[Study on the effect of simple incision of ventral tunica albuginea on the correction of penile curvature in hypospadias].

Objective: To investigate the therapeutic effect of simple tunica albugineaincision and ventral penile lengthening surgery on the correction of penile curvature due to asymmetry of the cavernous bodies in hypospadias. Methods: A retrospective analysis was performed in 39 children with hypospadias who underwent simple tunica albuginea incision and ventral penile lengthening surgery for correcting asymmetry of the cavernous bodies from January 2016 to December 2018(36 of them were from Department of Pediatric Urology surgery, The Children's Hospital, Zhejiang University School of Medicine, and 3 from Department of Urology surgery, Affiliated Hospital ofJiaxing University), all of whom aged from 0.5 to 5, with a median age of 1.1 years. During the first stage of the operation, firstly penile skin and sarcoma was released by completely degloving the skin and fascia of penis, secondly the factor of short urethral plate was solved by transection of urethral plate, and then the dorsal length of penis (A), the ventral length of the penis before and after straightening by incision of tunica albuginea (B and C) were measured and recorded; onto the second stage of the operation, an artificial erection test was performed to observe the curvature of the penis, the dorsal and ventral length of the penis (D and E) were measured. The dorsal and ventral length of the penis before and after straightening were compared. Results: The dorsal length of penis (A) was 33-39(35.6±3.2) mm, the length of ventral length of penis before straightening (B) was 28-35 (29.8±2.8) mm and the length of ventral length of penis after straightening (C) was 32-38 (34.3±2.1) mm, which were measured during the first stage of operation, and the difference between B and C was statistically significant (P<0.05), while the difference between A and C was not statistically significant (P>0.05). The dorsal length of penis (D) was34-41 (36.4±2.5) mm and the ventral length of penis (E) was 33-40 (35.7±3.6) mm, which were measured during the second stage of operation, and there was no significant difference between D and E (P>0.05). The degree of penile curvature at the time of erection was less than 15° by measuring with the side photos in all patients during 0.5 to 2.5 years of follow-ups with an average of 1.7 years. Conclusions: Penile curvature due to the asymmetry of the cavernous bodies could be effectively corrected by simple incision of ventral tunica albuginea, which showed a good result of early follow-up. The effect of this surgery on ventral penile straightening could be verified by measuring and comparing the ventral and dorsal length of penis during surgery.

Use of 4+5 extensor compartmental vascularized bone graft and K-wire fixation for treating stage II-IIIA Kienböck's disease.

Vascularized bone grafts have shown favorable outcomes in Kienböck's disease, preventing the progression of lunate collapse and avascular necrosis. Here we describe our experience using a 4+5 extensor compartmental artery (ECA) vascularized bone graft combined with K-wire fixation. Between September 2010 and June 2013, 9 patients with Lichtman stage II-IIIA disease underwent arthroscopy prior to 4+5 ECA graft placement combined with temporary fixation (scaphocapitate and triquetrum-capitate joints). The average follow-up was 69 months (range, 51-92 months). Changes in pain, range of motion, grip strength, and pinch strength were analyzed. All patients had satisfactory recovery, especially pain relief and grip strength improvement (both P<0.01). Furthermore, magnetic resonance imaging follow-up was critical for monitoring lunate revascularization, especially in the early postoperative period.

Designing a 20 mm incision to protect the dorsal branch of the ulnar nerve during arthroscopic repair of triangular fibrocartilage complex injuries: Cadaver study and preliminary clinical results.

The ulnar-sided approach for arthroscopic peripheral triangular fibrocartilage complex (TFCC) repair may be associated with injury to the dorsal branch of the ulnar nerve (DBUN). The goal of this study was to develop a small incision to help minimize DBUN injury. Ten cadaveric upper limbs were used to measure the anatomic parameters of the DBUN. Based on these measured anatomical relationships, a 20 mm longitudinal incision with the ulnar styloid process as the midpoint was designed to explore and protect the DBUN. Three additional cadaveric upper limbs were used to test the feasibility of this method. Then this method was applied in 15 patients with TFCC injury (IB type). In 10 cadavers, the DBUN was located volar to the ulnar styloid process. The mean linear distance between the DBUN and the ulnar styloid process was 8.04 mm (range: 7.02-8.82mm) in the transverse-volar direction and 13.78 mm (range: 11.06-16.02mm) in the longitudinal-distal volar direction. In three additional cadavers, the DBUN was successfully explored and retracted with this incision, creating a safer space for passing sutures and tying knots. This modified method was used successfully in 15 patients, and the DBUN was protected during surgery. There were no complications, and most importantly, no injuries to the DBUN at the 6-month follow-up visit. Therefore, we recommend that a 20 mm longitudinal incision with the ulnar styloid process as the midpoint be made prior to passing sutures during the arthroscopic repair of TFCC tears to avoid injuring the various branches of the DBUN.

Nutrient addition does not increase the benefits of clonal integration in an invasive plant spreading from open patches into plant communities.

One benefit of clonal integration is that resource translocation between connected ramets enhances the growth of the ramets grown under stressful conditions, but whether such resource translocation reduces the performance of the ramets grown under favourable conditions has not produced consistent results. In this study, we tested the hypothesis that resource translocation to recipient ramets may reduce the performance of donor ramets when resources are limiting but not when resources are abundant. We grew Mikania micrantha stolon fragments (each consisting of two ramets, either connected or not connected) under spatially heterogeneous competition conditions such that the developmentally younger, distal ramets were grown in competition with a plant community and the developmentally older, proximal ramets were grown without competition. For half of the stolon fragments, slow-release fertiliser pellets were applied to both the distal and proximal ramets. Under both the low and increased soil nutrient conditions, the biomass, leaf number and stolon length of the distal ramets were higher, and those of the proximal ramets were lower when the stolon internode was intact than when it was severed. For the whole clone, the biomass, leaf number and stolon length did not differ between the two connection treatments. Connection did not change the biomass of the plant communities competing with distal ramets of M. micrantha. Although clonal integration may promote the invasion of M. micrantha into plant communities, resource translocation to recipient ramets of M. micrantha will induce a cost to the donor ramets, even when resources are relatively abundant.

[Effects of berberine on the serum cystatin C levels and urine albumin/creatine ratio in patients with type 2 diabetes mellitus].

Objective: To investigate the effects of berberine on urine albumin/creatine ratio (UACR) and serum cystatin C (Cys C) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 114 T2DM inpatients or outpatients, including 46 males and 68 females aged (55±14) years between January 2015 and January 2016 were randomly divided into two groups: the control group (n=57) only with hypoglycemic agents, and the intervention group (n=57) with berberine (0.4 g, 3 times a day) on the basis of treatment from the control group. Both groups were treated and followed up for six months. All the clinical and biochemical parameters were routinely evaluated before and after treatment. And the safety of berberine was assessed. Results: After the treatment, the improvement of glycosylated hemoglobin (HbA1c), blood urea nitrogen (BUN), systolic pressure (SP), high sensitive C-reactive protein (hs-CRP), rythrocyte sedimentation rate (ESR), estimated glomerular filtration rate (eGFR) in the intervention group were significantly better than those in the control group (all P<0.05), as well as the UACR[47(26, 120) mg/g vs 103(42, 267) mg/g, P<0.001]and serum Cys C[(0.83±0.30) mg/L vs (0.98±0.25) mg/L, P=0.031]. However, there was no statistically significant difference of UACR and Cys C between before and after treatment in the control group (all P>0.05). Compared to the control group, the patients in the intervention group had lesser UACR[47(26, 120) mg/g vs 68(28, 158) mg/g, P=0.039], and lower serum Cys C[(0.83±0.30) mg/L vs (0.96±0.30)mg/L, P=0.041]. Berberine had no obvious adverse effects. Multiple linear regression analysis revealed that the berberine administration was independently associated with the reduction of UACR (ß=-0.051, P=0.041) and Cys C (ß=-0.068, P=0.033) in T2DM patients. Conclusion: Berberine improves diabetic kidney disease by reducing UACR and serum Cys C in T2DM patients, and it was safe.

[Association between serum uric acid levels and high sensitive C-reactive protein in patients with type 2 diabetes].

Objective: To investigate the relationship between serum uric acid (SUA) levels and high sensitive C-reactive protein (hs-CRP) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 400 patients who were hospitalized in the Department of Endocrinology and Metabolism of Jinshan Branch, Shanghai Sixth People's Hospital between April 2014 and December 2015 were divided into normouricemia (NUA, n=319) group and hyperuricemia (HUA, n=81) group according to the presence of HUA. Clinical features of the two groups were compared. Patients were further stratified into quartiles based on SUA levels, and then association between hs-CRP and SUA was analyzed. Results: Compared to the NUA group, the patients with HUA had higher hs-CRP concentration [2.12 (1.15, 6.73) mg/L vs 1.14 (0.52, 3.44) mg/L, P<0.001], erythrocyte sedimentation rate (ESR) [19.0 (10.5, 29.5) mm/h vs 12.0 (8.0, 17.0) mm/h, P<0.001], body mass index (BMI) [(25.2±3.6) kg/m(2) vs (23.6±3.6) kg/m(2,) P<0.001], and homeostasis model assessment-2 of insulin resistance (HOMA2-IR) index [1.88 (1.11, 2.94) vs 1.27 (0.77, 2.00), P<0.001]. After adjusting for age, the median level of hs-CRP of female with HUA was higher than that of male, female with NUA, and male with NUA (2.59, 1.94, 1.25 and 1.09 mg/L, respectively, P<0.001). There was significant difference in the prevalence of HUA among the patients with underweight, normal weight, overweight, and obesity (0, 12.3%, 21.6% and 25.8%, respectively, P=0.002). After adjusting for age and gender, duration of diabetes, BMI, serum lipids, level of SUA was still correlated with hs-CRP, HOMA2-IR, fasting C-peptide, blood urea nitrogen, serum creatinine, Cystatin C, microalbuminuria, respectively(all P<0.05). The level of SUA was positively associated with the increase of hs-CRP level (P=0.001). Multiple linear regression analysis showed that there was an independent and positive association between SUA and hs-CRP levels. Conclusion: SUA was independently associated with hs-CRP in T2DM patients, which suggested that chronic inflammation exists in HUA patients.