Precise flap surgery for reconstruction of knee defects / 中华创伤骨科杂志

Objective:To introduce the concept and procedures of precise flap surgery in construction of knee defects and to report the preliminary clinical outcomes.Methods:The data of 16 patients with knee defects at 17 sides were retrospectively analyzed who had been treated under the guidance of the concept of precise flap surgery at Department of Orthopedic Surgery, The 920th Hospital of Joint Logistic Support Force of PLA from August 2014 to March 2022. There were 12 males and 4 females, aged 44(34, 54) years. The wounds were at the left side in 8 cases, at the right side in 7 ones and at bilateral sides in one, and their sizes ranged from 5 cm×3 cm to 15 cm×11 cm. The time from injury to surgery was 8.5(6.0, 13.0) days. Optimal repair protocols were chosen after the donor and recipient sites were evaluated according to the methods of precise flap surgery: a retrograde anterolateral thigh flap in 7 sides, a descending genicular artery perforator flap in 3 ones, a saphenous artery flap in 2 ones, and a superior genicular lateral artery perforator flap, a popliteal artery perforator flap, a medial sural perforator propeller flap, a peroneal artery perforator propeller flap, and a randomized flap in one, respectively. The flap sizes ranged from 10 cm×6 cm to 15 cm×15 cm. The outcomes and complications of skin flap repair, and functional recovery of the affected limb were recorded.Results:All the flaps at 17 sides survived after surgery; 3 cases developed distal edge necrosis which responded to dressing change. The follow-ups for the 16 patients were 14.5(10.0, 28.0) months. All the flaps presented with good color, texture and contour. Flap bulking, local osteomyelitis, and scar ulcer was found in one case respectively. According to the revascularization assessments in the digital replantation criteria by Hand Surgery Society, Chinese Medical Association, all the flaps at 17 sides were excellent. Accoding to the knee functional evaluation of Hospital for Special Surgery (HSS) at the last follow-up, the 17 affected limbs scored 86(80,91) points, yielding 9 excellent, 7 good and 1 fair sides.Conclusion:Although the defects and donor sites around the knee vary greatly, precise flap surgery may lead to effective control of the variations, choice of an optimal reconstruction protocol, and precise wound repair.

Association of screen time with psychological and behavioral development problems in children aged 3-6 years / 中国学校卫生

Objective@#To investigate the distribution of various types of screen time and examine the association of screen time with psychological and behavioral development problems in children aged 3-6 years, so as to provide scientific basis for children s screen use and mental health promotion.@*Methods@#A total of 3 875 mother child dyads who completed the follow up in Shanghai Maternal-Child Pairs Cohort were included. The daily usage time of children s tablet, mobile phone, TV, projectors, and other types of screens were obtained in questionnaire survey. Children s psychological and behavioral development problems were evaluated by Age-Stage Questionnaire, Third Edition (ASQ-3) and Strengths and Difficulties Questionnaire (Parent version) (SDQ). The Chi-square test, Mann Whitney U and Kruskal Wallis rank sum test were used to compare the detection rate of psychological and behavioral development problems and screen time in children with different characteristics. Multivariate binary Logistic regression was used to analyze the association of screen time with psychological and behavioral development problems.@*Results@#There were 49.91% of children having screen time more than 1 h/d. Children s TV, tablet and mobile phone screen time were 0.39(0.25, 0.96 ), 0.25(0,0.61) and 0.18(0,0.25) h/d. The detection rates of suspected developmental delay in fine motor, problem solving and personal-social domains and pro social behavior deficiency and externalizing behaviors in boys (8.54%, 6.77%, 5.46%, 30.07 %, 27.39%) were higher than that in girls (4.64%, 4.85%, 2.48%, 22.10%, 22.36%) ( χ 2=23.76, 6.49, 22.37, 31.81, 13.06, P <0.05). There were statistically significant differences in the detection rates of suspected developmental delay in communication, fine motor and problem solving, as well as internalizing behavior and externalizing behavior of children with different parents educational levels ( χ 2=14.37, 15.18, 21.10, 11.66, 9.27; 16.34, 26.75, 32.89, 16.97, 6.37, P <0.05). There were significant differences in the detection rates of suspected developmental delay in problem solving, prosocial behavior deficiency, internalizing behavior and externalizing behavior of children whose mothers had anxiety/depression symptoms during pregnancy ( χ 2= 5.61 , 9.05, 21.90, 7.17; 8.75, 6.06, 12.76 , 5.55, P <0.05). The average total screen time of boys was longer than that of girls (1.07, 1.00 h/d, Z=-2.08, P =0.04). Compared with children with other educational levels of their parents, the total screen time, mobile phone and TV screen time of children whose parents had college education or above were short (father: H =42.01, 44.49 , 21.24, mother: H =42.31, 39.21 , 26.47, P <0.01). Among all types of screen time, mobile phone screen time had the most impact on psychological and behavioral development. More mobile phone screen time increased the risk of suspected developmental delay and abnormal emotional behavior ( P < 0.05). Screen time of tablet, mobile phone and TV were positively correlated with externalizing behavior ( OR=1.36, 1.57, 1.27 , P <0.05).@*Conclusions@#Screen time is related to children s psychological and behavioral development problems and mobile phones affect the most. Parents should limit their children s screen time to avoid excessive screen time affecting their psychological and behavioral development.

Treatment of calcaneal fracture with anatomical calcaneal external fixator / 中华创伤骨科杂志

Objective:To investigate the short-term efficacy of anatomical calcaneal external fixator in the treatment of calcaneal fractures.Methods:A retrospective study was conducted of the 9 patients with calcaneal fracture who had been admitted to Department of Orthopedics, 920 Hospital of the PLA Joint Logistics Support Force between September 2019 and March 2020. There were 7 males and 2 females, aged from 23 to 66 years (mean, 41.3 years). The injury was caused by a fall from a height in 6 cases and a traffic accident in 3 cases. By the Sanders classification, there were 2 cases of type ⅡB, 2 cases of type ⅢAC, 3 type Ⅲ AB, one of type Ⅲ BC and one type Ⅳ. By the AO grading for closed soft tissue injury in the 8 closed fractures, there were 5 cases of grade Ⅰ and 3 cases of grade Ⅱ. The one open fracture was type ⅢB by the Gustilo-Anderson classification and treated with skin flap repair after debridement. All the 9 patients were treated with an anatomic calcaneal external fixator during stage-one or stage-two surgery (8 patients in stage-one and one in stage-two). The fracture union time for the patients was recorded; the ankle and hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS) and the protocol of Association for the Study and Application of the Method of Ilizarov (ASAMI) were used at the last follow-up to assess the short-term efficacy.Results:Postoperative follow-up for the 9 patients ranged from 6 to 18 months (mean, 9.8 months). The duration of fracture union in the 9 patients ranged from 2 to 4 months (mean 2.8 months). The AOFAS ankle and hindfoot score at last follow-up ranged from 79 to 93 points (mean, 84.7 points) for the male patients (6 excellent and one good), and from 82 to 91 points (mean, 86.5 points) for the female patients (one excellent and one good). According to the ASAMI protocol at last follow-up, the short-term efficacy was rated as excellent in 6 cases, as good in 2 cases and as fair in one. The patients with closed fracture could get out of bed for rehabilitation on day 3 after surgery. None of the patients experienced such complications as pin tract infection and osteomyelitis during follow-up.Conclusion:The anatomic external calcaneal fixator demonstrates fine short-term efficacy in the treatment of calcaneal fractures, due to its advantages like anatomical configuration, a limited number of implants, and a possibility of partial weight-bearing for exercises on the third postoperative day.

Ilizarov external fixation combined with bone surface roughening technique for tibial dystrophic nonunion / 中华创伤骨科杂志

Objective:To investigate the clinical effects of Ilizarov external fixation combined with bone surface roughening technique in the treatment of tibial dystrophic nonunion.Methods:The data were retrospectively studied of the 11 patients with tibial dystrophic nonunion who had been treated at Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force of PLA from April 2018 to January 2021. They were 7 males and 4 females, aged from 32 to 61 years (average, 44.6 years). Their last surgical fixation before admission was Hoffman Ⅱ external fixation in 6 cases and locking plate internal fixation in 5 cases. The time from their last operation to the present operation ranged from 9 to 26 months (average, 14.2 months). After treatment by Ilizarov external fixation combined with bone surface roughening technique, the 11 patients started weight-bearing walking with double crutches from the second day after operation, gradually progressed to walking with a single crutch 2 months after operation, and resumed normal weight-bearing walking without any crutch 3 months after operation.Results:All the 11 patients were followed up for 12 to 30 months (average, 20.0 months). The time for bearing Ilizarov external fixation ranged from 6 to 10 months (average, 8.6 months). Mild pin track infection occurred in 4 cases but was healed by pin track rinse with normal saline; moderate pin track infection happened in another 2 cases but responded to oral amoxicillin capsules for one week in addition to pin track rinse with normal saline. All the bone dystrophic nonunion was cured after 6 to 10 months (average, 8.6 months). By the bone criteria of Association for Study and Application of Method of Ilizarov (ASAMI), the efficacy was excellent in 8 cases, good in 2 and fair in one at the last follow-up; by the limb function criteria of ASAMI, the efficacy was excellent in 9 cases and good in 2 at the last follow-up.Conclusion:Ilizarov external fixation combined with bone surface roughening technique is an effective treatment of tibial dystrophic nonunion.

Comparison of clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy versus extraperitoneal single port robot assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.

Masquelet technique plus leg flap transfer to repair tibial infected defects complicated with extensive soft tissue defects / 中华创伤骨科杂志

Objective:To evaluate Masquelet technique plus flap transfer in repair of tibial infected defects complicated with extensive soft tissue defects in the lower leg.Methods:A retrospective analysis was performed in the 23 patients who had been treated by Masquelet technique plus flap transfer at Institute of Orthopedics and Trauma, 920 Hospital for tibial infected defects complicated with extensive soft tissue defects in the lower leg from March 2016 to June 2019. They were 15 males and 8 females, aged from 18 to 59 years (average, 38.4 years). The duration of disease ranged from 6 to 312 months (average, 23.6 months). All patients underwent surgery by 2 stages:1) debridement, locking compression plate fixation, formation of induced membrane by antibiotic-loaded bone cement, and repair of soft tissue defects with lower leg flaps; 2) removal of bone cement and fixation 6 to 8 weeks after infection control, fixation of broken ends after rinse, followed by grafting of cancellous bone particles in the induced membrane. The area of wound soft tissue defects after debridement ranged from 4.0 cm × 3.5 cm to 18.0 cm × 6.0 cm, and the length of bone defects from 6 to 12 cm (average, 8.4 cm). Locally grafted were pedicled fasciocutaneous flap in 4 cases, sural nerve nutrition skin flap in 9 cases (including 4 anterograde and 5 retrograde ones), saphenous nerve nutrition vascular flap in 7 cases (including 2 anterograde and 5 retrograde ones), retrograde superficial peroneal nerve nutrient vessel flap in one and free flap in 2 cases. The curative efficacy was evaluated according to the Paley fracture healing scores.Results:All the 23 patients were followed up for 9 to 46 months (average, 15.6 months). Flaps healed by the first stage in 18 cases and after skin grafting in 3 cases; skin flap transfer was conducted again in 2 cases. Infection was controlled in 21 cases but recurred in 2 cases at 9 and 14 months respectively after secondary surgery. The time for bone reunion ranged from 4 to 11 months (average, 6.2 months). According to the Paley criteria for fracture healing, 21 cases were excellent, one was good and one poor.Conclusion:In the treatment of tibial infected defects complicated with extensive soft tissue defects, Masquelet technique plus transfer of a variety of lower leg flaps can result in reliable outcomes because it controls infection, promotes formation of complete induced membrane and accelerates the process of bone reconstruction along with repair of soft tissue defects.

Transplanted low-set perforating branch propeller flap of fibular artery for repairing calcaneal soft tissue defects / 中华创伤杂志

Objective:To investigate the clinical efficacy of low-set perforating branch propeller flap of fibular artery for repairing calcaneal soft tissue defects.Methods:A retrospective case series study was conducted on 28 patients with calcaneal soft tissue defects admitted to 920th Hospital of Joint Logistics Support Force of PLA from January 2013 to December 2019. There were 19 males and 9 females，aged 13-69 years［（33.8±13.7）years］. The size of soft tissue defects ranged from 5 cm×2 cm to 18 cm×12 cm，and the size of flaps ranged from 12 cm×4 cm to 24 cm×10 cm. The soft tissue defects were repaired with the low-set fibular artery perforator propeller flap after emergency debridement or flap transplantation at the second stage after debridement according to the wound surface conditions. The survival of the flap，wound healing at the recipient and donor sites and complications were recorded. The function of the affected ankle was assessed according to American Orthopedic Foot and Ankle Society（AOFAS）ankle-hindfoot score before operation and at the final follow-up. The degree of satisfaction of flap appearance was assessed by Thankappan flap appearance satisfaction score at the final follow-up.Results:All patients were followed up for 2-40 months［（17.4±5.9）months］. All flaps survived and wounds at both donor and recipient sites were healed well，with satisfactory color and texture of the flaps，without thinning operation performed. Three patients experienced numbness on both sides of the incision at donor sites within 1 week after operation and returned to normal on their own about 2 months after operation，with all flaps restoring partial light pain sensation 1 year after operation. No complications occurred such as blood flow disorder of the affected limb or compartment syndrome. The AOFAS ankle-hindfoot score was 56-95 points［（82.3±15.2）points］at the final follow-up，significantly higher than the preoperative score of 17-68 points［（35.7±13.4）points］（ P<0.01）. The results were excellent in 21 patients，good in 5 and fair in 2，with excellent and good rate of 93%.The appearance satisfaction score was 4-10 points［（7.6±2.9）points］according to Thankappan flap appearance satisfaction score. The results were excellent in 6 patients，good in 15 and fair in 7，with the excellent and good rate of 75%. Conclusions:The low-set perforating branch propeller flap of fibular artery for reconstruction of calcaneal soft tissue defects has advantages of reliable blood supply and high survival rate of the flap as well as good restoration of the appearance and function of the affected limb.

The modified single incision robot-assisted laparoscopic radical prostatectomy: initial experience and clinical efficiency / 中华泌尿外科杂志

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

The experience of suprapubic extraperitoneal single-port robot-assisted radical prostatectomy / 中华泌尿外科杂志

Six patients with prostate cancer, treated by suprapubic extraperitoneal single-port robot-assisted radical prostatectomy, had been studied retrospectively from December 2019 to January 2020. All 6 patients have been treated by suprapubic peritoneum single port robot assisted laparoscopic surgery without other channels. The robot assisted laparoscopic radical prostatectomy via suprapubic peritoneum is safe and feasible when based on reasonable selection criteria of patients. It has been shown that the postoperative recovery was fast and the tumor control and continence rate were good under the short-term follow-up. However, the long-term outcome should be evaluated by a long-term follow-up.

Clinical application of different bladder neck separation techniques in robot-assisted laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the clinical effect of different bladder neck separation methods in robot-assisted laparoscopic radical prostatectomy (RARP).Methods:To retrospective analysis the data of robot-assisted laparoscopic radical prostatectomy (RARP)in our center from October, 2014 to October, 2018. All operations were performed by the same urologist. According to the different methods of bladder neck separationAccording to the different methods of bladder neck separation, all the patients were divided into four groups. Group A routine forward peeling method (500 cases): Make a 1cm incision at 12 o'clock on the front of the bladder neck, cut off the detrusor muscle and cut the bladder neck. Group B T-cut incision of the bladder neck (133 cases): identify the bladder and prostate Junction, T-shaped incision of the anterior wall of the bladder neck. Group C conventional stripping method combined with T-shaped incision of the bladder neck (81 cases). Group D lateral approach (36 cases): along the lateral side of the bladder neck and the medial posterior ligament of the prostate is separated and merges with the previously established Dirichlet space. The general data of patients were analyzed statistically.The average ages of groups A, B, C, and D were 63 years (62.5 to 67 years), 65 years (61 to 68 years), 66 years (64.5 to 70.5 years), and 62 years (59.5 to 66.5 years)respectively, there was no statistical significance difference in terms of age in 4 groups( P>0.05); PSA is 13 ng/ml(9.0 to 22 ng/ml), 7.4 ng/ml(6.4 to 26.0 ng/ml), 6.2 ng/ml(5.3 to 27.0 ng/ml), 14ng/ml(8.4 to 21.0 ng/ml), ( P>0.05); Gleason scores of puncture were 6.9(5 to 9), 7(6 to 12), 9(8 to 16), 10(6 to 18), ( P>0.05); the prostate volume was 66ml(42 to 78 ml), 70ml(50 to 89 ml), 53ml (43 to 72 ml), 80 ml (68 to 92 ml), ( P>0.05); the proportions of body mass index ≤25 kg/m 2 were 60.0%, 63.9%, 39.1%, 42.0%, and>25 kg/m 2 were 40%, 36.1%, 60.9%, and 58.0%, respectively, ( P>0.05). The operation time, bleeding volume, anastomosis time, postoperative hospital stay, postoperative complications, positive rate of proximal incision margin, urinary indwelling time, and urinary control rate in the four groups analyzed. Results:All 750 RARP operations were successful, and none were converted to open.The operation time of groups A, B, C, and D were 100 min(70 to 120 min), 89 min(70 to 95 min), 105 min(80 to 127 min), and 110 min(90 to 130 min), ( P>0.05); anastomosis time was 20.5 min (18.0 to 25.0 min)、16.1min (10.7 to 17.3 min)、25.4 min (18.9 to 27.0 min)、and 28.5 min (21.0 to 32.0 min), the anastomosis time in group B was significantly shorter than other groups ( P<0.05); the postoperative hospital stays were 9.3 days (8.0 to 13.0 days), 8.4 days (6.0 to 16.0 days), 10.8 days (8.0 to 16.0 days)and 7.8 days (7.0 to 14.0 days), ( P>0.05). Postoperative complications: Anastomotic fistula and ureteral injury occurred in 3 cases in group A, and no serious complications occurred in the other 3 groups. Proximal marginal positive rate: 40 cases (8.0%) in group A, 0 cases in group B, 6 cases (7.3%) in group C, 3 cases (8.3%) in group D, and low positive rate of margin incision in group B( P<0.05). The urinary indwelling time was 7 d (6 to 8 d), 6 d(4 to 8 d), 12 d(6 to 18 d), 10 d(6 to 13 d), ( P>0.05). Six-month postoperative urine control rate: 381 cases (75.2%) in group A, 102 cases (76.9%) in group B, 61 (75.4%) in group C, and 27 (73.8%) in group D, ( P>0.05). Conclusions:The above four method of bladder neck separation during robot-assisted laparoscopic radical prostatectomy is safe and feasible, which can effectively avoid ureteral damage. Each method can obtain better urine control within six months after surgery rate. The positive rate of proximal incision margin after T-shaped bladder neck was lowest among four groups.

Diagnostic value of shear wave elastography and real-time tissue elastography for thyroid ACR TR5 nodules / 中华地方病学杂志

Objective:To investigate the application value of shear wave elastography (SWE) and real-time tissue elastography (RTE) in differential diagnosis of thyroid Amereican College Radiology (ACR) TR5 nodules.Methods:Patients who underwent ultrasound examination at the Fourth Affiliated Hospital of Harbin Medical University from August 2018 to June 2019 diagnosed as ACR TR5 nodules were surveyed, and received SWE and RTE examinations to evaluate the nodules hardness. The receiver operating characteristic curve (ROC curve) was drawn to obtain the best diagnostic cutoff value for the Young's modulus maximum (Emax) of the benign and malignant thyroid ACR TR5 nodules using SWE technique; using the 5-point method, the elasticity score (ES) was used to evaluate the benign and malignant ACR TR5 nodules by RTE technology, and the pathological results were regarded as "gold standard". The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of SWE, RTE and two elastography techniques in differential diagnosis of benign and malignant thyroid ACR TR5 nodules were compared.Results:A total of 65 patients were enrolled, with a total of 73 ACR TR5 nodules. The optimal Emax threshold for differential diagnosis of ACR TR5 nodules by SWE technology was 41.8 kPa, and 32 malignant nodules and 41 benign ones were determined. Of the 73 ACR TR5 nodules using RTE technology, 38 had ES scores of 1 to 3 and 35 had ES scores of ≥4. Pathological results showed that among 73 thyroid ACR TR5 nodules, benign nodules accounted for 45.21% (33/73), malignant nodules accounted for 54.79% (40/73). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SWE, RTE and two elastography techniques for differential diagnosis of benign and malignant thyroid ACR TR5 nodules were 72.50%, 77.50%, 87.50%; 90.91%, 87.88%, 87.88%; 80.82%, 82.19%, 87.67%; 90.63%, 88.57%, 89.24% and 73.17%, 76.32%, 85.29%.Conclusions:Ultrasound elastography of two different imaging principles of SWE and RTE is an effective method for differential diagnosis of benign and malignant thyroid ACR TR5 nodules. The combination of the two is more advantageous.

Lodine nutrition level and ultrasonic manifestations of thyroid in forest and non-forest residents of Heilongjiang province / 中国医学影像技术

Objective: To observe the iodine nutrition level and ultrasonic manifestations of thyroid in forest and non-forest land residents of Heilongjiang province. Methods: Using random sampling method, 3 645 residents form 13 forests and 17 non-forests sites were selected and divided into 5 groups according to ages, i.e. group A (20-30 years), B (31-40 years), C (41-50 years), D (51-60 years) and E (61-70 years), and the ratio of male and female in each group was 1:1. Then all objects underwent thyroid ultrasound and urinary iodine. Results: ①The median urinary iodine of forest residents was lower than non-forest residents (P0.05). Thyroid structure abnormal rate of group D and E in forest residents were both higher than those in non-forest (both P<0.05). ③The urine iodine median in forest residents with ultrasonic abnormal thyroid was lower than in non-forest (P<0.05), while in forest residents in group D and E were both lower than non-forest (both P<0.05). Conclusion: The rate of thyroid structure abnormality increased with aging in both forest and non-forest residents of Heilongjiang province, the thyroid structure abnormal rate in middle-aged and elderly forest residents was higher, whereas the urine iodine median was lower than non-forest. Iodine nutritional status were at adequate levels in forest and non-forest 20-29 years old residents, while at appropriate levels in all other ages. The urine iodine content in forest residents were lower than that in non-forest of the same ages.

Clinical effect of double filtration plasmapheresis combined with glucocorticoid and immunosuppressant in treatment of children with severe Henoch-Schönlein purpura nephritis / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect and safety of double filtration plasmapheresis (DFPP) combined with double pulse therapy with methylprednisolone (MP) and cyclophosphamide (CTX) in the treatment of children with severe Henoch-Schönlein purpura nephritis (HSPN).@*METHODS@#A total of 60 children with severe HSPN who were admitted to the hospital from January 2014 to March 2018 were enrolled and were randomly divided into an observation group and a control group (n=30 each). In addition to routine treatment, the children in the control group were given MP+CTX pulse therapy. Those in the observation group were given DFPP treatment in addition to the treatment in the control group, with three courses of treatment in total. After three courses of treatment, the two groups were compared in terms of 24-hour urinary protein, urinary microproteins, renal function parameters, adverse reactions, and clinical outcome.@*RESULTS@#After three courses of treatment, the observation group had significantly greater reductions in 24-hour urinary protein, urinary albumin, urinary immunoglobulin G, urinary β2-microglobulin, serum creatinine, and blood urea nitrogen than the control group (P0.05).@*CONCLUSIONS@#Compared with MP+CTX pulse therapy alone in the treatment of severe HSPN in children, DFPP combined with MP+CTX pulse therapy can further alleviate renal injury and improve clinical outcome and does not increase the incidence rate of adverse reactions.

Clinical application of a self-designed controllable and portable double-pin traction device on calf / 中华创伤骨科杂志

Objective To explore the clinical application of our self-designed controllable and portable double-pin traction device on calf in the treatment of tibiofibular fractures.Methods Our controllable and portable double-pin traction device on calf was designed to fulfill the purpose of traction and address current problems in traction for tibiofibular fractures.This device is composed of double-hole connectors,nuts of various specifications,traction pin sleeves,2 transfixion pins and 2 threaded rods for traction.The transfixion pins are fixed at conventional traction positions.The threaded rods for traction are paralleled to the long axis of lower limb and located on both sides of the calf.Bone ends can be distracted by adjusting the nut of M8 width and the speed of pulling can be controlled.This device can be used not only for rapid traction during surgery but also for slow traction preoperatively.It was applied in the 30 patients with tibiofibular fracture who had been treated at Department of Orthopaedic Surgery,920th Hospital of Joint Logistic Support Force from January to December 2017.Their radiographs were taken before traction and at 3 and 6 days after traction to observe the changes in overlapped fracture ends and fracture gap.The lengths of distraction were measured.After limited open reduction,fracture gaps and tensions of surrounding soft-tissues were observed.Results Their radiographs before and after traction demonstrated that their overlapped and displaced fracture ends were distracted more or less.The length of distraction ranged from 7.2 mm to 45.8 mm (mean,23.1 mm);it was ＜ 15 mm in 6 cases,between 15 mm and 30 mm in 18,between 31 mm and 45 mm in 5,and ＞ 45 mm in one.Their radiographs showed that regular traction for 6 days was more obvious than that for 3 days.The limited open reduction revealed that the gap between fracture ends was expanded,the soft-tissue tension effectively relaxed,the overlapping of fracture ends diminished,and the dissection of surrounding soft-tissue and periosteum decreased,leading to less difficulty in reduction.In fractures near the joint or involving the articular surface,the joint space was expanded.The 30 patients were followed up for one to 16 months (mean,5.8 months).No such complications as pin site infection,traction fracture or osteomyelitis was observed.Conclusion Our self-designed controllable and portable double-pin traction device on calf is effective and advantageous,because it is simple,easy,light in weight,and controllable for traction speed.

An investigation based on HBM: cognitive of breast cancer patients about emotional disclosure / 中国实用护理杂志

Objective To understand the tendency of negative emotional expression and its cognitive influencing factors in breast cancer survivors in China, in order to provide evidence for emotional expression intervention. Methods The qualitative research based on the health belief model (HBM) was adopted. In-depth interviews were conducted with 21 breast cancer survivors. Data were analyzed by content analysis method. Results Among 21 people interviewed, 4 were emotionally expressed and 17 were emotionally suppressed. Aware of the negative emotions, recognize the seriousness of emotional depression, the benefits of emotional expression, the less obstacles of expression and the sense of self-efficacy can promote the occurrence of emotional expression. Conclusions Chinese breast cancer survivors are not good at expressing their negative emotions.Health care workers can change the behavior of patients through the aware of the negative emotions, recognize the seriousness of emotional depression, the benefits of emotional expression,the obstacles of expression and the sense of self-efficacy.

Perioperative nursing care of patients with pernicious placenta previa and placenta accreta treated with temporary ballon occlusion of the abdominal aorta / 中国实用护理杂志

Objective To study the nursing effect of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete. Methods Nursing points and experience of 126 cases of pernicious placenta previa and placenta accreta using temporary ballon occlusion of the abdominal aorta to prevent intraoperative bleeding in caesarean section were retrospectively summarized. This paper introduced the method, safety and superiority of the way of temporary ballon occlusion of the abdominal aorta, and the method of nursing care of patients with temporary ballon occlusion of the abdominal aorta, and the methods of the observation and prevention of postoperative bleeding and the nursing of pain. Results Totally 126 patients successfully achieved hemostasis, no hysterectomy occurred. Conclusions Through effective nursing of temporary ballon occlusion of the abdominal aorta in the treatment of pernicious placenta previa and placenta accrete, the postpartum hemorrhage, blood transfusion and the risk of hysterectomy can be reduced.

Bridging-combined internal fixation for extremity fractures / 中华创伤骨科杂志

Objective To explore the application of bridging-combined internal fixation for extremity fractures.Methods From May 2010 to August 2017,56 patients were treated by bridging-combined internal fixation for 58 different extremity fractures at Department of Orthopaedics,Military Orthopaedic Trauma Institute,Kunming General Hospital of PLA.They were 34 males and 22 females,aged from 16 to 83 years (average,48 years).There were 48 comminuted and 16 open fractures.The interval from injury to surgery ranged from one to 34 days (average,8 days).Early functional rehabilitation was encouraged for the patients.The therapeutic outcomes were evaluated in terms of fracture union time,postoperative infection,and postoperative functional recovery.Results Fifty-two of the patients were followed up for 12 to 28 months (average,16 months).The fractures united after 3 to 6 months (average,3.5 months).Comprehensive evaluation of the therapeutic outcomes resulted in 36 excellent,12 good,and 4 fair cases,yielding an excellent to good rate of 92.3％.Follow-ups revealed no postoperative infection,bone nonunion,loosening or breakage of the implants.Conclusion The bridging-combined internal fixation may lead to fine therapeutic outcomes for traumatic extremity fractures,because this system is flexible and easy to apply,and leads to fine reduction and limited postoperative complications.

Reliability and validity of Chinese version of ambivalence over emotional expression questionnaire:testing in breast cancer survivors / 中华行为医学与脑科学杂志

Objective To examine the validity and reliability of the Chinese version of ambivalence over emotional expression questionnaire(AEQ) in breast cancer survivors.Methods A total of 323 breast cancer survivors were divided into 2 parts:sample 1 contains 122 breast cancer survivors for item and exploratory factor analysis,while sample 2 contains 201 breast cancer survivors for further confirmatory factor analysis,criterion validity,and internal consistency reliability.Results One-factor construct was determined and the results of confirmatory factor analysis showed that one-factor construct AEQ had a good construct validity (x2/df=1.01,CFI=0.99,TLI=0.99,NFI=0.86,IFI=0.99,RMSEA=0.02).The AEQ score was correlated with TAS-20 (r=0.28,P＜0.01).Cronbach α coefficient,Spearman-Brown split coefficient and the test-retest reliability of AEQ were 0.86,0.80 and 0.79,respectively.Conclusion The AEQ is a reliable tool to assess the ambivalence over emotional expression in Chinese breast cancer survivors.

Mutation analysis of NTRK1 gene in a family affected with congenital insensitivity to pain with anhidrosis / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To screen for mutations of NTRK1 gene in a Chinese family affected with congenital insensitivity to pain with anhidrosis (CIPA).</p><p><b>METHODS</b>Genomic DNA was extracted from the proband and her family members. All of the 17 exons and intron-exon boundaries of the NTRK1 gene were analyzed by direct Sanger sequencing. For the deletional mutation, the PCR products were subjected to T-A cloning and sequencing to verify the mutation.</p><p><b>RESULTS</b>NTRK1 gene analysis revealed that proband has carried a c.1786C>T (p.Arg596*) nonsense mutation inherited from her mother and a novel deletional mutation c.1928-2028+23del from her father. Her elder brother only carried the deletional mutation.</p><p><b>CONCLUSION</b>The diagnosis of CIPA relied on typical clinical symptoms of no pain, anhidrosis and intellectual disability and detection of the biallelic NTRK1 mutations. The novel deletional mutation has enriched the spectrum of NTRK1 mutations.</p>

Identification and analysis of gene mutations of an neurofibromatosis type 1 patient / 中国医师杂志

Objective To explore mutation diagnosis and discuss the pathogenic and clinical characteristics of neurofibromatosis type 1 (NF1).Methods DNA sequencing combined with denaturing highperformance liquid chromatography (DHPLC) method was used to diagnose patients and parents.Results A new nonsense mutations c.503C ＞ G(p.S168 *) was identified.Conclusions NF1 is a rare autosomal dominant genetic disease.Most of them are caused by new mutations.Genetic diagnosis of sporadic cases is very important for treatment and the future generations.