Abstract:The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been confirmed as the etiological pathogen of the coronavirus disease 2019 (COVID-19). SARS-CoV-2 is the seventh member of coronavirus family that can infect humans after the emergence of the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). SARS-CoV-2 is a single-stranded, positive-sense RNA virus. Due to its strong infectiousness and the lack of immunity in humans, the epidemic of the COVID-19 is still spreading. On January 30, 2020 (local time), the World Health Organization (WHO) defined the epidemics of SARS-CoV-2-infected pneumonia as a Public Health Emergency of International Concern (PHEIC). This paper reviews the etiology and pathogenicity of SARS-CoV-2, and the detection and diagnosis, prevention and control, as well as the treatment of COVID-19.

Abstract:Objective To explore the safety and efficacy of emergent angioplasty in the treatment of acute middle cerebral artery atherosclerosis-related occlusion. Methods Retrospective analysis was performed in 210 patients with acute ischemic stroke due to middle cerebral artery occlusion, who underwent arterial thrombectomy and emergent angioplasty in our hospital from May 2013 to August 2018. Demographic information, general information, imaging data, treatment, revascularization (assessed by modified thrombolysis in cerebral infarction[mTICI], mTICI 2b/3 was taken as successful recanalization), prognosis and follow-up results were evaluated. Results According to inclusion criteria, 37 patients with acute occlusion of M1 segment stenosis of the middle cerebral artery, who underwent Gateway balloon dilatation and stent implantation, were included in this study. There were 31 males and 6 females with a mean age of (61.1±11.4) years (range, 35-81 years). Computed tomography perfusion imaging was performed in 25 patients before operation, including 17 (68.0%) patients without core infarct volume, 6 (24.0%) with 1-10 mL core infarct volume and 2 (8.0%) with 11-30 mL core infarct volume. M1 lesion was located in proximal 1/2 in 22 (59.5%) patients and in distal 1/2 in 15 (40.5%) patients. Bridging technique was used in 14 (37.8%) patients and direct thrombectomy was used in 23 (62.2%) patients. Five patients were treated with Gateway balloon dilatation alone and 32 patients with stenting (Apollo, Enterprise, Neuroform, Solitaire), with a 100% technical successful rate. Residual stenosis was less than 30% in 30 (81.1%) patients, and between 30% and 50% in 7(18.9%) patients. mTICI 2b/3 recanalization rate was 100%, including 35 cases (94.6%) of grade 3 recanalization.No vascular perforation occurred. Three patients (8.1%) presented stent reocclusion within 1 week after surgery. One patient (2.7%) had symptomatic hemorrhagic transformation. National Institutes of Health stroke scale (NIHSS) increased by 4 points 24 h postoperatively, and modified Rankin scale was 4 at 3 months after surgery. The rate of vascular restenosis was 34.5% (10/29) during follow-up (3-12 months after surgery). Conclusion In acute occlusion of middle cerebral artery M1 segment stenosis, stent retriever is the first choice with a high recanalization rate. Emergent angioplasty is a safe and effective method to treat residual stenosis. Good prognosis can be achieved 3 months after surgery, but the high rate of vascular restenosis cannot be ignored.

Abstract:Objective To investigate the expression of lin-28 homolog B (LIN28B) in adult head and neck rhabdomyosarcoma and its clinical significance. Methods Tumor tissues from 22 patients with head and neck rhabdomyosarcoma (aged ≥ 16 years) treated in our hospital from January 2009 to December 2015 were collected. The normal striated muscle tissues of 5 patients who underwent surgical treatment for other solid tumors were used as negative controls. The expression of LIN28B protein in tumor tissues was detected by immunohistochemistry. The relationship between the expression of LIN28B and clinicopathological parameters of adult head and neck rhabdomyosarcoma was analyzed, including sex, age, histological type, tumor size, lymph node metastasis, TNM stage, risk group, and cranial base bony erosion. Meanwhile, the relationship between the expression of LIN28B and prognosis was evaluated. Results Immunohistochemistry showed that LIN28B protein was negative in normal striated muscle tissues, while LIN28B protein was positive in adult head and neck rhabdomyosarcoma. Brownish yellow in cytoplasm was considered as positive staining. According to the histological score, the expression of LIN28B was low in 12 adult head and neck rhabdomyosarcoma patients (0-3 points) and high in 10 patients (≥ 4 points). LIN28B presented high expression in patients with non-embryonal rhabdomyosarcoma and with tumor size>5 cm (P=0.020, 0.030). The expression of LIN28B was not correlated with sex, age, lymph node metastasis, TNM stage, risk group or cranial base bony erosion (all P>0.05). The median follow-up period of 22 adult head and neck rhabdomyosarcoma patients was 78.4 months. The median progression-free survival (PFS) and median overall survival (OS) of the whole cohort were 12.4 months and 17.9 months, respectively. The 5-year PFS rate and 5-year OS rate were 11.4% and 13.6%, respectively. The patients with low expression of LIN28B had longer median PFS than patients with high expression (17.9 months vs 8.2 months, P=0.003), so was the median OS (23.5 months vs 10.9 months, P=0.009). Conclusion The expression of LIN28B is related to tumor size and histological type in adult head and neck rhabdomyosarcoma. LIN28B may play a potential role in the occurrence and progress of this tumor, and its high expression indicates a poor prognosis.

Abstract:Objective To evaluate the role of plasma microRNA-146a (miRNA-146a) in risk prediction and prognosis of the sepsis. Methods A total of 132 sepsis patients admitted to Department of Emergency and Intensive Care Unit (ICU) of Gongli Hospital affiliated to Naval Medical University (Second Military Medical University) between October 2015 and March 2017 and 131 healthy controls were consecutively enrolled in this study. Blood samples from septic patients and healthy controls were collected. Plasma miRNA-146a expression was detected by qRT-PCR. Serum inflammatory cytokines (C-reactive protein[CRP], tumor necrosis factor α[TNF-α], interleukin[IL]-1β, IL-6, IL-8 and IL-10) were detected by enzyme-linked immunosorbent assay (ELISA). Results Low expression of plasma miRNA-146a was found in sepsis patients compared to healthy controls (Z=-7.423, P<0.01). Receiver operating characteristic (ROC) curve revealed that plasma miRNA-146a disclosed a good diagnostic value for sepsis, with an area under curve (AUC) of 0.765 (95% confidence interval[CI] 0.707-0.823); sensitivity and specificity were 87.9% and 61.8% at the best cut-off point, respectively. Multivariate logistic analysis indicated that low plasma miRNA-146a expression was an independent predictive factor for sepsis (odds ratio[OR]=0.312, 95% CI 0.225-0.434, P<0.01). Spearman correlation showed that miRNA-146a expression was negatively correlated with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (r=-0.562, P<0.01), CRP (r=-0.304, P<0.001), TNF-α (r=-0.287, P=0.001), IL-1β (r=-0.173, P=0.047) and IL-6 (r=-0.213, P=0.014), while it was positively correlated with IL-10 (r=0.225, P=0.009). miRNA-146a expression in plasma of non-survivors was lower than that in survivors (Z=-2.818, P=0.005). ROC curve revealed that plasma miRNA-146a had a good prognostic value for sepsis, with AUC being 0.660 (95% CI 0.546-0.773), and the sensitivity and specificity were 88.5% and 47.2% at the best cut-off point, respectively. Conclusion Low expression of plasma miRNA-146a is an independent predictive factor for sepsis, and it is correlated with high severity of the disease, high levels of inflammatory cytokine, and poor prognosis.

Abstract:Objective To evaluate the influence of frozen-thawed embryo transfer (FET) on the cumulative live birth rate (cLBR) of the first cycle of controlled ovarian hyperstimulation in normal ovarian responsers. Methods Infertile patients who received in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Tangdu Hospital of Air Force Medical University from January 1 to December 31, 2016 were enrolled in this retrospective cohort study. Inclusion criteria:aged 20-39 years, normal ovarian reserve, and the first controlled ovarian hyperstimulation. Exclusion criteria:donor cycles, impaired ovarian reserve, polycystic ovarian syndrome or no embryo transfer after the first oocyte retrieval cycle. Logistic analysis was employed to explore the influence of FET on the cLBR and miscarriage rate after IVF/ICSI. Results A total of 1 141 patients who met the inclusion criteria were enrolled in this cohort, including 377 fresh embryo transfer cycles and 764 FET cycles. In FET cycles, the mean age of the patients was (29.85±3.68) years old, the mean body mass index was (22.06±2.81) kg/m², the mean duration of controlled ovarian hyperstimulation was (11.28±2.16) d, the mean dose of gonadotropin was (1 862.04±863.21) U, and the mean number of oocytes retrieved was 15.14±5.45. There was no statistical difference in the cLBR or miscarriage rate between fresh embryo cycles and FET cycles (68.44%[258/377] vs 66.10%[505/764], P=0.430; 5.31%[20/377] vs 8.38%[64/764], P=0.062). Logistic regression analysis results showed no beneficial effect of FET on the cLBR when compared to the fresh embryo transfer (odds ratio[OR]=0.99, 95% confidence interval[CI] 0.73-1.34, P=0.936); however, there was a trend that FET could increase the risk of miscarriage rate (OR=1.57, 95% CI 0.87-2.82, P=0.130). Conclusion FET cannot improve the cLBR after IVF/ICSI, but it might increase the miscarriage rate. Patients and clinicians should be very cautious when the "freeze all" strategy is about to be chosen. FET can be recommended only in case of high risk of ovarian hyperstimulation syndrome, pre-implantation genetic testing or prospective randomized controlled trial.

Abstract:Objective To explore whether the combination of bortezomib and Bcl-2 inhibitor (obatoclax, AT-101, ABT-199) can synergistically induce the apoptosis of human acute B lymphoblastic leukemia cell line Nalm-6. Methods MTT assay was used to evaluate cell viability of Nalm-6 cells in response to Bcl-2 inhibitor alone or combined treatment for 48 h. Apoptosis was examined by flow cytometry and the expression of Bcl-2 family proteins, ubiquitin, microtubule-associated protein 1 light chain 3B (LC3B), p62, binding immunoglobulin protein (Bip), phosphorylated p38 (p-p38), phosphorylated c-Jun N-terminal kinase (p-JNK), and C/EBP homologous protein (CHOP) was detected by Western blotting after drug alone or combined treatment. The mRNA levels of critical factors of endoplasmic reticulum stress (ERS)response, including Bip, CHOP, activating transcription factor (ATF) 4, ATF6, inositol-requiring enzyme 1α (IRE1α) and X-box binding protein 1 (XBP1) were measured by qRT-PCR. Finally, MTT and flow cytometry were used to determine whether tauroursodeoxycholate acid (TUDCA, an ERS inhibitor) could reverse the apoptosis induced by the combination of the two drugs. Results The application of bortezomib, obatoclax, AT-101 and ABT-199 alone reduced the viability of Nalm-6 cells. Obatoclax potentiated the cytotoxicity of Nalm-6 cells in response to bortezomib, but not including AT-101 or ABT-199. Obatoclax blocked autophagy flux by upregulating the protein expression of LC3B-Ⅱ and p62. The accumulation of ubiquitin protein was observed after use of bortezomib or obatoclax alone, but the protein significantly increased after two drug combination. Bortezomib combined with obatoclax caused the dual blockade of autophagy and proteasome and a large amount of protein accumulation, leading to activated ERS, finally to cell apoptosis. TUDCA reduced the apoptosis induced by two drug combination. Conclusion Bortezomib in combination with obatoclax can simultaneously inhibit autophagy and protease activity, triggering ERS, finally inducing human acute B lymphoblastic leukemia cell apoptosis.

Abstract:Objective To explore the effect of small molecule compound I942 on melanogenesis in melanocytes and the possible mechanism. Methods Dopa staining was used to identify the PIG1 normal human immortal melanocyte cell line. PIG1 melanocytes were treated with different concentrations of small molecule compound I942. The effect of small molecule compound I942 on the cell viability of PIG1 melanocytes was detected by CCK-8 assay. The content of melanin was determined by sodium hydroxide solubilization. The activity of tyrosinase was detected by dopa oxidation. The mRNA expression of melanin synthesis-related proteins (smicrophthalmia-associated transcription factor[MITF], tyrosinase[TYR], tyrosinase-related protein 1[TRP1] and tyrosinase-related protein 2[TRP2]) were detected by qRT-PCR. The protein expression of TYR and TRP2 was detected by Western blotting. Results There were no significant differences in the effect of small molecule compound I942 on the cell viability of PIG1 melanocytes at the concentration ranging from 0 μmol/L to 50 μmol/L. Small molecule compound I942 was found to increase both melanin content and tyrosinase activity in PIG1 melanocytes (both P<0.01). The mRNA levels of MITF, TYR, TRP1 and TRP2 were also increased after being treated with small molecule compound I942 (P<0.01, P<0.05). There were no significant changes in the expression of TYR or TRP2 protein. Conclusion Small molecule compound I942 can increase the melanin content of PIG1 melanocytes by increasing the tyrosinase activity with no obvious inhibition of cell viability. The mRNA expression of melanin synthesis-related proteins (MITF, TYR, TRP1 and TRP2) are also increased.

Abstract:Objective To investigate the expression and clinical significance of P-element-induced wimpy testis (Piwi)-interacting RNAs (piRNAs) in childhood nephroblastoma. Methods The differential piRNAs of Piwil2-iCSC (P-element-induced wimpy testis like 2[Piwil2] reprogramming human fibroblast) were screened by high-throughput sequencing. Target genes were predicted by miRanda software and performed by gene ontology (GO) function analysis. Differential piRNAs and their target genes were detected by qRT-PCR in tumor tissues and normal kidney tissues of 34 children with nephroblastoma. The correlation of differential piRNAs and their target genes with clinicopathological characteristics of nephroblastoma was analyzed. Results A total of 230 differential piRNAs were screened out through high-throughput sequencing, and 43 target genes were predicted by miRanda. The GO analysis showed that the biological process of target genes was mainly involved in regulating the cytosolic calcium ion concentration and its molecular function was mainly involved in the activity of ATPase and poly (A) RNA binding. The expression of five unknown differentially expressed piRNAs and their target genes were detected in nephroblastoma and normal kidney tissues. The expression of NU13 (13th unknown upregulated piRNA) and NU9 (9th unknown upregulated piRNA) were significantly downregulated in tumor tissues (both P<0.01), while the expression of their target genes NOP56 ribonucleoprotein (NOP56, P=0.58) and 40S ribosomal protein S8 (RPS8, P=0.29) had no significant difference between tumor tissues and normal kidney tissues. The expression of ND5, ND7, ND9 (5th, 7th, 9th unknown downregulated piRNA) and their target gene MT-RNR2 like protein 1 (MTRNR2L1) were significantly downregulated in tumor tissues (all P<0.01). The above-mentioned piRNAs and their target genes had no significant correlation with age, gender, tumor stage, or pathological type of the children (all P>0.05). Conclusion piRNA NU9, NU13, ND5, ND7, ND9 and the target gene MTRNR2L1 are differentially expressed in children with nephroblastoma. They are expected to be markers to distinguish nephroblastoma from normal kidney tissues.

Abstract:Objective To study the advantages of trypsin in isolating rat ovarian granulosa cells. Methods Ovarian granulosa cells of female SD rats aged 3-4 weeks were isolated and cultured by mechanical method and trypsin method, respectively. Mechanical method:under 40 folds anatomic microscope, mature follicles were punctured with a needle, and the culture solution containing the remaining tissue and follicular fluid of ovary was filtered with 200 mesh filter screen. Trypsin method:the ovary was cut into small pieces less than 2 mm³ with a sterile eye scissors, and then 0.25% trypsin was added. After digestion at room temperature for 1 h, the digestion solution containing the fragments of ovary was filtered with 200 mesh filter screen. The cell count, cell viability and secretion of estradiol and progesterone were compared. Results The survival rate of primary ovarian granulosa cells isolated by the two methods was both higher than 90%. When cultured for 9 d, the proliferation rate of the ovarian granulosa cells isolated by trypsin method was higher than that by mechanical method, except for 24 h. The peak time of cell proliferation rate of trypsin method was 24 h earlier than that of mechanical method, and the maximum cell proliferation rate of trypsin method was higher than that of mechanical method (72 h:[210.09±0.95]% vs 96 h:[180.50±0.74]%, P<0.05). The maximum secretion amount, total secretion amount and average daily secretion amount of estradiol and progesterone in ovarian granulosa cells isolated using trypsin method were significantly higher than that using mechanical method (all P<0.05). Conclusion Both cell viability and hormone secretion function of rat ovarian granulosa cells isolated by trypsin method are obviously superior to those by mechanical method. Trypsin method is worthy of further promotion in the study of premature ovarian failure.

Abstract:Objective To report a case of severe coronavirus disease 2019 (COVID-19) that had been successfully treated with glucocorticoid and intravenous immunoglobulin therapy. Methods and results The patient was a healthcare provider in Wuhan City who was taking care of COVID-19 patients before the onset of the disease. He started to cough with a little white sticky sputum on January 16, 2020 and had a fever on January 22 (up to 38.5℃) before admission. CT results showed mild exudation in both lungs. Oral oseltamivir and intravenous moxifloxacin, cefoperazone and sulbactam sodium were given in addition to nutritional support. On January 26, the patient had chest tightness and shortness of breath. A swab test was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid, and chest CT results showed moderate exudation in both lungs. On January 28, shortness of breath worsened and intravenous methylprednisolone (40 mg, qd) and immunoglobulin (10 g, qd) were given. On January 30, shortness of breath further worsened; he had a body temperature of 40.7℃, pulse oxygen saturation (SpO₂) of 83% with oxygen inhalation at 10 L/min, and lymphocyte count of 0.5×10⁹/L. The dose of methylprednisolone and immunoglobulin were adjusted to 40 mg, q12h and 20 g, qd, respectively. Subcutaneous injection of thymalfasin (1.6 mg, qd) was added. Then the body temperature returned to normal, and symptoms such as chest tightness and shortness of breath were gradually improved. On January 31, SpO₂ was 88% with oxygen inhalation at 10 L/min and a chest CT results revealed large amount of exudation in both lungs. On February 2, SpO₂ was 95% with oxygen inhalation at 5 L/min and the dose of methylprednisolone was then gradually reduced. A chest CT results on February 3 revealed improved lung inflammation, and a throat swab on February 4 and 9 was negative for SARS-CoV-2 nucleic acid. Conclusion Glucocorticoid should be used with caution in patients with early and mild COVID-19. However, appropriate dosage of glucocorticoid can be used to modulate lung inflammation in patients with decompensated respiratory failure. Additionally, large dose of immunoglobulin can be given if necessary.

Abstract:Objective To explore the psychological status and interventions in confirmed and suspected coronavirus disease 2019 （COVID-19） patients. Methods The data of 2 confirmed cases and 6 suspected cases of COVID-19 were collected through the Internet. Demographic data of the patients were collected by self-designed self-assessment general situation questionnaire. Post-traumatic stress symptoms were assessed by post-traumatic stress disorder checklist for DSM-5 （PCL-5）. Sleep quality was evaluated by Pittsburgh sleep quality index. Results There were 5 females and 3 males aged from 17 to 71 years old. The education level was junior college, bachelor degree and above in 7 patients, and senior high school or below in one patient. Five cases had the contact history with Wuhan residents. The screening result of post-traumatic stress symptom was positive in one confirmed case and one suspected case. Invasive symptoms presented in 5 cases. The epidemic affected the sleep quality of 8 patients in different degrees, mainly manifested as sleep fitfully at night or early morning awakening （5 cases）. The total score of PCL-5 was consistent with the change trend of sleep quality. The higher the total score of PCL-5, and the worse the sleep quality. Conclusion Confirmed and suspected COVID-19 patients have sleep disorders （sleep fitfully at night or early morning awakening） and psychological trauma （invasive symptoms）, and they need timely and effective psychological interventions.

Abstract:Since December 2019, many cases of pneumonia of unknown causes have been found in Wuhan and surrounding areas of Hubei Province, China. With the aggravation of the epidemic, on January 24, 2020, medical team of Naval Medical University (Second Military Medical University) in Wuhan started emergency medical rescue. This medical rescue was not only a treatment war, but also an antiepidemic war. It is very important to have strict personal protection, disinfection and isolation measures and epidemic prevention in the camp, which are the precondition and guarantee to ensure zero infection of medical staff. In this paper, we introduce our measures and experience on epidemic prevention and infection control, such as personnel management and decontamination.

Abstract:Low-intensity pulsed ultrasound (LIPUS) is a non-invasive treatment widely used in the treatment of musculoskeletal diseases. In the early stage, LIPUS was mainly used in fresh fracture and nonunion. In recent research, the therapeutic effect of LIPUS on cartilage tissue injury, intervertebral disc degeneration and other soft tissue diseases has also been noted. Moreover, LIPUS is also used in the orthopaedic surgery such as distraction osteogenesis and spinal fusion. With research on the mechanism of LIPUS progressing, its clinical application will become more extensive. This article reviews the research and application of LIPUS in musculoskeletal diseases.

Abstract:Bronchopulmonary dysplasia (BPD) is a common premature chronic respiratory disease affecting the survival rate and the quality of life of premature infants. Pulmonary hypertension is a common complication of neonatal chronic respiratory diseases including BPD. Studies have shown that the mortality rate of BPD-associated pulmonary hypertension was 14%-38%. Although there are many methods to diagnose BPD-associated pulmonary hypertension, echocardiography is the most important one. The pathogenesis and preventive measures of BPD-associated pulmonary hypertension have not been fully elucidated. In-depth study on BPD-associated pulmonary hypertension is beneficial to reduce the mortality and improve the prognosis of children. This paper reviews the risk factors, pathogenesis, diagnosis criteria, screening methods and control measures of BPD-associated pulmonary hypertension.

Abstract:The biphasic calcium phosphate material is the golden standard alternative materials in bone reconstruction operation. It is mostly from artificially synthesized, but the method is featured by intricate preparation process, uncontrollable pore size distribution, high cost, and low biological activity. Some researches have found that marine fish bone, as a natural bone source, can also be used to prepare biphasic calcium phosphate materials. With a wide range of sources, simple preparation methods and high content of β-tricalcium phosphate, it retains the natural microscopic pore structure, making it a potential bone replacement support material. In this paper, the research progress on biphasic calcium phosphate material from marine fish bone is reviewed regarding preparation methods and material characterization.

Abstract:Objective To investigate the sleep quality and life quality of navy officers and soldiers stationed on an island, and to explore the correlation between sleep quality and life quality, and their influencing factors. Methods Random sampling method was used to select navy officers and soldiers stationed on an island. A questionnaire survey was performed by using the Pittsburgh sleep quality index （PSQI） and the World Health Organization quality of life-brief version （WHOQOLBREF）. Results A total of 150 questionnaires were finally collected, of which 146 （97.3%） were valid. 28.1% （41/146） of the navy officers and soldiers stationed on the island had poor sleep quality. Most had troubles in sleep time （70.6%[103/146]）, daytime dysfunction （52.1%[76/146]） and sleep latency （46.6%[68/146]）. Most scores of sleep quality factors and total PSQI score of these navy officers and soldiers were negatively correlated with the scores of four aspects of quality of life （P<0.05, P<0.01）. The good sleep quality leads to good quality of life. Age, stationing time and physical illness had an impact on the sleep quality of the navy officers and soldiers stationed on the island. Compared with the personnel stationed on the island for 1-2 months and 5-16 months, those stationed for 3-4 months scored higher sleep time factor （both P<0.05）, and their sleep quality was worse. The sleep quality of older interviewees was poor, and both sleep quality and quality of life of sick interviewees were poor （all P<0.01）. Conclusion Sleep quality and quality of life of navy officers and soldiers stationed on islands need to be improved urgently. Improving sleep quality is an effective way to improve quality of life. Age, length of stay on islands and health status have an impact on the sleep quality and quality of life of navy officers and soldiers stationed on islands. We should pay more attention to the navy officers and soldiers who are aged, have been stationed on islands for 3-4 months and are physically ill. We should improve medical services on islands and carry out professional psychological support and intervention, such as relaxation training and sleep guidance, so as to improve the sleep quality and quality of life of navy officers and soldiers stationed on islands and maintain their physical and mental health.

Abstract:Objective To explore the causes of reoperation after pyeloplasty for ureteropelvic junction obstruction (UPJO) in children. Methods Clinical data of pediatric patients undergoing reoperation after pyeloplasty for UPJO from January 2015 to December 2017 were collected. The reasons of reoperation were analyzed. Results A total of 36 UPJO children underwent reoperation after pyeloplasty. Anastomotic edema, adhesion and fibrotic scar around the stoma was found in 26 (72.22%) patients. Other reasons were polypus near the anastomotic stoma (5 cases, 13.89%), high insertion of the ureteropelvic junction (5 cases, 13.89%), aberrant vessels compressing the ureter (3 cases, 8.33%), stenosis of distal ureter (2 cases, 5.56%), and renal calyx atresia (2 cases, 5.56%). Two patients who were diagnosed as having renal calyx atresia underwent renal calyx plasty and lower calyceal ureteral anastomosis. The other patients received open pyeloplasty. The median follow-up time was 28 months after reoperation. During the follow-up, 34 patients experienced no restenosis of ureteropelvic junction. But one patient suffered from second restenosis, and underwent renal calyx plasty and lower calyceal ureteral anastomosis again. One patient experienced abdominal pain and aggravation in hydronephrosis 30 months after the reoperation. He was diagnosed as having cicatricial stenosis after the third pyeloplasty. The two patients had no stenosis after follow-up for 37 and 20 months, respectively. Conclusion Anastomotic edema, adhesion and fibrotic scar are the main causes of reoperation after pyeloplasty. Other rare but important causes are iatrogenic fibroepithelial polyps, high insertion of the ureteropelvic junction, aberrant vessel compression, stenosis of distal ureter, and renal calyx atresia. During the operation, it is necessary to perform accurate anastomosis in spacious space of the ureter, keep the anastomotic stoma at the low renal pelvis, avoid the injury of renal calices and the ignorance of the aberrant renal vessels, and keep the head of the fistula as far as possible from the anastomotic stoma. These may help to reduce the possibility of reoperation after pyeloplasty.

Abstract:Objective To investigate the clinical outcome of laparoscopic extraperitoneal uterine suspension for uterine prolapse. Methods A total of 66 patients with uterine prolapse who underwent laparoscopic extraperitoneal uterine suspension from February 2011 to March 2018 in our hospital were enrolled in this study. Therapeutic effects were retrospectively analyzed. Results All the operation was successfully completed. The mean operation time was (78.64±36.23) min, the mean bleeding volume was (80.00±28.62) mL, and the mean hospitalization time was (8.27±3.31) d. One case (1.52%) had poor healing of abdominal incision. One case (1.52%) had erosion of material exposure. No deep vein thromboembolism was found. Clinical symptoms and life quality of all patients were significantly improved. The location of Aa, Ba, C, D, Ap, and Bp in the Pelvic Organ Prolapse Quantitation (POP-Q) system at 3 months after surgery were significantly different from preoperative ones (all P<0.01). Conclusion Laparoscopic extraperitoneal uterine suspension is simple and practicable for prolapse. It has the advantages of significant effect, small trauma, quick recovery, and low incidence of complications, and can effectively alleviate clinical symptoms and improve life quality of patients.

Abstract:Objective To analyze the risk factors of posterior capsular rupture (PCR) in phacoemulsification. Methods A total of 5 415 patients (5 743 eyes) who underwent phacoemulsification combined with intraocular lens implantation in Shanghai Fengxian District Hospital of Traditional Chinese Medicine from January 2011 to December 2017 were selected in this retrospective study. A total of 120 eyes from 105 patients with intraoperative lens PCR were assigned to observation group, and 480 eyes from 452 patients were randomly selected as control group. The data was compared between 2 groups, including general information (gender, age), systemic risk factors (hypertension, diabetes, cardiovascular disease, history of glucocorticoid use, smoking, drinking), basic ophthalmic information and risk factors (vision, intraocular pressure, history of glaucoma, history of high myopia, history of keratopathy, history of uveitis, cataract type, vitreous hemorrhage, history of vitreous surgery), and cataract nucleus hardness. Results The ratios of eyes with preoperative visual acuity<20/200 (89.2%[107/120] vs 58.1%[279/480]), vitreous hemorrhage (10.8%[13/120] vs 2.3%[11/480]), and vitreous operation history (20.8%[25/120] vs 4.8%[23/480]) in observation group were significantly higher than those in control group (P<0.05). The lens nucleus hardness was classified in 111 eyes in the observation group and 459 eyes in the control group. There was significant difference in the hardness of lens nucleus between the observation group (9 eyes[8.1%] of grade Ⅰ, 11 eyes[9.9%] of grade Ⅱ, 10 eyes[9.0%] of grade Ⅲ, 46 eyes[41.4%] of grade Ⅳ and 35 eyes[31.5%] of grade Ⅴ) and the control group (88 eyes[19.2%] of grade Ⅰ, 82 eyes[17.9%] of grade Ⅱ, 109 eyes[23.7%] of grade Ⅲ, 97 eyes[21.1%] of grade Ⅳ and 83 eyes[18.1%] of grade Ⅴ) (P<0.05). The visual acuity of logMAR was restored from 2.11±0.98 to 1.07±0.44 in the observation group (P<0.05), and from 1.37±0.90 to 0.72±0.37 in the control group (P<0.05). LogMAR visual acuity of the patients before and after operation was poor in the observation group versus the control group (both P< 0.05). Conclusion Preoperative visual acuity<20/200, vitreous hemorrhage, history of vitreous surgery and lens nucleus hardness classification are the risk factors of PCR in phacoemulsification.

Abstract: