Objective The aim of this study was to explore the minimally invasive treatment for palpable undescended testes in the inguinal area.Methods Between August 2007 and March 2008,60 cases(74 testicular units)with palpable undescended testes in the inguinal area were treated by scrotal incision orchiopexy or/and laparoscopic orchiopexy depending on the location of inguinal testes.Results Among the 60 patients,26 cases who had the testes located between the external inguinal ring and the upper scrotum,received scrotal incision orchiopexy,of which the testes were fixed at the bottom of the scrotum in 23 cases,and at the upper scrotum in 1 case;the other 2(both had the undescended testis at the right side,between the external inguinal ring and the upper scrotum)were converted to laparoscopic orchiopexy because of unsatisfying surgical outcomes.The other 34 cases received laparoscopic orchiopexy,of which the testes were located in the groin in 16(41.1%)cases,close to the external inguinal ring in 18(52.9%),and complicated with indirect inguinal hernia in 8(23.5%,ligation of the hernia sac was performed at the level of internal inguinal ring);the testes were fixed at the bottom scrotum in the cases.The 60 patients were followed up for 3-6 months(mean,4.3 months)by B-ultrasonography,none of them showed atrophy or retraction of the testes,or indirect inguinal hernia.ConclusionsScrotal incision orchiopexy is feasible for palpable inguinal testes if the testis can be pulled upon to the upper scrotum,if not or the testis cannot be fixed on the bottom scrotum,laparoscopic orchiopexy should be used.Both of the procedures are effective.

Objective To summarize the outcomes and clinical experience of orthotopic heart transplantations in Shanghai Zhongshan Hospital.Methods From May 2000 through October 2005,141 patients,101 males and 40 females,diagnosed as having dilated cardiomyopathy in 118,hypertrophic cardiomyopathy in 2,restrictive cardiomyopathy in 2,end-stage ischemic heart disease in 9, primary malignant cardiac tumor in 4,valvular heart disease in 3 and others in 3,underwent orthotopic heart(transplantations) at our center.The operative procedures included 120 bicaval anastomotic cardiac transplantations,19 conventional Stanford orthotopic cardiac transplantations and 2 total heart transplantations.The immunosuppressive therapy strategies included Cyclosporine A or tacrolimus,corticosteroids and mycophenolate mofetil.For the latest 28 patients,induction therapy with Daclizumab was applied.Results There were 3 operative deaths with an operative survival of 97.9 %.During the follow-up from 1 month to 65 months,the actuarial survival rate was 90.8 % after 1 year,84.6 % after 3 year and 81.4 % after 5 year.Acute rejection,infections,graft failure and metastasis of primary cardiac tumor were the main causes of death in the 1st postoperative year,while acute rejection and graft coronary vasculopathy were the leading causes of death thereafter.Postoperative complications included acute rejection,infections,renal dysfunction and graft failure.Conclusions Orthotopic heart transplantation was proved to be a reliable choice for endstage heart disease with excellent outcomes.More attention should be paid to surveillance and management of acute rejection, infections and graft coronary vasculopathy in the long-term follow-up.

Objective To investigate longitudinal systolic function of transplanted heart using two dimensional speckle tracking echocardiography and tissue Doppler imaging.Methods 56 consecutive patients with heart transplant were recruited,according to myocardial biopsy and 1 year's follow up,they were divided into non-rejection group (group A) and rejection group (group B).36 healthy controls (group C) were also randomly recruited.Left ventricular ejection fraction (LVEF),pulmonary arterial systolic pressure,tricuspid annular plane systolic excursion (TAPSE),tricuspid annular plane systolic velocity (TAS') and global longitudinal strain (GLS) were calculated via Qlab 9.0 analysis software offline.Results Compared with group C,LVEF was reduced in group B (P ＜0.01).Differences of GLS,TAPSE,and TA-S' among groups were all statistically significant (P ＜0.01),group B＜group A＜ group C.LVEF,TAPSE and TA-S' were correlated with GLS (r =-0.64,r =-0.69,r =-0.71 ; all P ＜ 0.01).Conclusions Left and right ventricles were a functional unity,the systolic function of which was impaired in patients with heart transplant.

Objective To investigate the value of real-time three-dimensional echocardiography 17 regional volume curves index in patients with heart transplantation. Methods Sixty patients with heart transplantation (no rejection), ten patients with heart transplantation (rejection), forty subjects with normal left ventricular(LV) function were examined by Philips iE33 with a X3-1 probe. Results Parameter index of 17 segment time to minimal systolic volume in patients with heat transplantation (rejection) were more than those in patients with heart transplantation (no rejection) and in subjects with normal LV function(all P <0.05). Parameter index of 17 segment time to minimal systolic volume were not significantly different in patients with heart transplantation (no rejection) compared with subjects with normal LV function. Parameter index of Tmsv16-SD (%), Tmsv12-SD (%) and Tmsv6-SD (%) show higher sensitivity and specificity for forecast rejection after heart transplantation. Conclusions Real-time three-dimensional 17 regional volume curves index can fast forecast early rejection after heart transplantation.

Objective To compare clinical outcomes in cardiac transplant recipients treated with individualized dosing (ID) and fixed dosing (FD) of mycophenolate mofetil (MMF).Methods Fortyeight de novo cardiac transplant patients in ID group received MMF (2.0 g/day) in combination with calcineurin inhibitors and prednisone.The MMF dosages were adjusted individually based on clinical events and MPA trough levels (MPA-C0).The target range of C0 was maintained within 2.0-4.0rng/L.The FD group included 55 recipients retrospectively from the transplant database who were also treated with MMF (2.0 g/day).In this group,the MMF dose adjustment was performed empirically according to clinical events only.All of the follow-up data were collected up to 12 months post-transplantation.Results The follow-up rate was 95.8％ and the mean MPA-AUC0-12 was (54.37± 17.03) rng h-1 L-1 in the ID group.The mean MPA-C0 on the day 7 post-transplantation was significantly higher in the ID group than that at 12th month [(3.44 ± 0.58) mg/L vs.(2.79 ± 0.54)mg/L] (P＜0.05).The dose of MMF was significantly lower in the ID group at 4th week posttransplantation than in control group [(1.49± 0.48) g/day vs.(1.96 ± 0.39) g/d] (P＜0.05),while there was no significant difference at 12 th month post-transplantation [(1.61 ± 0.77) g/day vs.(1.68 ± 0.84) g/day] (P＞ 0.05).No significant difference was found in the incidence of acute rejection episode between two groups (8.7％ vs.9.1％,P＞0.05).57.6％ of overall side effects were observed within one month postoperatively,and the incidence of MPA-related side effects was significantly lower in the ID group than in the control group (47.8％ vs.67.3％,P＜0.05).Conclusion It was demonstrated that individualized use of MMF based on therapeutic drug monitoring may prevent MMF-related side effect and appears to be valuable to optimize the treatment of cardiac transplantation.

Objective : To investigate the trends in incidence of malignant tumors in Yongkang City, Zhejiang Province from 2013 to 2019, so as to provide insights into formulation of the malignant tumor control strategy. Methods: Data pertaining to the incidence of malignant tumors from 2013 to 2019 were captured from the Zhejiang Chronic Disease Monitoring Information System. Based on the International Classification of Diseases 10th Revision (ICD-10) and data from the national population census, the constituent ratio, crude incidence and Chinese population-standardized incidence of malignant tumors were estimated, and the trends in incidence of malignant tumors were investigated using annual percent change (APC). Results: The annual mean crude incidence and Chinese population-standardized incidence of malignant tumors were 356.75/105 and 226.97/105, which both appeared an overall tendency towards a rise (APC=5.887% and 4.815%, both P<0.05). The crude incidence of malignant tumors appeared a tendency towards a rise among both men (APC=3.860%, P<0.05) and women (APC=8.534%, P<0.05) from 2013 to 2019, and the Chinese population-standardized incidence of malignant tumors appeared a tendency towards a rise among women (APC=8.392%, P<0.05). The largest increase in the crude incidence of malignant tumors was seen among women at ages of 15 to 44 years (APC=11.599%, P<0.05). In addition, the Chinese population-standardized incidence of lung cancer, colorectal cancer and thyroid cancer all showed a tendency towards a rise among men (all P<0.05), and the Chinese population-standardized incidence of lung cancer and thyroid cancer both appeared a tendency towards a rise among women (both P<0.05). Conclusions The incidence of malignant tumors showed a tendency towards a rise in Yongkang City from 2013 to 2019, and the elderly and young females are high-risk populations for malignant tumors. Lung cancer, thyroid cancer and colorectal cancer are cancers that should be given a high priority.

Objective To explore the incidence and etiology of infection after heart transplantation and discuss the prophylaxis and management. Methods Retrospective study was conducted on the 140 survival heart transplant recipients (HTs) with detail follow-up information. All patients received preventive therapy against bacterial infections postoperatively, of which 87. 8% patients used antiviral drugs to prevent cytomegalovirus (CMV) infection. The immuosuppressive regiment was as follows: tacrolimus (Tac) or cyclosporine A (CsA), mycophenolate mofetil (MMF),glucocorticoid. Postoperatively all patients had throat swabs, sputum smear Gram stain, sputum culture, blood culture, urine culture and fecal culture for microbiological monitoring. Schedule tables were made to record and analyze the demography of the patients and the timetable of infections. Results The incidence of infections was 42.9 episodes per 100 HTs. Sixty-four cases (76. 2% ) of the infections occurred in the first month after transplantation and all recovered, 20 cases (23.8%) took place after 1 months, and 4 patients died. Conclusion Perioperative infections are mostly caused by bacteria and the prognosis is good. Infections 2 months after operation are commonly caused by virus or fungi with poor prognosis.

Objective Mechanisms for the dissection of aorta, a devastating disease, remain unknown. Studies showed that cytokine transforming growth factor (TGF)-131, a multifunctional regulator, was highly expressed in the aneurysms or dis-section of aorta and was responsible for the onset of the diseases. We try to explore the mechanisms of thoracic aortic dissection (TAD) by comparing the expression and distribution of TGF-β1 in the aortic wall and analyzing the association of TGF-β1 with extracellular matrix (ECM) in patients with TAD and control subjects. Methods Aortic specimens taken from surgical pa-tients with TAD( n = 20 ) at Zhongshao Hospital and organ donors ( n = 20, controls) were prepared with paraffin embedded tis-sue slide. ECM was investigated with hematoxylin-eosin, Verhoeff van-Giesen (EVG) and Maason's triehrome (MT) staining.Distribution and expression of TGF-β1 within aortic wall was examined with double immunofluoreseent staining and semi-quan-tiffed by fluoreseent intensity analysis. The expression of TGF-β1 in the two groups and among various layers of the arterial wall was compared. Results TAD was morphologically characterized by decreased and disrupted elastic fibers in the tunica media of the aorta wall with hyperplasia of the collagen fibers. TGF-β1 was expressed unevenly within aortic wall, with highest in the media, followed by intima and adventitia, in both TAD patients and eantrols. Specimen from TAD patients exhibited overall in-creased TGF-β1 expression by 9.56% as compared with that from the controls ( P <0.05 ). TGF-131 expression was increased by 16.09% (P<0.05) in the media and 16.75% (P<0.05) in the adventitia in TAD group as compared with those in the control group, but no difference was detected in intima between the two groups. TGF-β1 distribution histogram analysis dis-closed that TGF-β1 expression in the tunica media was evident in the elastic fibers, and was increased by 34.83% in TAD pa-tients as compared with that in the controls (P <0. 01 ). No significant associations between TGF-β1 expression and age, gen-der, maximal aortic diameter and type of dissection in TAD patients were detected. Conclusion TGF-β1 expression is up-reg-ulated and unevenly distributed in the dissected aortic wall of TAD patients. The finding that TGF-β1 was significantly up-regulated and condensed in the elastic fibers of the tuniea media suggested the crucial role of TGF-β1 in the development of TAD.

Objective To investigate the therapeutic effect of modified transperitoneal laparoscopic dismembered pyeloplasty in children with with ureteropelvic junction obstruction (UPJO).Methods The clinical data of 27 children with UPJO treated with transperitoneal laparoscopic dismembered pyeloplasty were analyzed retrospectively.The age ranged from 5 to 104 months (mean,37 months).All cases were diagnosed by ultrasonography,IVU,CT and/or renal radionuclide scanning.The antero-posterior pelvic diameter was more than 3 cm by ultrasound in all cases.Indications of surgery were as followings:symptoms of upper abdominal pain or low back pain and/or split renal function ＜40％ and/or progressive dilatation.Modified transperitoneal laparoscopic dismembered pyeloplasty was performed.Double hitch stitches were transfixed at the top of pelvis and ureter to be anastomosed,and a 6 F urethral catheter was inserted as a ureteral stent percutaneously through the puncture hole and was removed 7-9 days postoperatively without double-J stent.Results All operations were completed laparoscopically without conversion to open surgery.The mean operative time was 118 min (range,85 to 176),the mean blood loss was 16 ml (range,10 to 30) and the mean postoperative hospital stay was 10.5 days (range 9 to 13).The perinephric urine drainage occurred in 2 patients with about 200 ml/d,and reduced to 6 ml/d and 4 ml/d 5 to 6 days after operation.During the follow-up period for 12 to 36 months(mean,22 months) in 27 cases,there was no stricture at UPJ and the hydronephrosis reduced significantly or disappeared.Conclusion Laparoscopic dismembered pyeloplasty with double hitch stitches and an ordinary urethral catheter as an ureteral stent is an easy method with high successful rate and less operative time,which avoids reoperation to remove the double-J stent and is worthy of clinical popularization.

Objective Aortic dilation in bicuspid aortic valve patients usually begins at the proximal tubular ascending aorta.This study,we investigate the risk factors of aortic root dilation,in advantage of reviewing medical records of bicuspid aortic valve patients with dilated ascending aorta.Methods Include all the bicuspid aortic valve patients with dilated proximal ascending aorta who needed surgical intervention from Jan 1,2003 to May 4,2011.We exclude patients accompanied with aor tic dissection or without echocardiographic report.Divide these patients into group dilation (≥45 mm) and group non-dilation (＜ 45 mm) according to sinus diameters and proceed statistical analysis in SPSS 20.0.Results In univariate analysis,group dilation are younger and higher,and possess higher proportion of male and fusion of right-left coronary cusps,more severe aortic regurgitation,larger left ventricular diameters and higher elevation of total bilirubin,conjugated bilirubin and creatinine,but shorter duration of symptoms,less aortic stenosis and lower ejection fraction.In multivariate analysis with logistic regression model,less aortic stenosis and larger left ventricular end-diastolic diameter are the significant risks of sinus dilation.It's demonstrated in ROC curve analysis,that left ventricular systolic diameter and diastolic diameter are the two most valuable parameters indicating sinus dilation,the sensitivity and specificity is 0.93,0.83 while left ventricular diastolic diameter ＞ 60 mm and 0.79,0.89 while systolic diameter ＞ 45 mm.Conclusion Less aortic stenosis and larger left ventricular end-diastolic diameter are the significant risks of aortic root dilation in bicuspid aortic valve patients accompanied with dilated ascending aorta.The left ventricular systolic and diastolic diameters are the most valuable parameters indicating aortic root dilation.