Abstract:IN post-human genomic era,the concept of precision medicine has provided opportunities for "reinterpretation" and "new orientation" for cancer therapy including prostate cancer.Prostate cancer is the leading cause of cancer-related death in men,and its traditional treatment meets bottleneck and needs broken through,while the concept of precision medicine is starting to have positive effect.Precision medicine has potential values in optimizing the clinical reclassification of patients,androgen deprivation therapy (ADT),chemotherapy,and radiation therapy strategies for prostate cancer.When traditional treatment of prostate cancer gradually loses efficacy,the prostate cancer molecular subtyping map and the development of targeted therapies are expected to bring new breakthrough.At the same time,precision medicine also prompts new therapeutic concepts for prostate cancer,such as reconstruction of the immune environment,tumor-specific neoantigens prediction,and organoid culture system.The future of precision medicine has been widely embraced and it will have promising application in the diagnosis and treatment of prostate cancer.However,currently the benefit of precision treatment of cancer is still far below the public expectations.Like for many emerging concepts,the potentially huge market behind precision medicine inevitably breeds overheated commercial propaganda.Full communication and cooperation of scientific researchers with clinical doctors and patients,and standardization and guidance of health administration are the keys to ensure that precision medicine benefits for human health.

Abstract:Objective To investigate the value of abnormal thickening of the junctional zone, and T₁ weighted imaging (WI) and (or) T₂WI hyperintense in magnetic resonance imaging (MRI) for the diagnosis of uterine adenomyosis. Methods The MRI images of 37 cases of adenomyosis confirmed by pathology in Changhai Hospital of Navy Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2016 were retrospectively analyzed, and 37 cases of normal uterus and ovary confirmed by MRI in the same period were randomly selected as controls. The maximal junctional zone thickness (JZ_max), the difference between the smallest and largest junctional zone thickness (JZ_diff), and the ratio of JZ_max to maximal myometrium thickness (JZ_max/M_max) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve of each parameter in diagnosis of adenomyosis was drawn, and the area under curve (AUC), cut-off value, sensitivity, specificity and accuracy were calculated. In addition, the T₁WI and T₂WI hyperintense and their types in the uterine wall were observed. Results There were significant differences in JZ_max, JZ_diff and JZ_max/M_max between the adenomyosis and control groups (all P<0.01). The AUC for the diagnosis of adenomyosis by JZ_max, JZ_diff, and JZ_max/M_max were 0.95, 0.90, and 0.85, respectively. When JZ_max ≥ 10 mm, the sensitivity, specificity and accuracy were 78.8%, 97.3% and 88.6%, respectively; when JZ_diff ≥ 3.4 mm, those were 81.8%, 91.9% and 87.1%, respectively; When JZ_max/M_max ≥ 61%, those were 72.7%, 83.8% and 78.6%, respectively. Eighteen cases (48.6%) had only T₂WI hyperintense, while 14 cases (37.8%) had both T₁WI and T₂WI hyperintense; most of them showed snowdrift sign on T₁WI and (or) T₂WI. T₁WI and (or) T₂WI showed linear stripe sign in 5 cases (13.5%), microcapsule sign in 5 cases (13.5%), and cystic hemorrhage syndrome in 1 case (2.7%). Conclusion JZ_max ≥ 10 mm, JZ_diff ≥ 3.4 mm and JZ_max/M_max ≥ 61% have significant diagnostic value in diagnosis of adenomyosis, and JZ_max has the best diagnostic efficiency. Snowdrift sign, linear stripe sign, microcapsule sign and cystic hemorrhage sign on T₁WI and (or) T₂WI are unique for the diagnosis of adenomyosis. Comprehensive evaluation of the above signs can improve the diagnostic value of MRI and early accurate diagnosis of adenomyosis.

Abstract:Objective To establish a submental tumorigenesis model by injecting human hypopharyngeal carcinoma cells to nude mice, and to compare the model with traditional axillary tumorigenesis model. Methods Five-week-old male nude mice were selected and divided into submental tumorigenesis model group (submental group) and axillary tumorigenesis model group (axillary group). Each group was divided into two subgroups by injecting human hypopharyngeal carcinoma cells FADU or HN31, namely sub-FADU, sub-HN31, ax-FADU, and ax-HN31 groups, with 12 nude mice in each group. The nude mice in the submental group were injected with tumor cells in the left side of submental area, and those in the axillary group were injected with tumor cells in the right side of axillary area. The time of tumor formation, tumor volume and body mass of nude mice were measured. The death of nude mice was recorded. After eight weeks, the local tumor growth, infiltration, and organ metastasis such as liver, spleen and kidney of the survival nude mice were examined by ultrasound, and the tumor metastasis was observed by routine H-E staining and immunohistochemical staining. Results On the 7^th and 9^th days after injection, the tumors were observed in the submental group and the axillary group. On the 33^rd day after injection, the tumor volume in the ax-FADU and ax-HN31 groups was significantly bigger than those in the sub-FADU and sub-HN31 groups (P<0.05, P<0.01). The body mass of nude mice in each group reached peak on the 17^th to 19^th days after injection, and thereafter the body mass in the submental group was gradually decreased and that in the axillary group was still increased. On the 33^rd day after injection, the body mass in the ax-FADU and ax-HN31 groups were significantly higher than those in the sub-FADU and sub-HN31 groups, respectively (P<0.01). After eight weeks, there were eight deaths in the sub-FADU group and 10 in the sub-HN31 group, with six mice alive in the submental group; there were six deaths in the ax-FADU group and six in the ax-HN31 group, with 12 alive in the axillary group. There was no significant difference in mortality of nude mice between the four subgroups. Ultrasound and pathological examination showed that four survived nude mice were found with cervical lymph node and liver metastases in the submental group, and only one was found with liver metastases in the axillary group; and the difference between the two groups was statistically significant (P<0.05). There were two pulmonary metastases in the submental group, and one in the axillary group; there was one spleen metastases in the submental group and no spleen metastases in the submental group; and there were no significant differences between the two groups. Conclusion Submental tumorigenesis model and axillary tumorigenesis model have their own characteristics. The submental tumorigenesis model has shorter tumorigenesis time, higher local invasion and higher distant metastasis rate, and is suitable for studying the invasiveness and metastasis of tumor in vivo. The axillary tumorigenesis model has larger volume of tumor, less injury to the adjacent organs and tissues, longer survival time and lower distant metastasis rate, and is suitable for the study of the characteristics of tumor cells.

Abstract:Objective To investigate the effect of preoperative carbohydrate antigen 19-9 (CA19-9) levels on the prognosis of hepatocellular carcinoma (HCC) patients with different α-fetoprotein (AFP) levels. Methods The medical records and follow-up data of 3 791 HCC patients undergoing hepatectomy in our hospital from Jan. 4, 2008 to Dec. 31, 2010 were prospectively collected. When 400 ng/mL was taken as the cut-off value of preoperative AFP level and 32 U/mL as the cut-off value of preoperative CA19-9 level, the patients were divided into four groups:double positive group (DP group), CA19-9 single positive group[SP (CA19-9) group], AFP single positive group[SP (AFP) group] and double negative group (DN group). The tumor characteristics of the patients in the four groups were compared. Kaplan-Meier analysis and log-rank test were used to analyze the overall survival (OS) and disease-free survival (DFS) of each group. Univariate and multivariate analyses were performed using Cox proportional hazards model to screen the independent factors influencing the prognosis of HCC patients. Results Patients in the four groups had different tumor characteristics. Compared with the DN group, the tumor maximal diameters of patients in the SP (AFP) and DP groups were significantly larger, the percentages of patients with Edmondson-Steiner grade Ⅲ-Ⅳ were significantly higher and the positive rates of microvascular invasion (MVI) were significantly higher (P<0.01), and the proportion of multiple tumor in the DP group was significantly higher (P<0.05); while the tumor maximal diameter in the SP (CA19-9) group was significantly smaller (P<0.05), and the proportion of multiple tumor was significantly higher (P<0.01). The 1-, 3- and 5-year OS rates of patients in the DN group, SP (CA19-9) group, SP (AFP) group and DP group were decreased successively (P<0.01). The 1-, 3- and 5-year DFS rates of patients in the DN group were the highest (P<0.01), while those in the DP group were the lowest (P<0.01); there were no significant differences in the 1-, 3- or 5-year DFS rates between the SP (CA19-9) and SP (AFP) groups. The stratified analysis of preoperative AFP levels showed that the 1-, 3- and 5-year OS rates and DFS rates in the CA19-9<32 U/mL group were significantly higher than those in the CA19-9 ≥ 32 U/mL group. Multivariable analysis showed that AFP ≥ 400 ng/mL, CA19-9 ≥ 32 U/mL, intraoperative bleeding ≥ 600 mL, tumor maximal diameter ≥ 5 cm, multiple tumor, absence of tumor capsule, MVI, and Edmondson-Steiner grade Ⅲ-Ⅳ were independent risk factors of OS (P<0.05); hepatitis B surface antigen (+), AFP ≥ 400 ng/mL, CA19-9 ≥ 32 U/mL, tumor maximal diameter ≥ 5 cm, multiple tumor, absence of tumor capsule, and MVI were independent risk factors of DFS (P<0.05). Conclusion Preoperative serum AFP ≥ 400 ng/mL and CA19-9 ≥ 32 U/mL are independent risk factors of OS and DFS in HCC patients. Preoperative CA19-9 level is an important indicator to further assess the prognosis of HCC patients with different AFP levels.

Abstract:Objective To investigate the changes of caesarean section rate, success rate of vaginal labor and intrapartum cesarean indications after applying the new criteria of labor. Methods The clinical data of 5 769 pregnant women who delivered in Changhai Hospital of Navy Medical University (Second Military Medical University) during Jan. 2013 to Dec. 2016 were collected. Among them, 2 829 pregnant women who delivered during Jan. 2015 to Dec. 2016 were enrolled into study group, of which 1 824 women undergoing vaginal trial production were treated with the new criteria of labor by Obstetrics Group of the Society of Obstetrics and Gynecology of the Chinese Medical Association to manage the labor process; 2 940 pregnant women who delivered during Jan. 2013 to Dec. 2014 were enrolled into control group, of which 1 779 women undergoing vaginal trial production were treated according to the original criteria of labor to manage the labor process. The caesarean section rate, the composition ratio of surgical indications, the success rate of vaginal labor and the indications of vaginal trial production for conversion to cesarean section between the two groups were statistically analyzed. Results The caesarean section rate in the study group was 52.7% (1 490/2 829), being significantly lower than that in the control group (57.7%, 1 696/2 940; P<0.05). Among the pregnant women undergoing vaginal trial production, the success rate of vaginal labor in the study group was significantly higher than that in the control group (73.4%[1 339/1 824] vs 69.9%[1 244/1 779], P<0.05). Scarred uterus (23.4%, 348/1 490), fetal distress (19.0%, 283/1 490), and social factors (11.3%, 168/1 490) were the primary cesarean indications in the study group, while fetal distress (21.0%, 356/1 696), social factors (16.2%, 275/1 696), and scarred uterus (14.5%, 246/1 696) were the primary cesarean indications in the control group. The composition ratio of scarred uterus in the study group was significantly higher than that in the control group, and the ratios of social factors and gestational diabetes mellitus (5.8%[86/1 490] vs 7.5%[127/1 696]) were significantly lower than those in the control group (P<0.05). The main indications of vaginal trial production for conversion to cesarean section were fetal distress and social factors. There was no significant difference in fetal distress between the study and control groups (36.3%[176/485] vs 37.2%[199/535]), P>0.05]. However, the ratio of social factors and abnormal fetal position in the study group were significantly higher than those in the control group (26.6%[129/485] vs 20.9%[112/535], 17.3%[84/485] vs 12.5%[67/535]; P<0.05), and the date of abnormal labor progresses at a rate (including labor protraction and labor arrest) was significantly lower (8.9%[43/485] vs 14.8%[79/535], P<0.05). There were no significant differences in the incidences of postpartum hemorrhage, deep perineal laceration, neonatal asphyxia, or puerperal infection between the two groups (P>0.05). Conclusion The new criteria of labor has great clinical value in reducing the cesarean section rate and improving the success rate of vaginal trial production. When implementing the new criteria of labor, we should emphasize the standardized management of birth process and follow the principle of individualization.

Abstract:Objective To investigate the quality of life of inpatients with lung cancer and its influencing factors. Methods A total of 120 inpatients with lung cancer in Department of Respiratory Medicine of Changhai Hospital of Navy Medical University (Second Military Medical University) from Sep. 2016 to Mar. 2017 were surveyed. The Chinese version of EORTC QLQ-C30 and lung cancer specific module QLQ-LC13 were used to assess the quality of life of the inpatients. The multiple linear regression analysis was performed to analyze the factors influencing life quality, with the general data of the inpatients as independent variables and the scores of various domains of life quality as dependent variables. Results A total of 95 valid questionnaires were recovered, and the response rate was 79.2%. Gender, age, occupation, residence, number of children, smoking, drinking, tumor staging, metastasis, with or without concomitant diseases and frequency of chemotherapy were related to the scores of different domains of life quality (P<0.05). Patients with younger age (<50 years old) had higher symptom scores of anorexia (β=-8.266), diarrhea (β=-5.263), and dysphagia (β=-6.307). Female patients had a lower score of cognitive function (β=-11.270), and had higher symptom scores of nausea/vomiting (β=11.725) and anorexia (β=17.090) versus male patients. Patients with advanced tumor stage (Ⅳ) or without occupation both had higher symptom scores of diarrhea (β=2.070, 7.130). Patients with frequent chemotherapies (more than six times) had a higher symptom score of pain (β=5.871). Patients with concomitant diseases had a lower score of overall health status (β=-17.239), and had higher symptom scores of peripheral neuropathy (β=11.970) and pain in the chest (β=11.061). Smoking patients had a higher symptom score of dyspnea (β=21.151). Drinking patients had a higher symptom score of constipation (β=13.525). Patients with tumor metastasis had a higher score of role function (β=15.039). Residence was associated with several domains of life quality; inpatients in Shanghai had better life quality. Patients with large number of children (≥ 2) were more emotionally stable (β=10.078). Conclusion Patients with lung cancer should be concerned about their physical condition and psychological condition during treatment. It is necessary to provide corresponding social support and psychological counseling based on the individual characteristics in order to improve the quality of life and prognosis of lung cancer patients.

Abstract:Objective To investigate the influencing factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods A total of 181 CKD patients undergoing multi-slice spiral computed tomography for coronary artery were selected. The patients were divided into four groups of CKD 1 stage, CKD 2-3 stage, CKD 4-5 stage and maintenance hemodialysis (MHD) according to the kidney disease outcome quality initiative (K/DOQI) guidelines established by the National Kidney Foundation. According to the CAC scores assessed using the Agatston scoring method, the patients were divided into non-CAC group (CAC score ≤ 10), mild CAC group (CAC score 11-100), moderate CAC group (CAC score 101-400), and severe CAC group (CAC score>400). The related factors and independent influencing factors of CAC in CKD patients were analyzed by Spearman linear regression analysis and multivariate Cox regression analysis, respectively. Results Of the 181 patients, 44 were CKD 1, 36 were CKD 2-3, 25 were CKD 4-5, and 76 were MHD. The incidence of CAC in the CKD patients and MHD patients was 55.3% (100/181) and 80.3% (61/76), respectively. The CAC score of CKD patients was significantly increased with the aggravation of renal impairment (r=0.526, P<0.001). The degree of CAC in the CKD patients was positively correlated to age, dialysis duration, average arterial pressure, blood urea nitrogen, serum creatinine, C-reactive protein, total cholesterol, serum calcium, serum phosphorus, calcium-phosphorus product, and serum fibroblast growth factor 23 (FGF23) level (r=0.135, 0.525, 0.139, 0.141, 0.824, 0.135, 0.140, 0.138, 0.391, 0.453, and 0.326; all P<0.05), and negatively correlated to estimated glomerular filtration rate (eGFR), fetuin A, and 25-hydroxy vitamin D₃ (r=-0.871, -0.135, and -0.138; all P<0.05); the degree of CAC was not significantly correlated with hemoglobin, blood glucose, triglyceride, alkaline phosphatase, or intact parathyroid hormone (all P>0.05). Multivariate Cox regression analysis showed that age, eGFR, serum phosphorus, calcium-phosphorus product and serum FGF23 level were the independent influencing factors of CAC in CKD patients (OR[95% CI]:3.723[2.521-8.363], 0.582[0.415-0.724], 5.252[0.415-0.724], 11.243[10.185-16.836], and 2.469[1.141-5.362]). Conclusion Age, eGFR, serum phosphorus, calciumphosphorus product and serum FGF23 level are independent influencing factors of CAC in CKD patients.

Abstract:Objective To analyze the pathological and anatomic features of myocardial bridge (MB) using coronary computed tomography angiography (CTA), so as to deepen the understanding of MB. Methods The data of 1 658 patients with MB diagnosed by coronary CTA were retrospectively analyzed. The distribution of MB in the coronary system were analyzed, the length of mural coronary artery (MCA) and average systolic stenosis rate of different types of MB were measured, and the anatomic morphological differences of different types of MB were statistically analyzed. Results Among the 1 658 patients, 1 606 (98.86%) were single MB in single coronary artery, 9 (0.54%) were multiple MB in single coronary artery, and 43 (2.60%) were single MB in different coronary arteries. A total of 1 606 MB lesions in 1 559 cases (94.03%) were located at the left anterior descending (LAD) coronary artery, 87 MB lesions in 81 cases (4.88%) at the left circumflex (LCX) coronary artery, and 19 MB lesions in 18 cases (1.09%) at the right coronary artery (RCA). There were 1 244 cases (75.03%) of incomplete MB, 362 cases (21.83%) of complete MB, and 52 cases (3.14%) of complex MB with the features of both types. The length of MCA in the complex MB was significantly longer than that of the complete MB ([24.32±4.02] mm vs[16.13±1.27] mm, P<0.05). The incidence of systolic stenosis rate>50% (31.19%[388/1 244] vs 41.16%[149/362]), incidence of proximal coronary artery disease (9.41%[117/1 244] vs 35.08%[127/362]), positive rate of ischemic symptom (32.88%[409/1 244] vs 58.29%[211/362]), and positive rate of ischemic electrocardiogram (37.78%[470/1 244] vs 65.75%[238/362]) of the incomplete MB were significantly lower than those of the complete MB (all P<0.05). Conclusion MB lesions mainly locate at LAD coronary artery and are single MB in single coronary artery. MB-MCA morphology can be divided into complete, incomplete and complex types by coronary CTA, with incomplete type being the main type, and each type of MB has different clinical and morphological features.

Abstract:Objective To investigate the protective effect of ginkgolide A and ginkgolide B (GKAB) mixture on neurons of rats with permanent middle cerebral artery occlusion (pMCAO) and related molecular mechanisms. Methods Sixty male Sprague-Dawley rats were randomly divided into sham group, pMCAO permanent focal cerebral ischemia group and GKAB-treated low-, medium- and high-dose groups. In addition to the sham group (only isolated without interruption of the arteries), the rats in the remaining four groups were induced pMCAO by blocking the right middle cerebral artery. Rats in the GKAB-treated low-, medium- and high-dose groups were injected with GKAB 12.5, 25, and 50 mg/kg through sublingual vein at 10 min after pMCAO, while the sham and pMCAO groups were injected with saline of the same volume as the medium-dose group. After 12 h of treatment, the neuronal apoptosis was determined by TUNEL method, the level of phosphorylated c-Jun N-terminal kinase (p-JNK) was determined by immunohistochemistry, the expressions of p-JNK, Bcl-2, Bax, cytochrome C (Cyt C), caspase-9, caspase-3, cleaved caspase-9, and cleaved caspase-3 in brain tissues were detected by Western blotting. Results Compared with the sham group, the apoptosis rate and p-JNK expression of neurons in the pMCAO group were significantly increased (P<0.01), and the expressions of apoptosis-related proteins Bax, cleaved caspase-9 and cleaved caspase-3 in brain tissues were significantly increased (P<0.01), while the expressions of Bcl-2, caspase-9 and caspase-3 in brain tissues were significantly decreased (P<0.01). Compared with the pMCAO group, the apoptosis rate and p-JNK expression of neurons in GKAB-treated low-, medium- and high-dose groups were significantly decreased (P<0.01), the expressions of Bax, cleaved caspase-9 and cleaved caspase-3 protein were significantly decreased (P<0.01), and the expressions of Bcl-2, caspase-9 and caspase-3 were significantly increased (P<0.01) in a dose-dependent manner. Compared with the sham group, the expression of Cyt C in cytoplasm in the pMCAO group was significantly increased, and the expression of mitochondrial Cyt C was significantly decreased (P<0.01). Compared with the pMCAO group, the expressions of Cyt C in cytoplasm in the GKAB-treated low-, medium- and high-dose groups were significantly decreased in a dose-dependent manner, and the expressions of mitochondrial Cyt C were significantly increased (P<0.05, P<0.01). Conclusion GKAB can inhibit neuronal apoptosis after pMCAO in rats, and its mechanism may be related to the inhibition of JNK phosphorylation and JNK signaling pathway and the block of mitochondrial apoptosis pathway.

Abstract:Objective To investigate the effect of celastrol on proliferation, migration and epithelial-mesenchymal transition of nasopharyngeal carcinoma cells. Methods Human nasopharyngeal carcinoma cells HNE1 and CNE2 were treated with 1.8 μmol/L celastrol, and the cells treated with equal volume of dimethyl sulfoxide (DMSO) were used as control. The proliferation of HNE1 and CNE2 cells was detected by CCK-8 assay, the migration of cells was detected by cell scratch test, the clone formation was detected by cell colony formation assay, the adhesion and separation abilities of cells were examined by cell adhesion and separation experiments, and the expression of E-cadherin, β-catenin, N-cadherin and vimentin was detected by Western blotting analysis. Results Compared with the DMSO group, the proliferation of HNE1 cells was significantly decreased after treated with 1.8 μmol/L celastrol for 24, 48 and 72 h (all P<0.05), and the proliferation of CNE2 cells was significantly decreased for 48 and 72 h (both P<0.05); the migration ability of HNE1 and CNE2 cells was significantly decreased after treated with 1.8 μmol/L celastrol for 48 h (both P<0.05); and the clone formation of HNE1 and CNE2 cells was significantly decreased after treated with 1.8 μmol/L celastrol for two weeks (both P<0.05). The adhesion rate of HNE1 and CNE2 cells 1 h after treatment and separation rate 24 h after treatment in the celastrol groups were significantly lower than those in the corresponding DMSO group (both P<0.05). Western blotting analysis showed that the expressions of E-cadherin and β-catenin in HNE1 and CNE2 cells in the celastrol groups were significantly increased compared with the DMSO group, while the expressions of N-cadherin and vimentin were significantly decreased 6 h after treatment (all P<0.05). Conclusion Celastrol can inhibit the proliferation, migration and epithelial-mesenchymal transition of nasopharyngeal carcinoma cells HNE1 and CNE2.

Abstract:Calcium as a ubiquitous messenger participates in the pathophysiology progresses of various cells. Synchronized calcium signaling transduction is related to normal cardiac myocyte excitation-contraction coupling and beating rhythm. Calcium homeostasis abnormality in atrial myocyte is an important influencing mechanism of atrial fibrillation (AF), and it is mostly resulted from calcium leak caused by destabilization of sarcoplasmic reticulum calcium release channel ryanodine receptor 2 (RyR2). Calcium leaks, including calcium sparks and calcium waves, can trigger extra depolarization and even action potential, and cause AF on the basis of atrial pathology altering matrices. In this review, we summarized the manifestations and influencing factors of calcium leak, and its potential role in the development and progress of AF.

Abstract:Asthma is a common inflammatory disease in childhood. The interaction of genes, environment and host factors contributes to the development and progression of asthma, and the heterogeneity of asthma leads to the complexity of asthma phenotype classification. In this article, we reviewed recent analyses of asthma phenotypes in children using different criteria, including the age of onset, breathing pattern, clinical characteristics, airway inflammatory cells, risk factors, immunity and genetics, and assessed the prognosis of previous asthma phenotypes based on the above criteria, hoping to provide evidence for the treatment and prognosis of children with asthma.

Abstract:Objective To explore the feasibility of single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia. Methods The clinical data of 350 patients with inguinal hernia, who underwent single channel laparoscopic extraperitoneal high ligation in our department from Jun. 2015 to May 2016, were analyzed retrospectively. The surgical methods, operation time and postoperative complications were analyzed. Results The surgery was completed successfully on 350 cases. The average operative time was (4.5±1.2) min in the unilateral inguinal hernia, and (8.0±1.2) min in the bilateral ones. All patients were discharged on the first day after surgery, and the average hospital stay was (2.6±0.8) days. No inguinal pain or scrotal hematoma occurred after surgery. During the follow-up of 6 months to 1 year, there were no complications such as hernia recurrence, line reaction or testicular atrophy. Conclusion Single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia keeps the puncture needle in the same tunnel, which avoids the postoperative pain at the puncture point and reduces the line reaction. It is safe and feasible, and is worth recommending for clinical use.

Abstract:Objective To investigate the epidemiology and causes of skin diseases in marine-training soldiers stationed in east coastal areas of China under the military training environment in new period, and to propose measures for prevention and treatment. Methods Multi-stage sampling including cluster sampling, stratified sampling and simple random sampling were used to select 768 marine-training soldiers stationed in the east coastal areas of China. They were surveyed by a questionnaire and received physical examination of skin diseases before diagnosing and prescribing by attending physicians. Logistic multiple regression analysis was used to analyze the relationship between skin diseases and the possible causes of skin diseases. Results A total of 696 (90.63%) valid questionnaires were collected, and the participants ranged in age from 17-32 years old. It was found that 349 (50.14%) soldiers had skin diseases, which fell into 34 types, with a total of 755 onsets, mainly infectious skin diseases (565 onsets, 74.83%). The incidence of skin diseases among marine-training soldiers was related to climate, environment, training conditions, and eating habits, and the causes of the disease were complicated. Conclusion The incidence of skin diseases among marine-training soldiers is high and has many influencing factors. More efforts should be made for promoting knowledge of skin disease prevention, scientific military training, better living condition and habit, more careful medical service, and provision of new drugs to reduce skin diseases among the soldiers.

Abstract:Objective To propose the three heights of intervertebral disc during cervical disc degeneration by measuring the cervical intervertebral disc heights in patients with cervical spondylosis. Methods Totally 96 patients with cervical spondylosis undergoing surgery in our hospital from Jan. 2017 to May 2017 were enrolled in this study, and their intervertebral disc heights of C_2-7 were measured by the lateral X-ray. The patients were divided into 3 groups according to the Pfirrmann score:anatomical height group (Pfirrmann scoreⅠ-Ⅱ grade without height loss), natural height group (Pfirrmann score Ⅲ grade), and pathological height group (Pfirrmann score Ⅳ-Ⅴgrade with moderate and severe intervertebral height loss). Two-way ANOVA and LSD analysis were performed to compare the intervertebral disc heights between the three groups. Results The average age of 96 patients was (53.4±19.6) years old, with 57 males and 39 females. Fifty-nine cases were diagnosed with cervical spondylotic myelopathy, 25 with nerve root type cervical spondylosis, and 12 with mixed cervical spondylosis. The average intervertebral disc heights in the anatomic height, natural height and pathological height groups were (7.7±1.2) mm, (7.1±0.9) mm and (5.9±1.0) mm, respectively, and there were significant differences between the three groups (all P<0.01). The cut-off values (sensitivity, specificity) of the anatomical heights and natural heights, natural heights and pathological heights of C_3-4, C_4-5, C_5-6 and C_6-7 were 7.45 mm (0.62, 0.65) and 6.95 mm (0.63, 1.00), 7.75 mm (0.49, 0.85) and 6.10 mm (0.89, 0.43), 7.75 mm (0.59, 0.77) and 6.95 mm (0.66, 0.91), and 7.85 mm (0.61, 0.89) and 5.95 mm (0.86, 0.73), respectively. Conclusion During the process of degeneration, cervical disc height can be classified as anatomical height, natural height (degenerative height) and pathological height. We should pay attention to the intervertebral disc height before operation and suggest to restore natural disc height.

Abstract:Objective To evaluate the value of systematic simulation training program in the training of flexible ureteroscopy. Methods The training course was divided into three parts:shifting and positioning of flexible ureteroscope, stone-grasping with basket and lithotripsy by holmium laser. Thirty trainees in the flexible ureteroscopy training class in our hospital in March 2017 were prospectively selected and divided into 2 groups:standardized systematic training group and autonomous training group, with 15 trainees in each group. The trainees in the standardized systematic training group gradually completed the training contents of the three parts in strict accordance with the contents and forms of the training courses using in vitro training dry simulator, spending 60 min in each course, while the trainees in the autonomous training group completed the training by self-study using in vitro training dry simulator for 180 min. After completing the training, the trainees in the two groups were assessed by the in vitro training dry simulator and pig animal surgery, and the examination items included the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser. The operating time and global rating scale (GRS) score for the operation by tutor were compared between the two groups. Results The operating time for the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser in the standardized systematic training group were significantly shorter than those in the autonomous training group (all P<0.05). The GRS scores for the above operations in the standardized systematic training group were higher than those in the autonomous training group (all P<0.05). Conclusion The systematic simulation training program divides the flexible ureteroscopy training course into three separate parts, improves the learning efficiency and enthusiasm of the trainees, helps the trainees quickly mastering the operation skills of flexible ureteroscopy, and shortens the learning curve.

Abstract:Objective To investigate the oral health status of preschool children in private kindergartens in Jiading District of Shanghai, and to analyze the relationship between dental caries and growth and nutrition. Methods From Apr. 2015 to Jun. 2016, 5 755 preschool children in private kindergartens in Jiading District of Shanghai were examined by oral examination according to the principle of informed consent. The height, weight, and hemoglobin level of the children were measured, and the effects of body mass index (BMI) and hemoglobin level on dental caries were analyzed. Results The dental caries rate of preschool children was 50.67% (2 916/5 755) in private kindergartens in Jiading District of Shanghai. The prevalence of dental caries was significantly decreased with the increase of BMI (P<0.01). The decayed, missing and filled tooth (DMFT) of children with obesity or thinness was significantly higher than that of normal children (P<0.05). The prevalence of dental caries and DMFT of children with anemia (hemoglobin level<110 g/L) were significantly higher than those of the normal children (P<0.05). Conclusion Dental caries is closely associated with growth and nutrition of preschool children in Jiading District of Shanghai.

Abstract:Objective To evaluate the effcacy of arthroscopic heel spur fasciotomy for the treatment of refractory plantar fasciitis in elderly patients. Methods Twenty-two patients with plantar fasciitis diagnosed from Jan. 2014 to Jun. 2017 in the Department of Orthopedics of Changzheng Hospital of Navy Medical University (Second Military Medical University) were enrolled. All the patients aged ≥ 70 years old, with the course lasting for more than 6 months and incurable pain after a variety of treatment, and received arthroscopic heel spur removal and partial iliac fascia lysis. The time for the recovery of daily walking was recorded. The visual analogue scale (VAS) score and the calcaneodynia score (CS) at 1 month after surgery and the 12-item short-form health survey questionnaire (SF-12) score at 6 months after surgery of the patients were analyzed and compared with the preoperative data to evaluate the curative effect. Results The average time for recovery of daily walking in the 22 patients was (12.4±5.5) d. Two patients with bilateral plantar fasciitis were lost to followup after surgery, and a total of 20 patients (22 feet) were followed up. Compared with pre-operation, the VAS score and CS of patients were signifcantly improved at 1 months after surgery (0.7[0.0-3.2] vs 5.3[3.8-7.0], Z=2.1, P<0.01; 87.0±11.3 vs 38.9±10.1, t=14.2, P<0.01). The physiological and psychological scores of SF-12 of patients were significantly increased at 6 months after operation versus pre-operation (50.9±10.7 vs 45.3±9.6, 47.2±9.2 vs 34.2±10.6; t=4.3 and 4.1, both P<0.01). Conclusion Arthroscopic heel spur removal with partial iliac fascia lysis can effectively relieve the symptoms of patients with plantar fasciitis, without serious complications.

Abstract:Objective To observe the clinical effect of pingyangmycin injection combined with hypercator resection on laryngopharyngeal and laryngeal hemangioma under suspension laryngoscope. Methods Twenty-seven patients with laryngopharyngeal or laryngeal hemangioma were included. After trachea cannula via mouth and general anesthesia, the suspension laryngoscope was used to completely uncover the hemangioma, and 8 mg pingyangmycin (diluted with 6 mL saline injection) was locally injected into the tumor. And then the tumor was completely resected along its root by polypus forceps-like hypercator or was completely coagulated by electric coagulation. The intra-operative and post-operative bleeding were recorded, and the patients were given liquid diets after surgery for two weeks. The fibrolaryngoscope was reviewed to judge the curative effect at 1 month, 3 months, 1 year, 2 years, and 3 years after surgery. Results The pink or prunosus tumor turned into pinkish-white tumor after injection of pingyangmycin. When the root pedicle of the tumor was revealed by forceps holder, the polypus forceps-like hypercator could completely resect the tumor along the base of root, nearly without bleeding in the operation; when the root pedicle was big or could not be revealed, the tumor could be completely coagulated by electric coagulation. After surgery, no patients had dyspnea or wound bleeding. One month later, fibrolaryngoscope showed that the wound was repaired with pink normal mucosa. No recurrence was found in all cases after follow-up for 1 year. After 2 years of follow-up, one case had flaky purple uplift of the pharyngeal wall mucosa, and the tumor was completely resected by the above treatment. No recurrence was found after 3 years of follow-up. Conclusion Hypercator resection after local injection of pingyangmycin under suspension laryngoscope can completely resect the lesions, with less surgery trauma and quick recovery, suggesting that the treatment has affirmative efficacy and is worth popularizing.

Abstract:Objective To explore the clinical features of children with Burkholderia gladioli (B. gladioli) bloodstream infection and the drug susceptibility of B. gladioli. Methods The clinical data of 63 children with B. gladioli bloodstream infection admitted to Wuhan Children's Hospital, Tongji Medical College of Huazhong University of Science and Technology from Jan. 2015 to Jan. 2016 were retrospectively analyzed, and 81 children with non-bacterial infectious diseases in the same period were enrolled as controls. The C-reactive protein (CRP) level, procalcitonin (PCT) level and white blood cell (WBC) counts of children were compared between the two groups. B. gladioli was isolated from the blood samples of children and cultured for preliminary identifying by Phoenixtm100 automatic microorganism identification instrument and confirming by MALDI-TOP MS mass spectrometer. The in vitro antimicrobial susceptibility testing of B. gladioli were performed by Kirby-Bauer method. Results The children infected with B. gladioli were mainly infants, with 52 cases (82.54%) being three years old or below. All cases had serious underlying diseases, including bronchitis, pneumonia and leukemia. Compared with the control group, the PCT level, CRP level, and WBC counts in the children of the B. gladioli group were significantly increased (all P<0.05). According to the drug susceptibility criteria of Pseudomonas aeruginosa, the isolated B. gladioli was highly sensitive to amikacin, gentamycin, tetracycline, minocycline, cotrimoxazole, ciprofloxacin, levofloxacin, imipenem, meropenem, cefepime, piperacillin, piperacillin/tazobactam and cefoperazone/sulbactam, but had low resistance to chloramphenicol and high resistance to ceftazidime and aztreonam. Conclusion Children infected with B. gladioli are mainly infants aged ≤ 3 years old, with low immunity and poor resistance. Blood culture and CRP level, PCT level and WBC counts can be used as diagnostic indicators of disease outcomes. Piperacillin/tazobactam and cefoperazone/sulbactam should be the first selected drugs for the treatment of children with B. gladioli bloodstream infection.

Abstract:Objective To explore the individualized treatment strategies for ureterovesical junction (UVJ) stricture with stones. Methods The clinical data of 75 patients with UVJ stricture accompanied by stones in our department from Jan. 2010 to Jan. 2018 were retrospectively analyzed. Fifty cases were treated with internal urethrotomy and placed F5 double J tube, including 7 cases with dilation of UVJ through cystoscopy (2 cases were cut open 3-5 mm at UVJ), 41 cases with dilation plus lithotripsy through ureteroscopy (or holmium laser), and 2 cases accompanied by cysts at UVJ undergoing lithotripsy after transurethral ureterocele cystotomy. Twenty-five patients received conservative treatment, such as spasmolysis, diuresis and lithagogue after controlling renal colic. Results No stone or ureteral reflux was found in 7 cases with small stones treated with dilation of UVJ or the 2 cases accompanied by cysts at UVJ after one month of follow-up. No stone was found in 41 cases treated by dilation plus lithotripsy under ureteroscope after one month of follow-up. No stone was found in 25 cases with conservative treatment after 1-2 months of follow-up. Conclusion The stricture of UVJ should be regarded as a kind of disease and should be treated with internal urethrotomy or conservative methods according to the stone size and obstruction. For the patients with cyst at the UVJ, cutting cyst is appropriate.

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