellent in 18 cases, good in 6 cases, fair in 4 cases and poor in 2 cases. The overall excellent and good rate was 80% (24/30). All patients were followed up for 6-24 months, the fractures were all healed, and all fractures healed for 2-5 months, with an average of 3.5 months. At the last follow-up, Majeed scores were 86.1±6.11 (range, 66-92), including 21 excellent cases, 7 good cases and 2 fair cases, with an excellent and good rate of 93.3% (28/30). As for complications, 1 patient developed deep venous thrombosis of the affected lower limb, and the thrombosis disappeared after thrombolytic therapy. One patient had fat liquefaction in the incision, and the wound healed after intensive dressing change. After INFIX fixation, 2 patients showed numbness on the lateral thigh of the affected side, and the symptoms were relieved after symptomatic treatment. Four patients were found to have internal fixation screws loosening during follow-up, but still achieved good fracture healing.Conclusion:The entire hemipelvic ring could be exposed through LRA without cutting the peritoneum, so that the sacroiliac joint, ilium wing and anterior ring fractures could be reduced under direct version. In the treatment of pelvis fragility fractures of the elderly, effective reduction and fixation could be achieved using reconstruction plates or channel screws through LRA.

Prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County of Henan Province in 2019 / 中国血吸虫病防治杂志

Objective To investigate the prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County, Henan Province in 2019, so as to provide insights into the management of enterobiasis. Methods Five kindergartens were selected in urban and rural areas of Fanxian County, Henan Province using the stratified sampling method in 2019, and a census of E. vermicularis infections was performed among all children in the kindergartens. E. vermicularis eggs were detected using adhesive and scotch cellophane-tape anal swab methods, and the basic characteristics of children and their families, health habits and the kindergartens’ information were investigated with questionnaires. Logistic regression analysis was used to investigate the risk factors and protective factors of pinworm infection in children. Results A total of 671 children were tested, and the mean prevalence of E. vermicularis infections was 15.50% (104/671). The prevalence of E. vermicularis infections was higher among children in rural kindergartens (28.13%, 72/256) than in urban kindergartens (7.71%, 32/415) (χ2 = 50.380, P < 0.01), and greater in private kindergartens (32.26%, 60/186) than in public kindergartens (9.07%, 44/485) (χ2 = 55.183, P < 0.01). There was no gender-specific prevalence of E. vermicularis infections among children (χ2 = 1.442, P > 0.05), and the prevalence of E. vermicularis infections presented a tendency towards a rise with age (χ2trend = 8.373, P < 0.05) and school grade (χ2trend = 30.274, P < 0.05). Logistic regression analysis identified rural kindergartens and high grades as risk factors, and separate washing of children’s and adults’ cloths, frequent bathing and frequent dinnerware disinfection in kindergartens as protective factors for E. vermicularis infections among children. In addition, there was no significant difference in the detection of E. vermicularis infections among children by using adhesive (73.08%, 76/104) and scotch cellophane-tape anal swab methods (56.73%, 59/104) (χ2 = 3.959, P > 0.05). Conclusions The prevalence of E. vermicularis infection is high among children in Fanxian Country, Henan Province. Health education and surveillance of enterobiasis are required to be intensified among children in rural kindergartens and senior grades and their parents and teachers.