Application of free skin graft or auricle composite tissue in the correction of nasal flange retraction / 中华医学美学美容杂志

Objective:To investigate the clinical effect and application value of free skin or auricle composite tissue transplantation in the correction of nasal alar retraction.Methods:From August 2019 to January 2023, a total of 45 patients with nasal retraction (7 males and 38 females) were treated in Shanghai United Regal Medical Cosmetology Hospital. Age ranged from 18 to 46 years, with a mean of 26.6 years. All patients had retroalar margin retraction caused by insufficient alar lining to varying degrees, with a retraction distance between 2-5 mm, with an average retraction distance of 3.3 mm. 11 cases of nasal flange retraction were corrected by free transplantation of composite tissue of auricle directly. The remaining 34 patients were corrected by alar border cartilage graft and free skin graft.Results:During 2-18 months of follow-up, 41 patients had satisfactory results and no obvious complications. Partial necrosis of free skin was observed in 2 patients, ischemic necrosis of complex flap of auricle was observed in 1 patient, and necrosis of free skin was observed in 1 patient. In addition to the above complications, 3 patients reported that the correction of alar retraction did not achieve the expected effect, but indicated that they were satisfied with the surgical effect, which was considered to be caused by skin contracture and other factors. The overall satisfaction rate of all patients was 91.1%. After follow-up and statistics, 41 patients in this group were satisfied with the results, with an overall satisfaction rate of 91.12%.Conclusions:The application of free skin graft (or auricle composite tissue) to correct nasal alar retraction has the advantages of simple operation, wide indications and accurate efficacy, and is worthy of clinical promotion.

Comparative Study of Three Minimally Invasive Surgical Approaches for the Treatment of L5/S1 Lumbar Intervertebral Disc Herniation.

AIM: To compare the efficacy and safety of minimally endoscopic discectomy (MED), percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of L5/S1 lumbar disc herniation (LDH). MATERIAL AND METHODS: From May 2012 to January 2017, 317 patients with L5/S1 LDH treated with MED, PETD or PEID were reviewed. Pre- and postoperative pain was measured using a visual analog scale (VAS; 0 ?10), and functional status was assessed using the Oswestry Disability Index (ODI; 0 ? 100%). Clinical outcomes, SF-36 scores and CK levels were compared between the 3 groups. RESULTS: There were 177 females and 140 males; the ages ranged from 22 to 74 years; and the course of disease was 15 to 85 days, with an average of 42.8 days. The postoperative bed rest time and average hospital stay in the MED group were higher than in the other two groups, and the differences were statistically significant. There was no significant difference in the results evaluated by the MacNab criteria. There were no significant differences in the levels of CK between the three groups before and after surgery (p > 0.05). CONCLUSION: Three minimally invasive surgeries for the treatment of L5/S1 LDH achieved satisfactory clinical outcomes; however, each procedure has its own advantages, disadvantages and indications. Surgeons need to choose the most appropriate surgery according to the individual condition of the patient to achieve the best therapeutic effect.

Self-Locking Stand-Alone Cage Used from Opposite Approach for the Treatment of Adjacent Segment Disease After an Anterior Cervical Corpectomy and Fusion.

AIM: To investigate the efficacy and safety of the self-locking stand-alone cage used from opposite approach for the treatment of adjacent segment disease (ASD) after an anterior cervical corpectomy and fusion (ACCF). MATERIAL AND METHODS: In this study, we retrospectively analyzed the clinical data of 8 cases of ACCF in the treatment of ASD cervical spondylopathy. All patients received self-locking stand-alone cage treatment. At different time points, the clinical status was evaluated using the Japan Orthopedic Association (JOA) score, JOA recovery rate (RR), and Neck Disability index (NDI) score. X-ray measurements included C2-C7 Cobb angle, fusion segment angle (FSA), cervical vertebral bow depth (VBP), and height of surgical segment (HOS). Statistical imaging parameters of sagittal cervical spine. Bone graft fusion in all self-locking stand-alone cage segments was evaluated. RESULTS: All operations were successfully completed, and no infection, epidural hematoma, or rupture of the dura mater were observed in all patients. Compared with pre-operation, the JOA and NDI scores at 3 months and at the last follow-up were significantly improved (p < 0.05). The JOA recovery rate between the final follow-up and preoperatively was 64.8±5.2%. One patient had dysphagia postoperatively, but was resolved after 3 months. Three months after surgery, the sagittal radiographic outcomes improved significantly and were well maintained during the final follow-up. CONCLUSION: The self-locking stand-alone cage is a reliable and effective method used from the opposite approach for the treatment of ASD after ACCF in terms of JOA and NDI scores. The cervical alignment correction is considered satisfactory.

Up-regulated SUMO1 expression by inhibition of miRNA-548m as a potential cause of congenital orofacial cleft in a fetus / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic etiology for a fetus with congenital orofacial cleft.@*METHODS@#Single nucleotide polymorphism microarray (SNP array) was carried out on skin tissues sampled from the fetus following induced abortion for the detection of copy number variation (CNVs). Pathogenicity of the candidate gene was validated through experiment.@*RESULTS@#SNP array revealed that the fetus has carried a hemizygous 9.23Mb deletion at Xq21.31-q22.1(91 063 807-100 293 555), which was inherited from its mother. The region contained 13 OMIM genes and 1 ncRNA coding gene(MIR548M). Inhibiting of the expression of the MIR548M gene in oral epithelial celllines has resulted in up-regulation of the expression of SUMO1 gene which was known to involve in the pathogenesis of orofacial cleft.@*CONCLUSION@#Dosage insufficiency of the MIR548M gene may underlie the etiology of orofacial cleft in this fetus.

Preimplantation genetic testing for a couple where the husband is affected by osteogenesis imperfecta combined with balanced translocation using karyomapping technique / 中华医学遗传学杂志

OBJECTIVE@#To carry out preimplantation genetic testing (PGT) for a couple where the husband was affected by osteogenesis imperfecta combined with balanced translocation using the karyomapping technique.@*METHODS@#Blastocysts were detected using karyomapping, the carrier status of COL1A1 c.760G>A (p.Gly254Arg) variant and the carrier status of the translocated chromosome were analyzed simultaneously.@*RESULTS@#For a total of 10 blastocysts, two euploid blastocysts were found to not carry the COL1A1 c.760G>A (p.Gly254Arg) variant but a balanced translocation. After transplanting one of the blastocysts, clinical pregnancy was achieved. Amniocentesis at 18th gestational week and prenatal genetic testing was in keeping with the result of PGT.A healthy female was born at 40+4 weeks gestation.@*CONCLUSION@#For patients simultaneously carrying genetic variant and balanced chromosomal translocation, PGT can be performed with efficiency by the use of karyomapping method.

The complications of strategic urethrostomy in the treatment of complicated hypospadias / 中华泌尿外科杂志

Objective To evaluate if strategic urethrostomy could reduce complications in complicated hypospadias repair.Methods From January 2016 to August 2018,165 patients of complicated hypospadias were reviewed according to inclusion criteria.They were divided into three groups of one-stage repair (group A,n =86),two-stage repair using Bracka procedure (group B,n =49) and strategic urethrostomy (group C,n =30).The median age was 26 months in group A,24 months in group B and 28 months in group C.The median length of urethral defect was 3.0 (2.0-10.0) cm,4.0 (2.5-10.0) cm and 3.8(2.5-11.0) cm in the different three groups,respectively.No difference showed in age or length of urethral defect among 3 groups.Three groups were compared with rates of urethral fistula,urethral stricture and urethral diverticulum.Results After average of 20.0 months follow-up,the urethral stricture incidence of group C [3.3％ (1/30)] was significantly lower than that of group A [22.0％ (19/86),P =0.023] and group B[24.5％ (12/49),P =0.032].The complications were found in 7 patients with urethral fistula and 11 patients with urethral diverticulum in group A,4 patients with urethral fistula and 3 patients with urethral diverticulum in group B,none patient with urethral fistula nor urethral diverticulum in group C,respectively.The incidence of urethral fistula was 8.1％ (7/86),8.2％ (4/49) and 0 in the three groups,and the rate of urethral diverticulum was 12.8％ (11/86),6.1％ (3/49) and 0,respectively.None difference was shown neither in the incidence of urethral fistula nor urethral diverticulum among the three groups(P ＞ 0.05).Conclusions Strategic urethrostomy is a novel and effective method for complicated hypospadias repair.Application of strategic urethrostomy can significantly decrease urethral stricture and improve success rate in complicated hypospadias repair.

Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group.

OBJECTIVE: The purpose of this study was to compare the outcomes of the buccal mucosa and lingual mucosa used in children who received multiple failed hypospadias surgeries. METHOD: We conducted a retrospective study of 62 children who received buccal or lingual mucosa graft urethroplasty in our hospital between 2012 and 2015. The ages ranged from 3.5-11 y. All cases included multiple failed hypospadias procedures, and the subjects received previous operations 2-3 times. All patients underwent one-stage operations. Thirty-three cases were treated with lingual mucosa grafts. The patient ages ranged from 3.5 to 11 y (median 7.5 y), and they had previous operations 2-3 times (mean 2.8±0.7). Grafts ranged from lengths of 2-6 cm (mean 5.1±0.46 cm) and widths of 0.5-1.5 cm (mean 1.2± 0.16 cm). Our follow-up was 5 to 12 m (mean 8.3±1.2 m). Twenty-nine cases were treated with buccal mucosa grafts. The patient ages ranged from 4 to 9.2 y (median 7.0 y), and they had previous operations 2-3 times (mean 2.5±0.2). Grafts ranged from lengths of 2-5.3 cm (mean 4.9± 0.28 cm) and widths of 0.5-1.5 cm (mean 1.0±0.11 cm). Our follow-up was 5 to 12 m (mean 7.9±0.5 m). The results were tested with SPSS 18.0. The rates of complications were compared by a chi-square test, and pre-operative conditions were compared by t test. RESULTS: For the outcomes of the two groups, there was no significant difference between the groups in terms of age, preoperative surgery time, and the length and width of the grafts (p>0.05). For the lingual mucosa graft group, fistula: 2/33 (6.0%), stricture: 1/33(3.0%), ventral curvature: 2/33(6.0%), complications: 5/33(15.0%), success rate: 28/33(84.8%), Hose score: 14.34±0.95, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.3±0.4 ml/s. For the buccal mucosa graft group, fistula: 2/29(6.8%), stricture: 2/29(6.8%), ventral curvature: 1/29 (3.4%), complication rate: 5/29(17.0%), success rate: 24/29 (83.0%), Hose score: 14.28±1.03, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.2±0.2 ml/s. There were no differences between the two groups for overall success, complication rates, peak flow, and the Hose scores(P>0.05). CONCLUSION: The lingual mucosal graft and the buccal mucosa graft both achieved good outcomes, and the lingual mucosa graft made up for the shortcomings of the buccal mucosa graft, which provided a reliable way to treat the multiple failed hypospadias surgeries in pre-pubertal boys.

Congenital urethral diverticulum with infertility in an adult man and review of the literature.

INTRODUCTION: Congenital anterior urethral diverticula in adult males are infrequent urological diseases, which they were mainly found in women. The etiology of female diverticula is that (Mohan et al. in J Urol 123(4):592-594, 1980) women have anatomically poorly supported urethral. Clinical presentation frequently involves urinary urgency, polyuria, postmicturition dribble, and hematuria. CASE DESCRIPTION: A 37 year-old male was presented to us complaining of infertility about 6 years after marriage. DISCUSSION AND EVALUATION: However, the complaint of infertility is extremely rare. Diagnostic imaging is useful to effectively confirm this disease in most cases. A complete review of the literature on this topic was also carried out. CONCLUSION: Manifestation as complaining of infertility is extremely rare among the congenital patients. The purpose of the operation is to complete the removal of the urethral diverticulum, reconstruct the urethra and maintain urinary tract unobstructed. This article and the operation could help the patient resolve the problem of infertility and dissatisfactory with the ejaculation.

Selecting the right method for hypospadias repair to achieve optimal results for the primary situation.

BACKGROUND: Over the past two decades, Snodgrass tubularized incised plate (TIP) urethroplasty has become one of the dominant surgical techniques with wide applications and excellent cosmetic results. However, TIP has many limitations. We performed a retrospective study at our department and assessed the outcome of the inlay internal preputial graft for extending the applications of TIP. METHODS: Between January 2009 and December 2013, we performed a retrospective study consisting of approximately 508 primary distal and moderate cases. Patients with primary distal hypospadias who had mild or no chordee and good penile development were divided into the following 3 groups based on their procedures: (1) classic TIP hypospadias repair group (n = 198); (2) inlay buccal mucosa graft group (n = 150); and (3) inlay internal preputial graft group (n = 160). The median age was 1.6 years (range 1-4 years). Our data were analyzed statistically by the Chi square test with P < 0.05 indicating significant differences. RESULTS: The mean follow-up period was 18 months (range 6‒24 months). In the classic TIP group, the incidence of urinary fistula and meatal stenosis were both 3.0 % (6/198); in the inlay buccal mucosal graft group, the incidence of urinary fistula was 3.3 % (5/150), and the incidence of stenosis was 2.7 % (4/150); and in the inlay internal preputial graft group, the incidence of urinary fistula was 3.1 % (5/160), and the incidence of meatal stenosis was 4.4 % (7/160). The success rates of each group were as follows: the classic TIP group has a success rate of 93.9 % (186/198); the inlay buccal mucosa graft group had a success rate of 94.0 % (141/150); and the inlay internal preputial graft group had a success rate of 92.5 % (148/160). There were no statistically significant differences between the 3 groups with respect to complication rates. CONCLUSIONS: As the inner foreskin Snodgraft does not appear to be worse than the buccal mucosa graft, it is a good method for hypospadias repair, and this method is not inferior to TIP.

Appliance of microsurgery in the treatment of male infertility / 中华泌尿外科杂志

Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.

A clinical analysis of inlay buccal mucosal urethroplasty for hypospadias repair / 中华泌尿外科杂志

ObjectiveTo evaluate the effect of inlay buccal mucosa graft with tubularized incised urethral plates (TIP) urethroplasty for hypospadias repair. MethodsFrom January 2005 to December 2010,a total of 343 cases of hypospadias underwent a buccal mucosa graft with TIP urethroplasty.The patients aged from 6 months to 61 years,mean 7 years.One hundred and forty-seven were primary surgery cases,and 196 cases had a history of failed surgery.In primary cases,124 were distal type and 23 were proximal type.There were 137 distal type cases and 59 proximal types in failed case group.A buccal mucosa graft was harvested from lower lip,fixed into the incised urethral plates in primary cases.In re-do cases,open urethral and remove scar tissue were necessary. ResultsThe width of the buccal mucosa ranged 0.5 - 2.5 cm,length ranged 1.0 - 8.5 cm.All the patients were followed up for 6 - 36 months,average 16 months.In primary group,fistula occurred in 14 cases (9.5％ ),and urethral stricture in 2 cases (1.4％),in which 1 proximal case occurred both with urethral stricture and fistula; the overall success rate was 89.8％.In re-do group,fistula occurred in 32 cases ( 16.3％ ),and stricture in 13 cases (6.6％),in which 1 distal and 5 proximal cases occurred with both urethral stricture and fistula; the overall success rate was 80.1％. ConclusionsInlay buccal mucosal graft with TIP technique is an effective instrumentality for hypospadias repair because of its high successful rate,good cosmetic effect and without affecting on oral appearance and function in donor site.

Effects of diet-induced obesity on the development of testicle in Sprague Dawley rats / 中华临床营养杂志

ObjectiveTo investigate the effects of diet-induced obesity on the developmental process of testes in pubertal Sprague Dawley (SD) rats and explore the possible reversibility. MethodsSixty one-month-old male SD rats were randomly divided into a control group ( n =10) and a model group ( n =50 ), which were fed on a normal diet and a high-fat diet, respectively. After 8 weeks, all the rats in the control group and 10 rats randomly picked out from the model group were killed. The serum testosterone and estradiol levels were measured by enzymelinked inununosorbent assay. Their left testes sections were stained by HE method, and the histology was observed under optical microscope and the spermatogenic activity was evaluated by Johnsen scoring system. The remaining 40 rats in the model group were further randomly divided into 3 subgroups: continued high-fat diet subgroup ( n =13), resume normal diet subgroup (n =13), and weight-loss subgroup (n =14). The continued high-fat diet subgroup was fed by high-fat diet, while the other two subgroups were fed by normal diet. Rats in weight-loss group took normal diet with running 20 min/d. After 6 weeks, the same parameters were assessed using the same methods. ResultsAfter 8 weeks, compared with the control group, the testosterone level of the model group significantly decreased (P =0.024) and the estradiol level significantly increased ( P =0. 017). The result of HE staining showed that the spermatogenic cell layers decreased, with part of seminiferous tubule experiencing atrophy.The number of Leydig cell also decreased and lipo vacuole was seen in the interstitial tissue of testis. The Johnsen score of the model group was significantly lower than that of the control group (P =0.000). The testosterone level was significantly lower in the continued high-fat diet subgroup than that in resume normal diet subgroup ( P =0.001 ) and weight-loss subgroup ( P =0.000), and was significantly lower in resume normal diet subgroup than that in weight-loss subgroup ( P =0.001 ). The estradiol level was significantly higher in continued high-fat diet subgroup than that in resume normal diet subgroup ( P =0.001 ) and weight-loss group ( P =0.000 ), and was significantly higher in resume normal diet subgroup than that in weight-loss group ( P =0.001 ). HE staining showed that, pathological changes aggravating and worsening compared with the control group, the model group had significantly decreased seminiferous tubule cell layers, with some seminiferous tubules experiencing atrophy.The Johnsen score was significantly higher in weight-loss subgroup than that in the other two subgroups ( P =0.000and 0.001, respectively). The Johnsen score was negatively correlated with body weight ( r =- 0.962, P =0.000), and positively correhted with the serum testosterone level ( r =0.916, P =0.000 ). Conclusions High-fat diet can induce pubertal obesity in male SD rats, which is featured by testicular hypoplasia, decreased spermatogenesis, and endocrine dysfunction. Physical exercise may improve the conditions. The degree of obesity may be negatively correlated with the spermatogenic function.

The effectiveness of intervention intergrated health education, positive reinforcement behavioral therapy,music therapy and exercise on negative symptoms in inpatient with schizophrenia / 中华行为医学与脑科学杂志

Objective To explore the effectiveness of intervention measure intergrated health education, positive reinforcement behavioral therapy, music therapy and exercise on the negative symptoms in the inpatient with schizophrenia. Methods Sixty waning inpatients with schizophrenia were randomly divided into intergral in-tervention group(30 cases) and control group (30 people). The intergral intervention group were treated with health education, positive reinforcement behavioral therapy, music therapy and exercise, that lasted 8 weeks, and control group received ordinary rehabilitation treatment. The effectiveness of the measures were evaluated by scale for the Assessment of Nagative Symptoms (SANS) and IPROS scales before and after the intergral intervention. Results The scores of SANS and IPROS in the intergral intervention group were significant lower than those in the control group after the intergral intervention[43.68±20. 11,61.37±29.43;18.09±7.60,26.62±13.48; P<0.01], while the scores showed no difference before the intergral intervention [60.42±20.83,64.47±29.45;36.81±10.47,36.67±10.84; P>0.05]. Conclusions The intervention intergrated health education, positive reinforcement behavioral therapy, music therapy and exercise could improve negative symptoms and social function of the inpatient with schizophrenia.

Stereotactic aspiration combined with gamma knife radiosurgery for cystic brain metastasis / 中国微创外科杂志

Objective To evaluate the outcome of stereotactic aspiration combined with gamma knife radiosurgery in the treatment of cystic brain metastasis.Methods The study included 21 cases of cystic brain metastasis.There were 16 males and 5 females,with their age ranged 45～78 years old(mean,64.5 years old).Nineteen patients had a solitary tumor and 2 patients had two lesions.The mean diameter of tumors was 36 mm.The Karnofsky Performance Score(KPS) was ≥50%.A stereotactic aspiration was performed under CT guidance to drain the cystic fluid.Then the MASEP-SRRS gamma knife radiosurgery was performed.All brain metastasis were averagely enclosed within the 40%～65%(mean,50%) isodose shells of the radiosurgical fields with a peripheral dose of 16～22 Gy(mean,19.5 Gy).Results All the cases were followed for 1～3 months(mean,2.3 months) with CT or MRI scanning.Tumors completely disappeared in 12 lesions,subsided in 9 lesions,changed less than 10% in 1 lesion,and enlarged in 1 lesion.Cerebral necrosis and edema adjacent to lesions respectively developed in 1 case.No other severe complications were seen.The control rate of tumor was 95.7%(22/23).Twenty-one patients were followed for 6～36 months(mean,23.5 months).The followed-up results showed improvement of symptoms in 18 cases,no change in 2 cases,and exacerbation in 1 case.The survival rate at 6 months was 90.5%(19/21).And the 1-and 2-year survival rates were 62.5%(10/16) and 25%(3/12),respectively.One case survived beyond 3 years.The median survival time was 14.1 months.Conclusions Stereotactic aspiration combined with gamma knife radiosurgery is an ideal treatment for cystic brain metastasis.

Endoscopic treatment of ureteral calculi accompanied with polyps: A report of 35 cases / 中国微创外科杂志

Objective To evaluate the curative effect of endoscopic treatment of ureteral stones accompanied with polyps. Methods A total of 35 cases of ureteral stones complicated with polyps were treated under ureteroscope by using electrocauterization and pneumatic lithotripter. Results All polyps were successfully cauterized. Stones were fragmented in 88.6% (31 of 35) of the cases.Because the stones moved into renal pelvis, ESWL was adopted after the intubation of double-J catheter in 2 cases. Conclusions After polyps have been cauterized by electrocauterization in advance, the treatment for ureteral stones by using ureteroscopy and pneumatic lithotripter is safe and effective.