Clinical observation of acupuncture treatment for children with accommodative myopia / 针灸推拿医学（英文版）

Objective:To observe the effect of acupuncture in the treatment of accommodative myopia in children.Methods:A total of 76 children with accommodative myopia who met the inclusion criteria were divided into a control group or a test group according to the random number table method,with 38 cases in each group.The control group was given education on eye hygiene,and the test group was treated with acupuncture twice a week for 2 months in addition to the intervention used in the control group.The patient's uncorrected visual acuity(UCVA),refraction,and axial length(AL)were measured before treatment and 1 month and 2 months after treatment.Results:After 1 month of treatment,there was no significant difference in the UCVA between the two groups(P＞0.05);after 2 months of treatment,the UCVA of the test group was better than that of the control group(P＜0.05).After 1 and 2 months of treatment,the refraction of the two groups was significantly different from that before treatment(P＜0.01),but there was no significant difference between the two groups(P＞0.05).After 1 and 2 months of treatment,the AL in the control group was increased compared with that before treatment(P＜0.05),while there was no significant change in the test group(P＞0.05),and there was no significant difference between the two groups(P＞0.05).Conclusion:Acupuncture treatment can improve UCVA in children with accommodative myopia.

Factors affecting penile appearance and erectile function for postoperative hypospadias patients in adulthood: a long-term follow-up observational study / 现代泌尿外科杂志

【Objective】 To investigate the penile appearance, sexual function, psychological status and related influencing factors of adult patients who underwent hypospadias repair surgery in their minors, so as to provide reference for the diagnosis, treatment and prognosis of hypospadias. 【Methods】 This study included 50 adult hypospadias patients who underwent urethroplasty in our hospital during May 2005 and Aug. 2018. The present appearance, sexual function and psychological status were evaluated. The correlation and consistency between hypospadias objective scoring evaluation (HOSE) and pediatric penile perception score (PPPS) were analyzed. Factors affecting the results were determined with univariate and multivariate regression analysis. 【Results】 The satisfaction rate of HOSE was significantly correlated with the urethral length and complications (P=0.024, P=0.033). The satisfaction rate of PPPS was significantly correlated with the number of urethral operations and postoperative complications (P=0.041, P=0.023). There was a weak correlation between HOSE and PPPS (r=0.291, P=0.040), but almost no consistency (Kappa=0.2, P=0.107). Sixty percent of the patients paid attention to the ventral appearance of penis, whose dissatisfaction rate of PPPS was higher than those who did not pay attention to the ventral appearance of the penis (19/30 vs. 6/20, P=0.021). Patients with multiple operations (>1), postoperative complications or unsatisfactory penile appearance were more likely to have inferiority complex (52.6% vs. 22.6%, P=0.029; 59.1% vs.14.3%, P=0.001;61.5% vs. 24.3%, P=0.015). Multivariate regression analysis showed that dissatisfaction with the appearance of the penis was an independent risk factor for patients’ perception of their own physical defects. Among the patients who believed that they had physical defects, the percentage of patients with grade IV penile erectile hardness was significantly lower than that of those who denied they had physical defects (9/17 vs. 27/33, P=0.047). 【Conclusion】 The undesirable postoperative penis appearance is likely to have a negative impact on patients’ long-term psychological state, which might further damage the sexual function in adulthood. Surgeons should pay attention to the penile appearance during the conduction of hypospadias repair.

Clinical efficacy of electroacupuncture in controlling myopia in children and its influence on retinal blood flow / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of electroacupuncture (EA) in controlling myopia in children and its effect on retinal blood flow. Methods: Sixty-eight myopic children were randomly divided into an observation group and a control group, with 34 cases in each group. The control group was given auricular acupressure treatment alone, and the observation group was treated with EA once a week in addition to the treatment used in the control group. The spherical equivalent refraction (SER) and axial length (AL) were measured at baseline, and after 3 months and 6 months of treatment. Optical coherence tomography angiography was used to measure the vessel density (VD) and perfusion density (PD) in the surface layer of the retina. Results: After 3 months and 6 months of treatment, the changes in SER between the two groups were not statistically significant (P>0.05). After 3 months of treatment, the changes in AL between the two groups were not statistically significant (P>0.05); after 6 months of treatment, the change amount of AL in the observation group was smaller than that in the control group (P<0.05); after 3 months and 6 months of treatment, the changes in VD and PD in the surface layer of the retina in the observation group were significantly greater than those in the control group (P<0.01). Conclusion: EA treatment once a week for 6 months can delay the increase of AL and improve the retinal surface blood flow in myopic children.

Surgical strategies for adenocarcinoma of esophagogastric junction under the era of mini-invasive surgery / 中华消化外科杂志

With the continuous update and improvement of minimally invasive techni-ques, laparoscopic and robotic surgeries have increased significantly for the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). Due to the anatomical particularity and biolo-gical characteristics of Siewert type Ⅱ AEG, surgical approach, the range of resection, lymph node dissection and digestive tract reconstruction cannot be unified at present, which is also the contro-versy between gastrointestinal surgery and thoracic surgery. Laparoscopic minimally invasive techni-que may be more conducive to lower mediastinal lymph node dissection. Laparoscopic surgery of AEG after neoadjuvant chemotherapy is safe and feasible. Robotic surgery may be the direction of minimally invasive surgery in the future. The authors mainly investigate strategies of minimally invasive surgery for the surgical treatment of AEG, and look forward to more clinical trials on Siewert type Ⅱ AEG surgery to guide surgical treatment.

Correlation between malnutrition and early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the correlation between malnutrition and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with ischemic stroke received intravenous thrombolysis in the Department of Neurology, Nanjing Jiangbei People's Hospital from January 2018 to December 2021 were retrospectively enrolled. Nutritional status was assessed by geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI). END was defined as an increase of ≥4 in the National Institutes of Health Stroke Scale score within 24 h after intravenous thrombolysis compared with the baseline value. The demographic and baseline clinical data of the patients in the END group and the non-END group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between malnutrition and END. Results:A total of 256 patients were enrolled, including 156 males (60.9%), aged 65.6±12.0 years. According to GNRI and PNI, there were 122 (46.7%) and 62 (24.2%) patients with malnutrition respectively. END occurred in 37 patients (14.5%) during hospitalization. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, there was a significant independent correlation between malnutrition and END after intravenous thrombolysis in patients with acute ischemic stroke (severe malnutrition as assessed by GNRI compared to normal nutritional status: odds ratio 5.736, 95% confidence interval 1.033-31.866, P=0.046; severe malnutrition as assessed by PNI compared to normal nutritional status: odds ratio 4.928, 95% confidence interval 1.589-15.282, P=0.006). Conclusion:Malnutrition is very common in patients with acute ischemic stroke and has a significant correlation with END after intravenous thrombolysis.

Clinical study of acupuncture plus Dang Gui Bu Xue Qu Feng Tang for benign essential blepharospasm / 针灸推拿医学（英文版）

Objective: To evaluate the therapeutic efficacy of acupuncture plus Dang Gui Bu Xue Qu Feng Tang for benign essential blepharospasm (BEB). Methods: A prospective randomized controlled trial was performed. A total of 105 participants were randomized 1:1:1 into an acupuncture group, a herbal medicine group and an acupuncture plus herbal medicine group. Participants in the acupuncture group received manual acupuncture treatment, twice a week. Participants in the herbal medicine group received Dang Gui Bu Xue Qu Feng Tang, oral administration, once a day. Participants in the acupuncture plus herbal medicine group received both treatments. The therapeutic effects of the three groups were evaluated after four weeks of treatment. The primary outcome was the Jankovic rating scale (JRS) score, and the secondary outcome was the blepharospasm disability index (BSDI) score. Results: After four weeks of treatment, the JRS total scores significantly decreased in all three groups versus baseline (P<0.05). A greater reduction in the JRS total score was reported in participants in the acupuncture plus herbal medicine group (P<0.05), but there was no significant difference between the acupuncture group and the herbal medicine group (P>0.05). The acupuncture plus herbal medicine group had a greater decrease in the JRS severity score than the herbal medicine group (P<0.05). The reduction in the JRS frequency score was not significantly different among the three groups (P>0.05). The BSDI scores significantly decreased in all three groups versus baseline (P<0.05), but the reduction in the BSDI score was insignificantly different among the three groups (P>0.05). Conclusion: It is effective in the treatment of BEB either to use acupuncture and Dang Gui Bu Xue Qu Feng Tang alone or in combination. The combination therapy shows a more significant effect than either of the treatment alone.

Clinical application of local anesthesia for TiRobot-assisted removal of sacroiliac screws / 中华创伤骨科杂志

Objective:To explore the feasibility and advantages and disadvantages of local anesthesia for TiRobot-assisted removal of sacroiliac screws by comparison with general anesthesia for TiRobot-assisted removal of sacroiliac screws.Methods:A retrospective study was performed in 39 patients with posterior pelvic ring fracture-dislocation who had undergone removal of percutaneous sacroiliac screws after fracture union from January 2017 to December 2020 at Department of Orthopaedic Surgery, Hospital Affiliated to Chengdu University. Their sacroiliac screws were removed with TiRobot assistance under local anesthesia (LA group) or general anesthesia (GA group). In the LA group of 18 cases, there were 10 males and 8 females, aged (43.3 ± 8.4) years (from 25 to 58 years); in the GA group of 21 cases, there were 12 males and 9 females, aged (44.9 ± 9.0) years (from 23 to 60 years). The 2 groups were compared in terms of time for planning screw removal path, fluoroscopy frequency, fluoroscopy time, operation time, anesthesia time, anesthesia cost, postoperative visual analogue scale (VAS) and postoperative ambulation time.Results:There was no statistically significant difference in baseline data between the 2 groups, showing comparability ( P>0.05). Follow-ups revealed grade A wound healing in all patients. There were no significant differences between the 2 groups in time for planning screw removal path, fluoroscopy frequency, fluoroscopy time or operation time ( P>0.05). The anesthesia time [(41.6 ± 8.3) min], anesthesia cost [(653.5 ± 102.6) yuan] and postoperative ambulation time [(2.6 ± 0.6) h] in the LA group were significantly less than those in the GA group [(52.3 ± 9.5) min, (2,475.6 ± 261.8) yuan and (8.7 ± 2.4) h] while the VAS score in the former group (3.8 ± 1.5) was significantly higher than that in the latter group (2.5 ± 1.3) (all P<0.05). Conclusions:It is feasible to use local anesthesia for TiRobot-assisted removal of sacroiliac screws. In TiRobot-assisted removal of sacroiliac screws, compared with general anesthesia, local anesthesia may lead to shorter anesthesia time, lower anesthesia cast and shorter ambulation time, but the patients need to be compliant enough.

Plasma Dickkopf-1 predicts early neurological deterioration and outcome in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the relationship between plasma Dickkopf-1 and early neurological deterioration (END) and outcome in patients with acute ischemic stroke.Methods:From January 2020 to December 2020, consecutive patients with first-ever ischemic stroke form the Department of Neurology, Nanjing Jiangbei Hospital were included. All patients were hospitalized within 24 h after onset. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after admission increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Poor outcome was defined as the modified Rankin Scale score >2 at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent correlation between plasma Dickkopf-1 and END and outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of plasma Dickkopf-1 for END and poor outcome. Results:A total of 176 patients were enrolled, including 92 males (52.3%), aged 66.7±9.6 years. The median Dickkopf-1 was 4.30 μg/L, 52 patients (29.5%) developed END, and 81 (46.0%) had poor outcome. Multivariate logistic regression analysis showed that the higher Dickkopf-1 was an independent predictor of END (odds ratio [ OR] 1.696, 95% confidence interval [ CI] 1.223-2.351; P=0.002) and poor outcome ( OR 1.566, 95% CI 1.156-2.121; P=0.004). ROC curve analysis showed that plasma Dickkopf-1 had good predictive value for END, and its area under the curve was 0.717 (95% CI 0.634-0.801); the optimal cut-off value was 4.40 μg/L, and the corresponding predictive sensitivity and specificity were 71.2% and 60.5%, respectively. Dickkopf-1 also had good predictive value for poor outcome, and its area under the curve was 0.701 (95% CI 0.624-0.778); the optimal cut-off value was 4.25 μg/L, and the corresponding predictive sensitivity and specificity were 65.4% and 61.1%, respectively. Conclusion:Plasma Dickkopf-1 has good predictive value for END and poor outcome in patients with acute ischemic stroke.

Evaluation of the effectiveness and benefit of influenza vaccination among school-age children in Xining, Qinghai / 公共卫生与预防医学

Objective To evaluate the effectiveness and benefit of influenza vaccination among school-age children in Xining, Qinghai. Methods A total of 215 children were randomly recruited as the vaccination group and vaccinated with trivalent split influenza vaccine. At the same time, 215 healthy children (no known diseases and past history reported, and no vaccinations) who underwent physical examinations during the same period were selected as the control group. The basic demographic information was investigated and a 1-year follow-up was carried out. Results The demographic characteristics of children in the vaccinated group and the control group were not significantly different (P>0.05), and were comparable between the two groups. After four follow-up visits within one year for the enrolled children, the overall incidence of influenza-like illness in children in the vaccinated group and the control group was 7.4% (16/215) and 16.7% (36/215), respectively, and the difference was statistically significant (χ2=8.75, P2=5.03, P2=1.37, P>0.05). The protection rate was 52.6%, and the protection index was 2.11. The proportions of irrational use of antibiotics were 6.0% (13/215) and 20.9% (45/215), respectively, and the difference was statistically significant (χ2=20.41, P<0.05). The protection rate was 71.3%, and the protection index was 3.48. The per capita income from vaccination was 667.9 yuan, and the benefit-cost ratio was 9.97:1. Conclusion Influenza vaccination for school-age children can effectively prevent the incidence of influenza-like diseases and the common cold, and the vaccination is cost-effective.

Periodic revalidation of autoverification for blood analysis and its suitability evaluation of application / 中华检验医学杂志

Objective:To conduct periodic revalidation of the 15 items and 43 terms autoverification rules of blood analysis after 1 year of application, analyze the application suitability and make the rules improved.Methods:Track the results of 528 010 blood analysis samples of our hospital from August 1, 2019 to January 31, 2020, and analyze the pass rate and interception rate of autoverification; 600 specimens in total were selected randomly for microscope examination, including 300 specimens which touched autoverification rules (1 012 items of autoverification rules) and were intercepted by autoverification and 300 specimens which untouched autoverification rules and were released by autoverification. The abnormal characteristics and unacceptable Delta check of the specimens also need to be concerned at the same time.The false negative rate and false positive rate, true negative rate, true positive rate and pass correct rate of autoverification were verified and compared with the rate of the second phase verification when the autoverification rule was established. The false negative rate, false positive rate, true negative rate and true positive rate of the Delta check rule which 54 716 specimens touched were calculated and compared with the second phase verification rate when the autoverification rule was established.The results of microscopic examination were used as the gold standard for the calculation of the rates, and P<0.05 was considered as a significant difference. The false positive and true positive of 1 012 autoverification rules were analyzed item by item.The false positive and true positive of 108 specimens which touched blast cell autoverification rule were analyzed terms by terms. The mean TAT and median TAT of 528 010 specimens and 193 750 outpatient specimens were calculated respectively, and the report percentages of 528 010 samples that TAT<30, 30-60　and>60 min were calculated respectively. Analyze and evaluate the application suitability of autoverification rules to juge whether they meet the needs of doctors and laboratory. The design process and the rules and application process of autoverification were optimized and improved.Results:The autoverification pass rate was 63.06% (332 971/528 010), the interception rate was 36.94% (195 039/528 010). The false negative rate was 1.00% (1/600), the false positive rate was 12.67% (76/600), the true negative rate was 49% (294/600), the true positive rate was 37.33% (224/600), and the correct rate was 98% (294/300). The pass rate, true negative rate, true positive rate and correct rate of the periodic reverification group were higher than the second phase verification group, the false negative rate and false positive rate were lower than that the second phase verification group. The false negative rate and true positive rate of the Delta check of periodic verification group were lower than that the second phase verification group, the false positive rate and true negative rate were higher than the second phase verification group, there were significant differences in the comparition results. The mean TAT of 528 010 specimens was25 min, and the median TAT was 22 min. The mean TAT of 193 750 outpatient specimens was 23 min, and the median TAT was 20 min. The report percentages of 528 010 samples that TAT<30 min, 30 min-60 min and>60 min were 83.30% (439 819/528 010), 8.00% (42 250/528 010) and 8.70% (45 941/528 010), respectively.Conclusion:The results of periodic revalidation of autoverification after 1 years application show that the 15 items and 43 terms autoverification rules of blood analysis could meet requirements about the accuracy and efficiency of the laboratory, and have a good suitability for application.

Predictive value of thromboelastographic parameters for early neurological deterioration after intravenous thrombolysis in patients with ischemic stroke / 国际脑血管病杂志

Objective:To investigate the predictive value of thromboelastographic (TEG) parameters for early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in Nanjing Jiangbei People's Hospital between January 2017 and December 2019 were enrolled. They completed TEG examination within 24 h after admission. END was defined as an increase of 4 points or more from the baseline National Institutes of Health Stroke Scale (NIHSS) score within 24 h after admission. Univariate analysis was used to compare the demographic characteristics, baseline data, laboratory indicators and TEG parameters between the END group and the non-END group. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of different models for END. Results:A total of 174 patients with acute ischemic stroke were enrolled, aged (68.9±13.4) years, 111 (63.8%) were male, median baseline NIHSS score was 5.0, and 29 (16.7%) had END. Compared with the patients in the non-END group, the age, homocysteine, fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), baseline NIHSS score and the proportion of patients with diabetes mellitus and hemorrhagic transformation (HT) in the END group were significantly increased (all P<0.05), and the coagulation reaction time of TEG was significantly reduced ( P=0.005). Multivariate logistic regression analysis showed that after adjusting for confounding factors, age (odds ratio [ OR] 1.023, 95% confidence interval [ CI] 1.002-1.066; P=0.031), diabetes mellitus ( OR 2.627, 95% CI 1.021-7.176; P=0.041), higher hs-CRP level ( OR 1.050, 95% CI 1.018-1.083; P=0.002), HT ( OR 3.088, 95% CI 1.707-13.492; P=0.034) and TEG coagulation reaction time reduction ( OR 0.440, 95% CI 0.213-0.907; P=0.026) were the independent risk factors for END in patients with acute ischemic stroke receiving intravenous thrombolysis. ROC analysis showed that the area under the curve of the basic model composed of age, diabetes, hs-CRP level, and HT for predicting END was 0.766 (95% CI 0.665-0.871). When TEG coagulation reaction time was added to the basic model, the area under ROC curve for predicting END was increased to 0.816 (95% CI 0.733-0.899). Conclusion:The TEG coagulation reaction time reduction has a certain predictive value for END in patients with acute ischemic stroke receiving intravenous thrombolytic therapy.

Deciduous dental caries among children aged 3-5 years in Henan Province and its influencing factors / 中国学校卫生

Objective@#To investigate the epidemiology and associated factors of deciduous dental caries in 3-5 years old children in Henan Province, and to provide a epidemiological reference for prevention work of deciduous dental caries among children.@*Methods@#According to the basic methods of the Fourth National Oral Health Survey, 12 kindergartens were randomly selected from 2 counties and 2 districts in Henan Province and a total of 1 296 children aged 3-5 years old were randomly selected with stratified multi-stage random sampling method. The deciduous teeth of these children were examined for caries and their guardians were surveyed with questionnaires regarding oral health behavior, knowledge and attitude.@*Results@#Deciduous dental caries occurred in 755 children, accounting for 58.3% and the average decay-missing-filled teeth (dmft) was 2.83. The differences of prevalence of dental caries of boys and girls (60.5%, 56.0%) and mean dmft index (2.88, 2.78) were of no statistical significance(χ2/F=2.64, 0.22, P>0.05). The prevalence of dental caries and mean dmft index for 3, 4 and 5-year-old group was 46.7%, 2.02 and 60.9%, 2.85 and 67.5%, 3.64, respectively. There was statistical significance among three age groups(χ2/F=40.00, 21.68, P<0.01). No significant difference was found in the dental caries prevalence and mean dmft index between urban (58.9%, 2.87) and rural area (57.7%, 2.79)(χ2/F=0.20, 0.16, P>0.05). Multivariate logistic regression showed that age, feeding pattern within the first six months after birth, dental care experience and self-perceived oral health status associated with deciduous caries in 3-5 year-old children in Henan Province(P<0.05).@*Conclusion@#Dental caries prevalence is highly prevalent among preschool children in Henan Province. Effective caries precaution measures should be taken to improve oral health level of these children.

Comparison of Onlay transverse island preputial flap and Onlay transverse free island preputial graft for midshaft hypospadias repair / 中华泌尿外科杂志

Objective To compare the postoperative effects of Onlay transverse island preputial flap and Onlay transverse free island preputial graft for midshaft hypospadias repair.Methods Retrospective analysis of clinical data of 59 patients with midshaft hypospadias who underwent hypospadias repair from January 2013 to December 2018.Among them,49 children were repaired with Onlay transverse island preputial flap,aged from 14 months to 81 months,with the median age of 28 months.Ten children were repaired with Onlay transverse free island preputial graft.The age at surgery was from 15 months to 51 months,with the median age of 30 months.There was no significant difference in term of the age at surgery between the two groups (Z =-0.384,P =0.701).There were 9 cases of Donnahoo Ⅱ and 40 cases of Donnahoo Ⅲ in the traditional Onaly group,and 3 cases of Donnahoo Ⅱ and 7 cases of Donnahoo Ⅲ in the free graft Onlay group,respectively.There was no significant difference in the type of chordee between the two groups(x2 =0.161,P =0.688).The classification of hypospadias,the length of the urethroplasty and surgical complications were compared.The maximum urinary flow rate of some patients was summarized and analyzed after operation.Results Follow-up ranged from 3 to 72 months,with a median period of 38 months.In the children who underwent Onlay transverse island preputial flap,there were 2 cases of distal shaft,5 cases of middle shaft,and 42 cases of proximal shaft.The neourethra was 1.3-3.5 cm,with a median of 2.3 cm.There were 11 cases of fistula,1 case of glan dehiscence,and 1 case of diverticulum.Ten children were treated with Onlay transverse free island preputial graft.There were 1 case of distal shaft,2 cases of middle shaft and 7 cases of proximal shaft.The neourethra was 1.2-2.5 cm,with a median of 2.0 cm.Two cases of fistula occurred after operation.There was no significant difference in hypospadias classification between the two groups(x2 =1.313,P =0.519).There was no significant difference in the length of the urethra between the two groups (Z =-1.732,P =0.083).There was no significant difference in the incidence of postoperative complications between the two surgical methods (x2 =0.001,P =0.973).The patients' parents were satisfied with the appearance of genital organ after operation.Fourteen patients finished the uroflowmetry 3 months after surgery.Twelve patients in the traditional Onlay group had a urine volume of 60.2-147.8 ml,with an average of 98.8 ml.The maximum urinary flow rate was 3.5-13.6 ml/s,with an average of 8.1 ml/s.In the free graft Onlay group,the urine volume was 101.3-165.4 ml,with an average of 133.5 ml,and the maximum urinary flow rate was 9.6-15.7 ml/s,with an average of 12.7 ml/s.Conclusions Onlay transverse free island preputial graft has the same complication incidence with Onlay transverse island preputial flap,but could get a good maximum urinary flow rate and cosmetic result,which could achieve a good choice for midshaft hypospadias repair.

Clinical value of standardized procedures of fine lymph node sorting from gastric can-cer samples after curative resection: a study of 727 cases / 中国肿瘤临床

Objective: To evaluate the potential clinical value of standardized procedures of fine lymph node sorting from gastric can-cer samples after curative resection. Methods: Between January 2016 and December 2017, 727 gastric cancer patients who under- went R0 resection in the Tianjin Medical University Cancer Institute and Hospital were retrospectively included and assigned to either the fine lymph node sorting group or regional lymph node sorting group in accordance with the lymph node sorting methods from the tumor samples of all patients. Both the numbers of examined lymph nodes and metastatic lymph nodes were compared between the two groups. Additionally, correlation analyses were performed between the numbers of examined lymph nodes and metastatic lymph nodes in the two groups. Results: There was no significant difference in sex, age, or tumor size between the two groups (P>0.05), indi-cating that there was comparability between the two groups. The number of examined lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P<0.001). Furthermore, the number of examined lymph nodes in the fine lymph node sorting group was much higher than that in the regional lymph node sorting group with the same pT, pN, or pTNM stage (P<0.001). The number of metastatic lymph nodes in the fine lymph node sorting group was significantly higher than that in the regional lymph node sorting group (P<0.001). There was a significant positive correlation between the numbers of ex-amined lymph nodes and metastatic lymph nodes in both groups (fine lymph node sorting group r=0.181, P=0.023; regional lymph node sorting group r=0.227, P<0.001). Additionally, the correlation coefficient between the numbers of examined lymph nodes and metastatic lymph nodes in the fine lymph node sorting group was weaker than that in the regional lymph node sorting group. Conclu-sions: The standard procedures of fine lymph node sorting from tumor samples of gastric cancer may increase the number of exam-ined lymph nodes, accurately provide the postoperative pN stage, reduce the stage migration, and should be applied in clinical stan-dardization.

Reoperation methods and effectiveness of urethral stricture after urethroplasty of hypospadias / 中国修复重建外科杂志

Objective: To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods: Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results: One hundred and fifty-four patients were followed up 6-86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion: If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.

A 3D CT-based fracture map study of intra-articular distal radial fractures / 中华骨科杂志

Objective@#To map OTA/AO type B and type C distal radial fractures according to three-dimensional (3D) CT scan data, and to describe the morphological distribution of fracture lines.@*Methods@#A total of 468 cases of distal radius fractures admitted to the Affiliated Hospital of Chengdu University from January 2016 to March 2019 were analyzed and AO classification were performed. AO type B and type C fractures meet the inclusion criteria and then CT data were 3D reconstructed, and morphological description were performed on the fracture lines of each joint surface, including fracture shape angle, fracture area and fracture ratio. At the same time, the articular surface fracture model was superimposed on the standard model, then fracture line and fracture area distribution map were drawn to create the fracture map of intra-articular distal radial fractures.@*Result@#Intra-articular fractures of the distal radius were 209 cases, accounting for 44.7% (209/468) of the distal radius fractures, among which 67 cases of AO type B fracture. In type B fractures, average fracture height were 20.30±11.26 mm, average fracture width were 12.24±6.83 mm, average fracture area were 189.61±101.84 mm2, average angle were 57.23°±14.95°, and average area ratio of fracture (fracture zone area/joint surface area ratio) were 32.42%±10.24%. 142 cases were OA type C fracture, the average fracture height were 24.43±11.37 mm, average fracture width were 20.38±7.59 mm, average fracture area were 425.26±314.31 mm2, average angle were 51.26°±13.17°, and average area ratio of fracture were 73.81%±26.29%. According to fracture map formed by main fracture lines, five different fracture areas were identified: ① 63 cases in central area; ② 25 cases in Lister's nodule area; ③ 59 cases in scaphoid area; ④ 36 cases in lumbar fossa area; ⑤ 26 cases in lower iliac area. Main fracture lines were concentrated in the area on the dorsal side of the central area and the scaphoid area. The fracture lines of type B fracture mainly concentrated in scaphoid region, which accounted for 29.85% (20/67), and dorsal side and central area accounted for 26.87% (18/67). The fracture lines of type C fracture accounted for 27.46% (39/142) in scaphoid area and 31.69% (45/142) in central area. The fracture line of type C fracture increased in the lumbar fossa region (17.61%, 25/142) and the lower ulnar region (12.68%, 18/142) compared with type B fracture (28.69%). Compared with the type B fracture, the overall distribution of the fracture line of the type C fracture is more central.@*Conclusion@#The map of intra-articular fracture of distal radius was drawn and morphological distribution of fracture lines were quantified. Fracture-prone site and shape of fracture line were visually recognized. At the same time, description of articular surface fracture line and fracture area of type B and type C fractures of OA classification were improved, which may help with new classification and diagnosis.

Multivariate analysis of outcome of fetal hydronephrosis based on the grading system of prenatal and postnatal urinary tract dilation / 中华实用儿科临床杂志

Objective@#To assess the reliability and validity of the Urinary Tract Dilation (UTD) classification system as a new grading system for fetal hydronephrosis, and analyze the risk factors for prognosis of fetal hydronephrosis.@*Methods@#The data of patients who presented with fetal hydronephrosis from January to July 2016 at Sichuan Aca-demy of Medical Sciences & Sichuan Provincial People′s Hospital were retrospectively reviewed.The outcome of the patients who were treated with surgery or without surgical treatment was recorded if they were older than 2 years old.All renal nephrons were regraded if UTD classification system had been used for antenatal hydronephrosis assessment reliability previously.Univariate and multivariate analysis was performed to analyze the risk factors for prognosis of fetal hydronephrosis.@*Results@#A total of 94 patients (136 renal nephrons) were eligible for enrollment.During the observation period, 43 kidneys received surgery which had clinical indications for surgery, and the remaining 93 kidneys without surgery were stable until the end of the observation period.Ultrasound finding of fetal hydronephrosis in the second trimester were graded according to UTD grading system.Among the 51 kidneys with UTD A1, 7 kidneys (13.73%) received surgery during the observation period, and 35 kidneys (47.30%) received surgery during the observation period among 74 kidneys with UTD A2-3.In the third trimester of pregnancy, among 54 kidneys with UTD A1, 3 kidneys (5.56%) were operated during the observation period, and among 82 kidneys with UTD A2-3, 40 kidneys (48.78%) were operated during the observation period.Multivariate analysis revealed that parenchymal thickness before 32 weeks and UTD classification system during the third trimester of pregnancy were risk factors for fetal hydronephrosis which required surgical treatment after birth.@*Conclusions@#The UTD classification system is reliable for the evaluation of fetal hydronephrosis and is valid in predicting surgical intervention.Parenchymal thickness before 32 weeks and grading UTD A2-3 after 32 weeks is a risk factor for postnatal surgery.Analysis of fetal hydronephrosis data based on UTD grading system and standardized follow-up are helpful to control the risk of fetal hydronephrosis effectively.

Comparison of external fixation with or without limited internal fixation for open knee fractures / 中华外科杂志

Objective@#To explore the characteristics and methods of different fixation methods and prevention of open knee joint fracture.@*Methods@#The data of 86 cases of open knee joint fracture admitted from January 2002 to December 2015 in Department of Orthopaedics, Affiliated Hospital of Chengdu University were analyzed retrospectively.There were 65 males and 21 females aged of 38.6 years. There were 38 cases treated with trans articular external fixation alone, 48 cases were in the trans articular external fixation plus auxiliary limited internal fixation group. All the patients were treated according to the same three stages except for different fixation methods. Observation of external fixation and fracture fixation, fracture healing, wound healing and treatment, treatment and related factors of infection control and knee function recovery. χ2 test was used to analyze data.@*Results@#Eleven patients had primary wound healing, accounting for 12.8%. Seventy-five patients had two wounds healed, accounting for 87.2%. Only 38 cases of trans articular external fixator group had 31 cases of articular surface reduction, accounting for 81.6%; Five cases of trans articular external fixator assisted limited internal fixation group had 5 cases of poor reduction, accounting for 10.4%; There was significant difference between the two groups (χ2=44.132, P<0.05). Take a single cross joint external fixation group, a total of 23 cases of patients with infection, accounted for 60.5% of external fixation group; trans articular external fixation assisted limited internal fixation group there were 30 cases of patients with infection, accounting for the assistance of external fixator and limited internal fixation group 62.5%; There was significant difference between the two groups(χ2=0.035, P>0.05). Five cases of fracture nonunion cases of serious infection, patients voluntarily underwent amputation. The Lysholm Knee Scale: In the external fixation group, 23 cases were less than 50 points, accounting for 60.5%, 15 cases were more than 50 points, accounting for 39.5%, external fixation and limited internal fixation group 20 cases were less than 50 points, accounting for 41.7%, 28 cases were more than 50 points, accounting for 58.3%; There was significant difference between the two groups(χ2=1.279, P>0.05).@*Conclusions@#Prevention and control of infection is a central link in the treatment of open fracture of the knee. Trans articular external fixator plus limited internal fixation is an important measure to treat open fracture of the knee-joint.

Effect of Dahuang-Zhidan decoction on postoperative peripheral inflammatory factors and prognosis in patients with hypertensive cerebral hemorrhage / 国际中医中药杂志

Objective@#To explore the effect of Dahuang-Zhidan decoction on postoperative peripheral inflammatory factors and prognosis in patients with hypertensive cerebral hemorrhage.@*Methods@#A total of 103 patients with hypertensive cerebral hemorrhage in our hospital from May 2015 to January 2017 were divided into two groups according to the randomly number tables method. The control group (n=51) were treated by conventional treatment of western medicine, and the observation group (n=52) were treated with Dahuang-Zhidan decoction based on the treatment of the control group.The inflammatory factors, including interleukin-6 (IL-6), tumor necrosis factor (TNF-α), highly sensitive C-reactive protein (hs-CRP), interleukin-1β (IL-1β) in hematoma lesions after treatment for 1st, 7th day between two groups were measured. The comparisons of awake rate after treatment for the 7th, 14th, 30th day between two groups was conducted. The National Institute of Health Stroke Scale (NIHSS) scores after treatment for 30th, 90th day between two groups was launched. The Glasgow Prognosis Score (GOS) between two groups was compared at the 90th day.@*Results@#After treatment for 7 d,the postoperative peripheral inflammatory factors IL-6 (90.55 ± 18.89 pg/ml vs. 122.71 ± 19.62 pg/ml, t=-6.892), TNF-α (172.26 ± 29.85 pg/ml vs. 229.02 ± 30.34 pg/ml, t=-10.332), hs-CRP (137.55 ± 24.60 pg/ml vs. 162.14 ± 23.98 pg/ml, t=-8.615), IL-1β (95.57 ± 18.92 pg/ml vs. 110.65 ± 17.38 pg/ml, t=-3.594) in the observation group was significantly lower than those in the control group (P<0.05). After treatment for 7, 14, 30 d, the awake rate was 44.23% (23/52), 69.23% (36/52), 90.38% (47/52) in the observation group, which was significantly higher than those in the control group (χ2=3.977, 4.355, 4.499, P<0.05). After treatment for 30, 90 d, the NIHSS scores (12.24 ± 6.38 vs. 16.27 ± 7.69, t=-2.906), (5.39 ± 6.24 vs. 9.94 ± 8.11 , t=-3.198) in the observation group were significantly lower than those in the control group (P<0.05). After treatment for 90 d, the distribution of GOS scores in the observation group was significantly different from the control group (Z=-2.400, P=0.016).@*Conclusions@#The Dahuang-Zhidan decoction in the treatment of patients with hypertensive cerebral hemorrhage significantly inhibit postoperative the inflammatory response around hematoma lesions, and improve the neurological function, the awake rate and the qualify of life.

Correlations of P2Y12 gene polymorphism with clopidogrel resistance and long -term outcome in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlations of P2Y12 gene polymorphisms with clopidogrel resistance and long-term outcome in patients with acute ischemic stroke. Methods From June 2015 to June 2017, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Nanjing Jiangbei People's Hospital were enrolled. Thromboelastography was used to measure platelet inhibition rate and assess clopidogrel resistance. Polymerase chain reaction was used to assay C34T and G52T polymorphisms of P2Y12 gene. The patients were followed up at 12 months after discharge. The primary outcome was combined outcome of stroke recurrence, myocardial infarction, and death due to cardiocerebrovascular events. Results A total of 214 patients were enrolled, 51 (23.8%) had clopidogrel re-sistance and 29 (13.4%) had major outcome events. One hundred twenty-eight (59.8%) patients were C34T CC genotype and 86 (40.2%) were CT+TT genotype. The proportion of clopidogrel resistance in patients with CT+TT genotype was significantly higher than that with CC genotype ( 76.5% vs.28.8%;χ2=25.672, P=0.001). There were 131 patients (61.2%) with G52T GG genotype and 83 (38.8%) with GT+TT genotype. There was no significant difference in the proportion of clopidogrel resistance between the GT+TT genotype and the GG genotype (43.1% vs.37.4%; χ2=0.534, P=0.465). Multiple logistic regression analysis indicated that age (odds ratio [OR] 1.064, 95%confidence interval [CI] 1.009-1.115;P=0.021), diabetes ( OR 3.773, 95%CI 1.672-8.475; P=0.004), and C34T CT+TT genotype ( OR 9.087, 95%CI 4.416-22.665; P=0.002) were the independent risk factors fot clopidogrel resistance. Cox proportional hazards model analysis showed that age (Hazard ratio [HR] 1.058, 95%CI 1.001-1.121; P=0.049), hypertension ( HR 3.105, 95%CI 1.149-9.523; P=0.028), homocysteine ( HR 1.101, 95%CI 1.020-1.190; P=0.014), and C34T CT+TT genotype ( HR 2.588, 95%CI 1.121-5.967; P=0.026) were independent risk factors for the composite outcome. Conclusion C34T polymorphism of P2Y12 gene in patients with acute ischemic stroke may be a risk factor for clopidogrel resistance and is independently associated with the risk of long-term recurrence of vascular events.