Carotid atherosclerosis is an important pathogenesis of ischemic stroke.Inflammation plays a crucial role in the artery atherosclerotic genesis and development as well as its caused complications.Human CXC chemokine ligand 16 (CXCL16),as a novel chemokine,involves in the formation and development of atherosclerotic plaques.It may be associated with atherosclerotic stroke.

Objective To evaluate factors influencing long-term survival of biliary atresia patients receiving Kasai procedure and the prevention and treatment of surgical complications.Methods Among 97 biliary atresia patients undergoing Kasai or Suruga operation from Mar 1989 to Mar 1999, 35 cases have survived over five years.These 35 cases were classified intraoperatively into type Ⅱ (4 cases) and type Ⅲ (31 cases).Procedures included hepaticojejunostomy (12 cases), Suruga operation (hepaticojejunostomy with a jejunal fistula in 21 cases), hepaticocystomy (2 cases).Six patients underwent second hepaticojejunostomy because of porta hepatis obstruction.Results (1) Eighteen patients suffered from early cholangiolitis, and four cases developed late cholangiolitis, 5-8 years after closing the ascending stoma.(2) Five cases presented upper digestive tract hemorrhage caused by portal hypertension.(3) All patients were followed up from 5 to 15 years with 2 deaths.Conclusion Conventional surgical procedures still take important part in treating biliary atresia before liver transplantation is popularized.Factors influencing long term survival of patients receiving Kasai′s operation include age at operation, pathological classification of extrahepatic bile duct, with or without cholangitis after operation, and portal hypertension.

Objective To investigate the correlation of plasma matrix metalloproteinase-3 (MMP-3)levels and MMP-3 Lys45Glu (rs679620) polyrnorphism with ischemic stroke and its TOAST subtypes.Methods The patients with large artery atherosclerotic stroke (LAA) and small artery occlusion stroke (SAO)according to TOAST etiological typing (ischemic stroke group) and healthy subjects (control group) were enrolled.The enzyme-linked immunosorbent assay was used to detect plasma MMP-3 level.The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the genotypes of MMP-3 Lys45Glu.Results A total of 233 patients with ischemic stroke were enrolled,in which 162 were LAA and 71 were SAO; 200 healthy subjects were taken as controls.The plasma MMP-3 level in the ischernic stroke group was significantly higher than that in the control goup (253.99 ± 75.02 ng/ml vs.196.38 ± 78.17 ng/ml;t =7.813,P=0.000).The plasma MMP-3 level in the LAA group (262.81 ±69.23 ng/ml) was significantly higher than those in thegroups of SAO (233.85 ± 83.90 ng/ml,P =0.008) and control (P =0.000),and the plasma MMP-3 level in the SAO was also significantly higher than that in the control group (P =0.000).Multivariate logistic regression analysis showed that the increased serum MMP-3 level was an independent risk factor for ischemic stroke (odds ratio [OR] 1.012,95％ confidence interval [CI] 1.008-1.015; P =0.000).There was no significant difference in the frequencies of genotype (x2 =2.085,P =0.353) and allele (x2 =2.29,P =0.130) of MMP-3 Lys45Glu between the ischemic stroke group and the control group.However,there were significant difference in MMP-3 Lys45Glu genotype frequencies among.the groups of LAA,SAO and control (x2 =10.39,P=0.034).The AA + GA genotype frequency in the LAA group was significant higher than those in the groups of SAO (65.4％ vs.49.3％ ;x2 =5.375,P =0.020) and control (65.4％ vs.54.0％ ;x2 =4.84,P =0.028).There was no significant difference in the allele frequencies among the groups of LAA,SAO and control (x2 =3.887,P =0.143).Multivariate logistic regression analysis showed that MMP-3 Lys45Glu polymorphism was an independent risk factor for LAA (OR 1.783,95％ CI 1.183-2.688; P =0.006).The plasma MMP-3 level in patients with the genotypes AA (n =73),GA (n =176) and GG (n =184)were 235.70 ± 70.85 ng/ml,(244.20 ± 85.90 ng/ml and 207.98 ± 77.61 ng/ml.There were significant difference in the plasma MMP-3 levels among the patients with the genotypes AA,GA and GG (F=9.682,P =0.000).The plasma MMP-3 level in the patients with the genotype AA + GA was significantly higher than that in patients with genotype GG (241.71 ± 81.73 ng/ml vs.207.98 ± 77.61 ng/ml; t =4.336,P =0.000).Conclusions The plasma MMP-3 level increased in patients with LAA or SAO,especially in the patients with LAA.The MMP-3 Lys45Glu polymorphism might be associated with the plasma MMP-3 level and LAA.

ObjectiveTo explore the importance and significance of classification diagnosis and treatment of chordee among hypospadias in children.MethodsA random sample review and controlled study was made in patients with hypospadias and chordee from 1989 to 2011 in First Affiliated Hospital of Sun Yat-Sen University,and the patients were divided into 2 groups.There were 232 cases in group A,who were all diagnosed as chordee only on the basis of clinical symptoms or an erection induced by artificial stimulation before operation.All the 232 cases were corrected empirically without objective assessment by degloving the penis,dissecting superficial and deep fascia,and cutting off the urethral plate,and so on during operation.There were 25 cases in group B,who were all strictly implemented on classification diagnosis and treatment of chordee,in sponge saline injection test during operation and correction effect evaluation after operation.Chordee was classified according to different etiology and pathology:skin type,fascia-type,urethra type,sponge type and the glans of penis type.There were different operating methods in different ways of folding tunica albuginea.ResultsIn group A,86 patients (37％) had postoperative recurrence of chordee,25 patients ( 11％ ) had pain during erection after surgery,183 patients were satisfied with correction of chordee (79％).In group A,25 patients were in their adulthood when followed up,and 7 patients had IIEF-5 score ＜21 points.In group B,the single type of chordee among hypospadias were 7/25 (28％),merged type were 18/25 (72％).All patients were followed up without chordee recurrence or painless erection,and 100％ patients or families were satisfied with correction of chordee.The efficacy difference were statistically significant between the two groups in chordee correction.In folding tunica albuginea group in group B,the penile erection length was (4.58 ± 1.59) cm before the correction,and (6.16 ±2.54) cm after correction.In non-folding tunica albuginea group,penile erection length was (4.O1 ± 1.18 ) cm before correction,and (5.82 ± 1.51 ) cm after correction.The difference was not significant between the 2 groups in penile erection length (P ＞ 0.05 ).ConclusionsSurgeon should pay more attention to the correction,effect evaluated,classified etiology and pathological diagnosis of hypospadias and chordee.And the targeted selection of the correct treatment of chordee can further improve the therapeutic effect.Chordee of hypospadias can exist in single or merged according to the pathological classification.Chordee correction surgery can increase length of penis,and dorsal tunica albuginea plication had no significantly different effect on the length of the penis compared to other chordee corrective surgery.

Objective:To attain comprehensive insight into the diagnostic X-ray equipment and examination frequency in radiological diagnosis and treatment institutions in Wuhan, with the purpose of assisting the health administration department in formulating medical exposure protection strategies and efficiently allocating radiological diagnosis and treatment resources.Methods:Using the census method, questionnaires on the basic information on diagnostic X-ray equipment and the annual number of examinations filled out in 2022 by the 1 030 radiological diagnosis and treatment institutions (excluding military and armed police hospitals) were collected through the Wuhan Prevention and Treatment Information Management Platform for Occupational Diseases. To obtain the data on number and frequency of diagnostic X-ray examinations, the different types of diagnostic X-ray examinations were divided by the total number of permanent residents by the end of 2021 in Wuhan.Results:In Wuhan, 1 030 radiological diagnosis and treatment institutions had 7 062 radiation workers and 2 540 diagnostic X-ray units of various types. 37.76% of units and 75.01% of radiation workers were concentrated in tertiary hospitals. The number of diagnostic X-ray units per million population was 186.10, with the top two being 48.65 DR machines per million population and 31.21 intraoral dental machines per million population. The total number of diagnostic X-ray examinations was 11 884 582, with plain radiographs and computed tomography (CT) examinations accounting for 43.61% and 43.59% of the total, respectively. The annual frequency of examinations was 379.75 and 379.52 per 1 000 population, respectively. Radiodiagnosis and treatment resources were higher in central urban areas than that in remote urban areas.Conclusions:The development of diagnostic X-ray equipment in Wuhan was experiencing rapid growth, with potential for further expansion, and the frequency has not yet recovered to the level before the COVID-19 pandemic. The allocation of radiodiagnosis and treatment resources between central urban areas and remote urban areas needs to be coordinated and the management of medical radiation protection should be continuously strengthened, so as to promote the sustainable development of inter-regional radiodiagnosis and treatment, and ensure the health and safety of examinaed patients and indivuduals.