Objective To study the influence of different anticoagulant tube of blood for blood plasma total homocysteine (tHcy) . Methods Six healthy subjects were selected, then the fasting venous blood samples were collected with EDTA-2k tube,sodium citrate tube and lithium heparin tube, respectively. The blood samples were kept under different conditions. The concentrations of tHcy were determined by quantitative HPLC method and the data were analyzed using SPSS17.0 software. Results Under the conditions of 4℃placed for 2 h, 4 h, 7 h, and- 20 ℃ placed for 1 d, 3 d, 5 d after separating plasma, the concentrations of plasma tHcy in different anticoagulant tubes were no statistical difference. In addition, after placing the whole blood at 4℃for 2 h, 4 h, 7 h, the concentrations of plasma tHcy of separated plasma in different anticoagulant tubes were no statistical differences. Conclusion There are no significant differences in determination of the concentration of plasma tHcy when using EDTA-2k tube,sodium citrate tube and lithium heparin tube sampling blood.

Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Objective To investigate the feasibility of urethral reconstruction by using stretched electrospun silk fibroin matrices.Methods Stretched electrospun silk fibroin matrix was prepared,and the structure of the material was assessed by electron microscopy.Canine urothelial cells were isolated,expanded and seeded onto the material for 1 week to obtain a tissue-engineered graft.The tissue-engineered graft was assessed using HE staining and electron microscopy scanning.A dorsal urethral mucosa defect was created in 9 female beagle dogs.In the experimental group,tissue-engineered mucosa was used to repair urethral mucosa defects in 6 dogs.No substitute was used in the 3 dogs of the control group.Retrograde urethrography was performed at 1,2 and 6 months after grafting.The urethral grafts were analyzed grossly and histologically.Results Electron microscopy scanning revealed that the material had a 3 dimensional porous structure.Urothelial cells grew on the material and showed good biocompatibility with the stretched silk fibroin matrices.Canines implanted with tissue-engineered mucosa voided without difficulty.Retrograde urethrography revealed no signs of stricture,and histological staining showed gradual epithelial cell development and stratified epithelial layers at 1,2 and 6 months.The canines in the control group showed difficulty in voiding.Retrograde urethrography showed urethral stricture,and histological staining showed that no or only one layer of epithelial cells developed.A severe inflammatory reaction was also observed in the control group.Conclusion Stretched electrospun silk fibroin matrices have good biocompatibility with urothelial cells,and could be a potential material for urethral reconstruction.

Objective To observe secreted protein acidic and rich in cysteine (SPARC) levels in serum and foot muscle tissue of patients with type 2 diabetic foot (DF).Methods All participants were divided into four groups with 40 cases in each group, including type 2 diabetic patients without (DMA) and with (DMB) lower limb arterial sclerosis and peripheral neuropathy, DF group, and normal control (NC) group.The muscle tissues of foot from DF group (n =6) and NC group (n =6) were taken.Serum SPARC level was measured with ELISA.RT-PCR, Western blot, immunofluorescence, and immunohistochemistry were used to examine SPARC mRNA and protein expressions in the foot muscle.Results Serum SPARC levels were higher in DMA and DMB groups compared with NC and DF groups[(1 040.48 ±212.12 and 1 068.36 ± 165.45 vs 841.93 ± 144.57 and 835.43 ± 188.37) ng/L, P＜ 0.01].There was no significant difference in serum SPARC level between DF and NC groups or DMA and DMB groups (P＞0.05).The expression levels of SPARC mRNA and protein in the foot muscle were higher in DF compared with NC group (P＜0.05).Conclusion SPARC mRNA and protein expressions in foot muscle tissue are higher in DF group compared with control group, indicating that SPARC may participate in the repair and healing of damaged muscle tissue of diabetic foot.

Objective To evaluate the effect of Roux-en-Y gastric bypass on patients with different preoperative glycosylated hemoglobin (HbAlc) level.Methods From Jan.2008 to Dec.2009,54 patients with gastric lesions and type 2 diabetes mellitus were preoperatively divided into 3 groups:group A (HbAlc:6.5％ -7.9％ ),group B ( HbAlc:8.0％ - 9.9％ ),and group C ( HbAlc ＞ 10％ ).They all underwent Roux-en-Y gastric bypass.The fasting plasma glucose(FPG) and HbAlc concentration were measured before surgery and 12,24,48 weeks after surgery.The antidiabetic medication was analyzed before surgery and 48 weeks after surgery.Results FPG and HbAlc concentration decreased significantly after surgery ( P ＜ 0.01 ).FPG and HbAlc concentration differed greatly between the different groups ( P ＜ 0.01 ).With the increase of preoperative HbAlc,FPG and HbAlc concentrations were poorly controlled after surgery.Conclusion Roux-en-Y gastric bypass surgery can effectively improve glucose metabolism for patients with preoperative HbAlc ＜ 10％.

ObjectiveTo investigate the etiology and management of male urethral stricture at 8 medical centers in China during the period from 2004 to 2009 years,and to investigate whether there were any changes in etiology and management of urethral stricture with time change.MethodsThe database on 3455 male patients with urethral stricture who underwent treatment at 8 medical centers in China between January 2004 and December 2009 were prospectively collected.The databases were analyzed for possible cause of stricture and treatment techniques for urethral stricture,and for the changes in etiology and management with time change.ResultsThere were 3455 operations for urethral stricture during the study period.The main causes of urethral strictures were traumas in 1833 patients (53.05％),among which pelvic fractures were in 1327 (38.41％) and perineal trauma in 506 (14.65％).The second cause was iatrogenic causes in 1181 patients (34.18％ ),among which transurethral operations or examinations were in 602 (17.42％),hypospadias surgery in 291 (8.42％) and urethral catheterization in 164 (4.75％ ).Less common causes were urethritis in 201 patients (5.82％),lichen sclerosus in 149 (4.31％),undefined in 91 (2.63％).The treatments of urethral strictures were endourological surgery including internal urethrotomy and dilation and open urethroplasty including end-to-end urethroplasty and the substitude urethroplasty etc.The ratios of using various techniques in total number of patients were obviously different by time.The most application technique for treatment of urethral stricture was endourological surgery ( 709 ) during 2004 -2006 and occupied 52.67％ in total number of patients.It was gradually decreased during 2007 -2009 (726) and only occupied 34.42％ (P ＜0.01 ).Open urethroplasty gradually increased during 2007 -2009 ( 1243,58.94％ ) compared with the first three years (563,41.83％ ) (P ＜ 0.01 ). Conclusions During the recent years there was an increase in the incidence of urethral stricture being trauma and iatrogenic causes.The main treatments of urethral strictures were endourological surgery and open urethroplasty.Endourological surgery was significantly decreased in total number of patients,while open urethroplasty were significantly increased during the late three years.

This study retrospectively analyzed the clinical data of 28 male patients with urethral stricture who had complications during urethrography, including 14 cases of infection, 8 cases of urethral bleeding, 5 cases of contrast agent hypersensitivity, and 1 case of bladder rupture. The infection manifested as acute cystitis in 11 cases, acute pyelonephritis in 1 case, acute epididymitis in 1 case, and sepsis in 1 case. Hypersensitivity reaction was mild in 3 cases, moderate and severe in 2 cases. A child with bladder rupture was immediately transferred to open surgery for bladder repair. All patients were cured by corresponding treatment. The complications of urethrography have various manifestations and different degrees of severity, so we should pay attention to prevention and proper treatment.

OBJECTIVE To analyse the result of mastoid abnormal MRI singals in infants without clinical symptoms and to evaluate the diagnostic value. METHODS The MRI data of abnormal signals in the middle ear and mastoid of 42 infants(62 ears) were analyzed with 1000 Hz probe tone tympanometry and oto-endoscope. RESULTS Of the infants with abnormal MRI signals of the middle ear and mastoid, 50 ears were secretory otitis media(80.7％), 10 ears had dysfunction of middle ear (16.1％), and 2 ears were not identified. CONCLUSION In the infant who had a abnormal long T2 singals MRI but without clinical symptoms, 80.7％ were caused by SOM or AOM. It is valuable for clinical efficacy evaluation and treatment planning in advance.

Objective To analyze current problems of widely-used balloon-mask ventilation, to explore progress in improved cardiopulmonary resuscitation ( CPR) balloon mask research and its advantages, so as to develop emergency rescue instruments applicable to common people. Methods Self-designed oxygen-feeding device in improved balloon mask was used on full-automated computer CPR simulation manikin for 250 times, and experimental data were analyzed. Results Qualified aspiration rate of new balloon-pressing device was 92. 4%, with 7. 6% unqualified. Conclusions Improved CPR balloon mask is with high operability, feasibility and scientificity. The plenum standards conform to requirements of current pre-hospital first aid.

Objective To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription.Methods Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope,and the drug susceptibility test was performed.Results Pathogenic bacteria were detected in 218 (19.4％) of 1 125 sputum specimens.Among the pathogenic bacteria,126 (57.79％) strains were gram-negative bacilli,consisting of 76 (34.86％) strains of Haemophilus influenzae,10 (4.59％) strains of Escherichia coli,7 (3.21％) strains of Sewer enterobacter,7 (3.21％) strains of Pseudomonas aeruginosa,and 6 (2.75％) strains of Klebsiella bacillus; and 92 (42.21％) strains were gram-positive bacilli,consisting of 80 (36.69％) strains of Streptococcus pneumonia and 10(4.59％)strains of Escherichia coli.Most of detected gram-negative bacilli were highly sensitive to cefepime,ceftazidine,imipenem and amikacin,no strains were resistant to meropenem and ciprofloxacin.None of the detected gram-positive bacilli were resistant to cefepime,vancomycin,levofloxacin and teicoplanin.Conclusions The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies.The Haemophilus influenzae were highly sensitive to cephalosporin,imipenem and amikacin,and the Streptococcus pneumonia to cefepime,vancomycin,levofloxacin and teicoplanin.