Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement. Methods    The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared. Results    There were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05). Conclusion    The aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.  

Evaluation of sacral neuromodulation system with new six-contact points electrode for the treatment of bladder dysfunction / 中华泌尿外科杂志

Objective:To investigate the effects of sacral neuromodulation (SNM)using the new six-contact electrode vs. the four-contact electrode in patients with refractory overactive bladder.Methods:The clinical data of 29 patients underwent SNM testing therapy from January 2018 to January 2020 in China Rehabilitation Research Center were reviewed. In six-contact points electrode group 16 patients accepted SNM with new six-contact points electrode, while 13 patients in four-contact points electrode group accepted SNM with four-contact points electrode. There were no significant differences between the two group in age [(51.63±4.67) vs. (51.85±7.18) years], gender (male/female, 4/12 and 5/8), urination frequency [(22.10±9.05) vs. (21.79±8.05) times/24h], mean voided volume [(135.68±56.98) vs. (131.00±53.05) ml], and urgency score [(2.78±0.97) vs. (3.02±0.91)] (all P>0.05). The number of sensitive contact points, the ratio of reaction contact points, operation time of stage I and the success rate of two groups were calculated. Results:The mean number of sensitive points of six-contact points electrode group (3.31± 0.95) was significantly higher than that of the four-contact points electrode group (1.85± 0.38), ( P<0.05). There was no significant difference in the ratio of reaction contact points [ (96.87±6.71)% vs. (96.15± 9.39)%] and operation time of stage I [(71.25± 18.21)min vs.(68.85± 10.83)min]between six-contact points electrode group and four-contact points electrode group ( P<0.05). The contact E4 and E5 of six-contact electrodes had similar reaction voltage ( P>0.05). The implant rate of six-contact points electrode group was (14/16, 87.5%), which was higher than that of four-contact points electrode group (10/13, 76.9%), but there was no statistical difference ( P>0.05). Conclusions:This study showed that six-contact electrodes has more sensitive points compared with four-contact electrodes. Application of six contact electrodes, patients might get a higher implant rate.

Long term follow up outcome of artificial urinary sphincter implantation to treat stress urinary incontinence / 中华泌尿外科杂志

Objective:To investigate the long term outcome of artificial urinary sphincter implantation for patients with stress urinary incontinence.Methods:The data of 46 patients who underwent artificial urethral sphincter implantation in China Rehabilitation Research Center from April 2002 to April 2022 were retrospectively analyzed.The patients’ age ranged from 19-80 years old (median 45.6 years). There were 45 males and 1 female. The history of illness was 8 months to 33 years. The patients category were urethral injuries associated urinary incontinence ( n=24), neurogenic urinary incontinence ( n=9) and post-prostatectomy incontinence ( n=13). Preoperative daily pad usage was 3.5±1.0. The impact of incontinence on the quality of life (QOL)measured by the visual analogue scale (VAS)was 7.1±1.2. All 46 patients underwent artificial urethral sphincter implantation, of which 20 patients were treated with anticholinergic drugs (5 cases) or urinary tract related surgery (urethral stenosis incision in 2 cases, sphincterectomy in 3 cases, urethral dilation in 5 cases, urethral calculus lithotripsy in 1 case, and augmentation cystoplasty in 4 cases) before artificial urethral sphincter implantation. Of the 45 male patients, 25 patients had the transperineal approach and 20 had the trans-scrotal approach. The female case had a trans-retropubic approach. Different cuffs size was used based on individual circumference of bulbar urethra (45 male cases: 4.5cm in 16 cases, 4.0cm in 29 cases; one female case: 8.0cm). Long-term surgical efficacy was evaluated. Assessments included postoperative urinary continence (socially continent: one pad per day or less; complete dry: wearing no pads), artificial urinary sphincter status and complications. The influences of patients of different etiologies, surgical approaches and cuff size on surgical results were compared. Results:The mean follow-up time was 7.1 years ranged from 6 months to 19 years. At the latest visit, 32 patients (69.6%) maintained the primary functional artificial urinary sphincter. Three patients (6.5%) had artificial urinary sphincter revisions and maintained continence with the new device. 11 patients (23.9%) removed the artificial urinary sphincter because of post-complications. Thirty-five patients were socially continent, of which 16 patients were totally dry, leading to the overall social continent rate as 76.1%(35/46). There was a significant reduction in pad usage to 1.2±0.6 diapers per day ( P<0.001). The impact of incontinence on the QOL measured by the VAS dropped to 2.6±1.9 ( P<0.001). The complication rate was 32.6%(15/46), including infections ( n=4), erosions ( n=5), mechanical failure ( n=3), dysurie ( n=2) and urethral atrophy ( n=1). There were no significant differences in social continent rate between patients with different etiologies[75.0%(18/24)vs. 66.7%(6/9) vs. 84.6%(11/13)], perioperative complications [37.5%(9/24)vs. 33.3%(3/9) vs. 23.1%(3/13)] and device re-intervention rate[37.5%(9/24) vs. 33.3%(3/9)vs. 15.4%(2/13)]. There were no statistically significant differences in postoperative complete dry rate [32%(8/25)vs. 40%(8/20), P=0.76] and postoperative device failure free rate [60%(15/25)vs. 80%(16/20), P=0.20] between trans-perineal group and trans-scrotal group. There was no statistically significant difference in postoperative social continent rate between 4.5cm cuff and 4.0 cuff[75%(12/16) vs. 65.5%(19/29), P=0.74]. Conclusions:Artificial urethral sphincter implantation is an effective treatment for stress urinary incontinence due to intrinsic sphincter deficiency. There was no difference in the continent rate and complication rate between patients of different etiologies, different surgical approaches and cuff size selection.

Augmentation uretero-enterocystoplasty for lower urinary tract dysfunction: a long-term retrospective efficacy study / 中华泌尿外科杂志

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Efficacy and predictive factors of sacral neuromodulation on neurogenic bladder / 中华泌尿外科杂志

Objective:To explore the efficacy of sacral neuromodulation (SNM) in the treatment of neurogenic bladder (NB), and to analyze the predictive factors.Methods:The clinical data of 91 patients underwent SNM testing therapy from January 2012 to January 2020 in China Rehabilitation Research Center were reviewed. There were 53 males and 48 females with the average age of 36.5(28.0-52.5)years. Urinary diary, residual urine, neurogenic bowel dysfunction score (NBDS), video-urodynamic and pelvic floor electrophysiological examination before treatment were recorded. Among the 91 patients, 60 patients had symptoms of urinary storage period, including urgency, frequency and / or incontinence.The average number of voids/24 h was 13 (11, 18), the average volume per void was (123.0±45.9) ml, the average degree of urgency was (3.5±1.0), and the average 24-hour urine leakage was 100.0(50.0, 231.5) ml. 78 patients had chronic urinary retention symptoms, and the average post-void residual volume (PVR) was 200.0 (132.3, 300.0) ml. The neurogenic bowel dysfunction score (NBDs) of 91 patients was 11 (6.25, 13). The mean maximum cystometric capacity (MCC), maximum detrusor pressure (P detmax) and bladder compliance were 250 (117, 369) ml, 33 (17, 72) cmH 2O and 8.275 (4.540, 20.307) ml / cmH 2O, respectively. Pelvic floor electrophysiological examination showed that somatosensory evoked potential (SEP) was normal in 39 cases, abnormal in 19 cases and undetected in 33 cases. Bulbocavernosus reflex (BCR) was normal in 39 patients, abnormal in 23 patients and undetected in 29 patients. At the end of the test phase, the patient was re-evaluated. If " effective" or the patient willing to implant, permanent implantation of pulse generator was done. " Effective" was defined as improvement of more than 50% in at least one of the following conditions, including the number of voids in 24 hours, volume per void, degree of urgency, leakage volume in 24 hours, PVR. Quantitative values were compared using the t-test or non-parametric test. The potential risk factors were considered by logistic regression analysis. Results:The average test time was (18.7±6.7) days. 43/60 patients (71.7%) had improvement of more than 50% in at least one symptom of the storage period, and 21/78 patients (26.9%) had more than 50% improvement in urination symptoms. NBDS decreased from 11(6.25, 13) to 3(0, 8)( P < 0.05). During the filling period, MCC increased from 173.0(98.0, 326.0) ml to 300.0(201.0, 386.0) ml ( P<0.05), P detmax decreased from 40.0(27.0, 84.0) cmH 2O to 22.0(15.0, 60.0) cmH 2O ( P < 0.05), and bladder compliance increased from 6.84(3.75, 11.79) ml/cm H 2O to 19.23(4.95, 32) ml/cm H 2O ( P < 0.05). At the end of the test phase, 54 (59.3%) patients underwent permanent implantation. The median follow-up was 25.5 (11.5, 60.5) months. Four patients lost their curative effect, two patients developed grade 2 vesicoureteral reflux, and one patient underwent cystoplasty. Risk factors analysis showed that chronic urinary retention was a statistically significant variable ( P<0.05). Conclusions:SNM can not only improve the lower urinary tract symptoms of patients with neurogenic bladder, but also improve the urodynamic parameters and bowel function. Patients with chronic urinary retention symptoms before treatment experienced low efficiency at the end of the test phase.

The efficacy and safety of intravesical electrical stimulation combined with a training for bladder motor sensory dysfunction in the treatment of neurogenic underactive bladder / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of intravesical electrical stimulation (IVES) combined with a training for bladder motor and sensory dysfunction in the treatment of neurogenic underactive bladder(UAB).Methods:A prospective, single-blind, randomized controlled trial was used to study neurogenic UAB patients admitted to the China Rehabilitation Research Center from October 2019 to May 2021. Inclusive criteria included age≥18 years old, the patients who have been diagnosed as neurogenic UAB and the course of disease being more than 3 months; patients who have been undergone intermittent catheterization to empty the bladder or patients indicated for intermittent catheterization (post-void residual urine accounts for more than 40% of the functional bladder volume), voluntary signing of written informed consent, able to communicate well with researchers and comply with the requirements of the whole trial, and the patient not undergoing any treatment other than oral medication before IVES. Exclusion criteria included patients with low bladder compliance by urodynamic examination(<20 ml/cmH 2O), patients with mechanical outflow obstruction, patients with complete spinal cord injury, the patients with symptomatic urinary tract infection which was not cured, patients with hydronephrosis or bladder-ureteral reflux, patients with renal insufficiency(serum creatinine greater than 1.5 times of the upper limit of normality), patients with malignant tumors of the bladder or prostate, overactive bladder, Alzheimer's disease, brain atrophy, acute cerebrovascular disease, or cognitive impairment, patients who were pregnant or planning to be pregnant, bladder mucosa injury, patients with pacemakers or defibrillators, those who participated in other clinical trials 3 months before the study, and other circumstances that the researcher consider it is not suitable to be involved in this study. The patients were randomly divided into experimental group and control group according to the ratio of 1∶1. The experimental group used conventional transurethral insertion of bipolar catheter electrodes for IVES combined with bladder motor and sensory dysfunction training, and the control group underwent IVES with open circuit combined with bladder motor and sensory dysfunction training. The stimulation parameters of the two groups were two-way square wave, 1-30 mA intensity, 10-20 Hz frequency, 200 μs pulse width, once a day, lasting 30 minutes for each treatment, and for continuous 20 working days. The post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation of bladder filling volume and American Urological Association Symptom Index Quality of Life(AUA-SI-QOL) scores were recorded before and at the end of treatment. The adverse events during the treatment were recorded. Results:Fifty-two patients were selected and 50 patients completed the trial, including 26 patients in the experimental group and 24 patients in the control group. Before treatment, there were no significant differences in gender[16(male)/10(female)vs.13(male)/11(female), P=0.598], age [(40.7±13.5)years vs.(38.5±12.3)years, P=0.543], course of disease[0.71(0.42, 1.63)years vs.0.79(0.42, 1.50)years, P=0.695], post-void residual urine[300(193, 400)ml vs.325(178, 380)ml, P=0.724], voiding efficiency[17%(0, 47.8)% vs.21%(0, 38.0)%, P=0.960], 24-hour intermittent catheterization times[4(2, 4)vs.3(2, 4), P=0.692], first sensation volume during bladder filling[(325.8±74.3)ml vs.(307.5±75.0)ml, P=0.391] or AUA-SI-QOL scores[5(4, 5)vs.4(4, 5), P=0.313] between the experimental group and the control group. At the end of treatment, the post-void residual urine, first sensation volume during bladder filling and AUA-SI-QOL scores of the experimental group were significantly lower than those of the control group [250(40, 350)ml vs.300(200, 390)ml, P=0.034; (276.5±68.8)ml vs.(315.4±67.3)ml, P=0.049; 4(2, 4)vs.4(3, 5), P=0.024], and the voiding efficiency was significantly higher than that of the control group[33%(14.5, 84.5)% vs.18%(0, 35.8)%, P=0.041], but there was no significant difference in the number of 24-hour intermittent catheterization between the two groups [3(1, 4)vs.3(2, 4), P=0.174]. In the control group, there were no significant changes in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [325(178, 380)ml vs.300(200, 390)ml, P=0.832; 21%(0, 38.0)% vs.18%(0, 35.8)%, P=0.943; 3(2, 4)vs.3(2, 4), P=0.239; (307.5±75.0)ml vs.(315.4±67.3)ml, P=0.257; 4(4, 5)vs.4(3, 5), P=0.157]. In the experimental group, there were significant improvements in post-void residual urine, voiding efficiency, 24-hour intermittent catheterization times, first sensation volume during bladder filling and AUA-SI-QOL scores before and after treatment [300(193, 400)ml vs.250(40, 350)ml, P<0.001; 17%(0, 47.8)% vs.33%(14.5, 84.5)%, P<0.001; 4(2, 4)vs.3(1, 4), P=0.011; (325.8±74.3)ml vs.(276.5±68.8)ml, P<0.001; 5(4, 5)vs.4(2, 4), P<0.001]. During the treatment period, 1 case of abdominal discomfort occurred in the experimental group and 1 case of urethral discomfort in the control group. After adjusting the stimulation intensity and catheter position, the discomfort disappeared without other serious adverse events. Conclusions:IVES combined with bladder motor sensory dysfunction training can not only effectively improve the bladder emptying efficiency and bladder sensation in patients with neurogenic UAB, but also be safe and easy to operate.

Application and progress of neuromodulation in lower urinary tract dysfunction / 生物医学工程学杂志

For those patients with refractory lower urinary tract dysfunction who are not well treated by traditional therapy such as behavior therapy and drug therapy, neuromodulation technologies have gradually become alternative treatments. Several neuromodulation technologies are also used in animal experimental and clinical scientific research by more and more scholars, in order to find more effective methods and mechanisms of treatment of lower urinary tract dysfunction. This article introduces the principle and advantages of common neuromodulation technologies, which focuses on the application in lower urinary tract dysfunction treatment, and analyzes the direction and the broad prospect of neuromodulation.

Safety and efficacy of sacral neuromodulation therapy for lower urinary tract dysfunction in elderly people: A multicenter study / 中华老年医学杂志

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.

Effects of Acute Sacral Neuromodulation at Different Pulse Widths on Bladder Overactivity in Pigs / 대한배뇨장애요실금학회지

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.

Role of immune nutrients in the nutritional support treatment / 中华消化外科杂志

Immune nutrient is one of the hotspots of surgical nutrition therapy in recent years, and its clinical application in critically ill patients during the perioperative period is particularly drawing attention. Omega-3 polyunsaturated fatty acids, glutamine, arginine, dietary fiber and other immune nutrients can coordinate inflammatory response of the body, maintain a moderate immune response, protect the integrity of intestinal mucosal barrier function, and reduce bacterial translocation. However, there are some controversies in the effects of various immune nutrients on the prognosis of patients between clinical research results.

Role of immune nutrients in the nutritional support treatment / 中华消化外科杂志

Immune nutrient is one of the hotspots of surgical nutrition therapy in recent years,and its clinical application in critically ill patients during the perioperative period is particularly drawing attention.Omega-3 polyunsaturated fatty acids,glutamine,arginine,dietary fiber and other immune nutrients can coordinate inflammatory response of the body,maintain a moderate immune response,protect the integrity of intestinal mucosal barrier function,and reduce bacterial translocation.However,there are some controversies in the effects of various immune nutrients on the prognosis of patients between clinical research results.

Clinical value and surgical method of the pancreatic cancer with PV/SMV invasion / 中华普通外科杂志

Objective To investigate the clinical value and surgical methods of pancreaticoduodenectomy (PD) combined with portal vein (PV)/superior mesenteric vein (SMV) resection and reconstruction in the treatment of pancreatic cancer with PV/SMV invaded by tumor.Methods The clinical data of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) and 62 patients of pancreatic head cancer without PV/SMV invaded by tumor (group B) in the same period were collected and analyzed retrospectively from Jan 2014 to Apr 2017.There were no distinct invasion of celiac artery (CA),hepatic common artery (HCA) and superior mesenteric artery (SMA) in two groups of pancreatic cancer patients.The patients of group A underwent PD combined with PV/SMV resection and reconstruction,and the patients of group B were only treated with PD surgery.The complication rate and overall survival time after PD was compared between the 21 patients of pancreatic cancer with PV/SMV invaded by tumor and the 62 patients of pancreatichead cancer without PV/SMV invaded by tumor.'Results The average overall survival time of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) was 19.2 months,specifically with 1-year survival rate of 57.1％ (12/21),2-year survival rate of 28.6％ (6/21),and 3-year survival rate of 14.3％ (3/21).Meanwhile,the average overall survival time of group B was 19.4 months,specifically with 1-year survival rate of 58.1％ (36/62),2-year survival rate of 30.6％ (19/62),and 3-year survival rate of 14.5％ (9/62).The results indicated that no differences for overall survival time of patients treated with PD including 1,2,3-year survival rate between two groups were found (P ＞ 0.05).Conclusions For pancreatic cancer accompanied by PV/SMV invasion without invasion of SMA,CA and HCA,PD combined with PV/SMV resection and reconstruction are safe and feasible surgical procedures.The surgical reconstruction method was determined according to the location and length of the invaded vessels,and also there were no significant differences on the complication rate and overall survival time after PD between the pancreatic cancer patients with invasion of PV/SMV and the pancreatic head cancer patients without invasion of PV/SMV.

Analysis of the characteristics of hemagglutinin and neuraminidase genes of influenza A/H1N1(09pdm) viruses isolated in Yancheng area in 2014-2017 / 中华实验和临床病毒学杂志

Objective@#To analyze the genetic characteristics of the hemagglutinin(HA) and neuraminidase(NA) genes of the influenza A/H1N1(09pdm) viruses isolated in the city of Yancheng in 2014-2017.@*Methods@#The throat swab specimens of patients with influenza-like illness (ILI) from sentinel surveillance hospitals and outbreak sites were detected using the method of real time RT-PCR. The influenza A/H1N1(09pdm) viruses were isolated using MDCK cell culture method in 2014-2017. The strains in 2014-2017 were selected randomly and their sequences of the HA1 and NA genes were amplified through one step RT -PCR method and the PCR products were sequenced. The mutations of genes and acid locus were analyzed and the evolutional trees were generated using bioinformatics software.@*Results@#The clustering relationships of the respective branches of HA1 and NA genes of seventeen A/H1N1(09pdm) strains isolated in Yancheng area were basically the same and the phylogenetic trees of HA1 and NA genes were respectively clustered into four evolutionary branches. Compared with the vaccine strain A/California/07/2009(H1N1pdm)in the Northern Hemisphere, a total of three antigen epitopes (Ca, Sa, Sb) in HA1 genes of strains in Yancheng area were involved in six antigenic sites (K154R, S162N, K163Q, S185T, L191I, S203T); there were three mutations (D222G/N, G223R, E224K) in the 220 ring and one locus (L191I) in the 190 helix of the receptor binding sites; the two strains (A/Jiangsu-YC/SWL1540/2017, A/Jiangsu-YC/SWL1545/2017) isolated in 2017 increased the 162NQS glycosylation site. Because the strains of the antigen epitopes, receptor binding sites and glycosylation sites in the HA1 genes had a certain degree of variations in Yancheng area in 2014-2017, the protective effects of vaccine strain A/California/07/2009 (H1N1pdm) was limited at the gene level. The two strains (A/Jiangsu-YC/SWL1540/2017 and A/Jiangsu-YC/SWL1545/2017) isolated in 2017 were clustered with vaccine strain A/Michigan/45/2015(H1N1pdm) and had better protective effects. Seventeen A/H1N1(09pdm) strains had no mutations in catalytic residues and drug resistant sites of NA genes, but a part of strains had a certain degree of variations in glycosylation sites of NA genes.@*Conclusions@#These results indicated the HA1 and NA genes of influenza A/H1N1(09pdm) viruses circulated in Yancheng area in 2014-2017 changed gradually. The accumulation of these mutations would result in antigenic drift of influenza A/H1N1(09pdm) viruses.

[Effect of hypoxia on the biological characteristics of human dental follicle cells].

OBJECTIVE: This study aimed to investigate the effects of hypoxia on the characteristics of human dental follicle cells (hDFCs). METHODS: The tissue explant collagenase method was used to isolate hDFCs from young permanent teeth. The immunofluorescence technique was used to detect cell surface markers, and the multi-differentiation potential was detected by multilineage differentiation induction assay. Then, the hypoxic microenvironment was physically mimicked, and the cells were divided into the normoxia group (20%O2) and the hypoxia group (2%O2). The effects of hypoxia on cell migration and proliferation were examined by Transwell chamber test and CCK-8 assay, respectively. The gene and protein expression levels of stemness-related markers at both oxygen concentrations were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot, respectively. After osteogenic induction of both groups, qRT-PCR was performed to evaluate the osteogenesis-related gene, and alizarin red staining was used to assess the formation of mineralized nodules. RESULTS: With the multi-differentiation capacity of osteogenic cells, adipogenic cells, and nerves, hDFCs demonstrate strong stem cell characteristics and possess the criteria of mesenchymal stem cells, which can meet the requirements of seed cells in dental tissue engineering. Hypoxia was conducive to the maintenance of hDFC stemness. Hypoxia promoted the migration and proliferation of hDFCs. The hDFCs were induced to osteogenic differentiation under hypoxic conditions, thereby enhancing osteogenesis. CONCLUSIONS: Hypoxic microenvironment plays an important role in maintaining the stemness and promoting the proliferation, migration, and differentiation of hDFCs. Thus, this microenvironment could also serve several important functions in future clinical applications.

Molecular genotyping of measles viruses in Yancheng area in 2016 and analysis of the genetic characterization of hemagglutinin genes / 中华实验和临床病毒学杂志

Objective@#To analyze the genotypes and the genetic evolution of the hemagglutinin genes of measles viruses in the city of Yancheng in 2016.@*Methods@#Using a set of primers and probes for screening positive for measles viruses, specimens of throat swab were detected using the method of real time RT-PCR. The sequences of the nucleoprotein and hemagglutinin genes of measles viruses were amplified through one step RT-PCR method and the PCR products were sequenced. The sequences of nucleotide and amino acid of the nucleoprotein and hemagglutinin genes of measles viruses were analyzed and the evolutional trees were generated using bioinformatics software.@*Results@#The genotypes of measles viruses in the Yancheng area in 2016 included subgenotype H1a and genotype D8. Phylogenetic trees analysis showed that the five representative strains of subgenotype H1a in Yancheng area and Jiangxi representative strain (KJ136545) clustered into independent evolutionary branches, belonged to the clade of H1a -1 evolutionary genes. The seven representative strains of genotype D8 in Yancheng area were clustered with the American representative strain in 2009 (JN635404), belonged to the D8-3-2 small clade genes. Compared with vaccine strain of Shanghai S191, the amino acid site in 240thof the five representative strains of subgenotype H1a in Yancheng area mutated from serine to asparagine, leading to a loss of the N-glycosylation site NLS238-240. The seven representative strains of genotype D8 in Yancheng area had no change in N-glycosylation.@*Conclusions@#In 2016, the prevalent strains of measles viruses in Yancheng area were mainly Chinese H1a dominant subgenotype and D8 imported genotype. In addition to a loss of the N-glycosylation site NLS238-240in 240thof the five representative strains of subgenotype H1a, most of the major neutralizing antigen sites of hemagglutinin gene of measles viruses in Yancheng area did not mutate. The Chinese vaccine of Shanghai S191 can effectively prevent infection caused by subgenotype H1a and subgenotype D8 strains.

Tibial nerve stimulation to inhibit the micturition reflex by an implantable wireless drivermicrostimulator in cats / 中华泌尿外科杂志

Objective Objective To evaluate the effects of a new type of tibial nerve microstimulator on the micturition reflex in cats.Methods From March to May in 2017,the implantable wireless driver micro-stimulator was implanted around the tibial nerve in 9 α-chloralose anesthetized domestic shorthairs cats (2.5-3.5 kg,6-12 months old).The stimulator was placed near the neurovascular bundle parallel to the tibial nerve and its cathode perpendicular to the cushion.The intensity which can induce toe movement was defined as threshold (T).The ureters were isolated via an abdominal incision.The ureters were cut and drained externally.The bladder was inserted via a double lumen catheter through the urethra.The catheter was then secured by a ligature around the urethra.One lumen of the catheter was used to infuse the bladder with either 0.9％ normal saline (NS) or 0.25％ AA at a rate of 1 to 2 ml/min after connecting to a pump.The other lumen was connected to a pressure transducer to measure the bladder pressure.The bladder capacity was used to test the inhibitory effect of the stimulator.After the appearance of the first large-amplitude (＞ 30 cmH2O) bladder contraction,the bladder infusion was stopped.First,after emptying the bladder,2 or 3 cystometrograms with NS were performed without stimulation to obtain the control bladder capacity.After the bladder was stabilized,TNS (6 Hz,1-2 T) was applied during 2 sequential cystometrograms.Second,after emptying the bladder,0.25 ％ AA was infused into the bladder to irritate and induce bladder overactivity.After the bladder stabilized,TNS (6 Hz,1-2 T) was applied again during 2-3 sequential cystometrograms.If bladder capacity increased significantly,the stimulationhad an inhibitory effect on the micturition reflex.Results During normal saline infusion,the bladder baseline was (17.03 ± 4.10) ml.TNS at 1T did not change the bladder capacity [(18.56 ±0.81)ml] (P ＞0.05).TNS at 2T significantly increased the bladder capacity [(25.05 ± 1.19) ml] (P ＜ 0.05).Compared to normal saline infusion,bladder overactivity was irritated by the intravesical infusion of 0.25％ acetic acid,which significantly reduced the bladder capacity [(9.34 ± 0.75) ml] (P ＜ 0.05).Compared to acetic acid infusion,TNS at 1T did not change the bladder capacity [(11.32 ± 0.82) ml] (P ＞ 0.05).TNS at 2T significantly increased the bladder capacity [(14.82 ± 1.15) ml] (P ＜ 0.05).Conclusions The implantable wireless driver tibial nerve micro-stimulator appears to be effective in inhibiting the micturition reflex during physiologic and pathologic conditions.The implantable wireless driver tibial nerve microstimulator was excepted to be used to treat overactive bladder (OAB).

Effects of Acute Sacral Neuromodulation at Different Frequencies on Bladder Overactivity in Pigs / 대한배뇨장애요실금학회지

PURPOSE: We investigated the effects of different stimulation frequencies on the inhibition of bladder overactivity by sacral neuromodulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 13 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM (pulse width, 210 µsec) at frequencies ranging from 5 to 50 Hz was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different frequencies on the micturition reflex. RESULTS: AA-induced bladder overactivity significantly reduced the bladder capacity (BC) to 34.4%±4.7% of the NS control level (354.4±35.9 mL) (P0.05), but SNM at 15, 30, and 50 Hz significantly increased the BC to 54.5%±7.1%, 55.2%±6.5%, and 57.2%±6.1% of the NS control level (P0.05). CONCLUSIONS: This study demonstrated that 15 Hz was an appropriate frequency for SNM and that frequencies higher than 15 Hz did not lead to better surgical outcomes.

Construction of a rabbit model of steroid-induced osteonecrosis of the femoral head by combining different concentrations of glucocorticoids with horse serum / 中国组织工程研究

BACKGROUND: Glucocorticoid has been shown to be a major factor of osteonecrosis of the femoral head (ONFH), so constructing a reliable, effective and low mortality ONFH model will be helpful for searching for a better treatment strategy of ONFH.OBJECTIVE: To construct a rabbit model of early ONFH by intravenous injection of different concentrations of glucocorticoids and horse serum.METHODS: Thirty healthy male New Zealand rabbits were randomly allotted to six groups, followed by given the injection of 10 mg/kg horse serum combined with 5 mg/kg dexamethasone (group A), 10 mg/kg horse serum combined with 10 mg/kg dexamethasone (group B), 20 mg/kg horse serum combined with 5 mg/kg dexamethasone (group C), 20 mg/kg horse serum combined with 10 mg/kg dexamethasone (group D), 10 mg/kg dexamethasone (group E), and 2 mL/kg normal saline (control group) via ear veins, respectively.RESULTS AND CONCLUSION: Abnormal MRI signal of the femoral head appeared in the group D at postoperative 2 weeks, while abnormal signal was seen at postoperative 4 weeks in the other groups except the controls. Six weeks postoperatively, 80% rabbits in the group D showed abnormal signals, which were significantly more than those in the groups C (50%), B (40%), A (25%), and E (20%) (P < 0.05). The serum levels of triglyceride and total cholesterol in the groups A, B, C, D were significantly higher than those in the control group at 3, 7, 14 and 30 days after injection (P <0.05). Compared with the control group, the ratio of empty lacuna sigmificantly increased in the group D (P < 0.05).These results indicate that the injection of high concentration of horse serum combined with the high concentration of dexamethasone is successful and safe to make an animal model of early ONFH.

[Expression and effect of S100A9 in the periodontium of diabetic rats].

OBJECTIVE: The study seeks to investigate the expression of S100A9 and its potential role in periodontal diseases induced by diabetes. METHODS: A diabetic SD rat model was established through intraperitoneal injection of streptozotocin (STZ). Hematoxylin-eosin (HE) staining was performed to study the structure of the periodontium of diabetic rats. Using immunohistochemical staining, the distribution of S100A9 expression was detected in the periodontium of diabetic rats. Ex-pressions of Toll-like receptor 4 (TLR4) (ligands of S100A9) and p-P65/nuclear factor κB (NF-κB) were also measured. RESULTS: The trabecular structure of alveolar bone was sparser, and lamina dura was disappeared in diabetic rats. Obviously higher expressions of S100A9 were observed in the periodontal ligament, alveolar bone, and gingival epithelial of diabetic rats than in the control rats. TLR4 expressions in the periodontal ligament, alveolar bone and gingival epithelial of the diabetic rats were also higher as compared to the control rats. p-P65 expression was not detected in the control rats, but was detected in the periodontal ligament and alveolar bone of the diabetic rats. CONCLUSIONS: Periodontium lesions in diabetes mellitus may be induced by the activation of TLR4 and NF-κB signaling pathway meditated by S100A9. 
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[Effects of different fibrin glue combination modes on the proliferation and viability of dental follicle cells].

OBJECTIVE: This study explores the effects of different fibrin glue combination modes on the survival, proliferation, and apoptosis of dental follicle cells (DFCs), as well as to evaluate the feasibility and effectiveness of fibrin glue as transplantation material. METHODS: The membranes of surviving DFCs were marked using 3,3'-dioctadecyloxa carbocyanine perchlorate (DIO), and the cell number was counted by using ImageJ2x software. The apoptotic cells were marked with prodium iodide (PI). RESULTS: Compared with that of the 3D-2 and 2D-1 groups, the degradation speed of the 3D-1 group was the slowest. DFCs could survive and grow well in fibrinogen with a concentration of 15 mg · mL⁻¹ supplemented with thrombin with a concentration of 2 U · mL⁻¹. In particular, the 3D-1 combination mode was significantly conducive to cell proliferation and stretching. CONCLUSION: Fibrin glue can be used as an effective cell transplantation material. The different combination modes have certain effects on cell proliferation. The 3D-1 combination mode is more conducive to the survival and proliferation of DFCs than other modes.