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.

OBJECTIVETo evaluate the direct effects of dobutamine as compared to adenosine on the coronary microcirculation in both normal and stenotic segments using myocardial contrast echocardiography (MCE).

METHODSLeft anterior descending (LAD) coronary artery stenosis, which was not flow limiting at rest, was established in 9 dogs. At the baseline and during intracoronary infusion of dobutamine (2 mg.kg(-1).min(-1)) and adenosine (5 mg.kg(-1).min(-1)), the radiolabeled microsphere (RM)-derived myocardial blood flow (MBF) were determined, and the double product (DP) and myocardial vascular resistance (MVR) were calculated. MCE was performed to determine the myocardial blood volume (MBV, represented by A) and microbubble velocity (beta).

RESULTSAs compared to the baseline level, the MBF increased and MVR decreased significantly in both the normal and abnormal beds during infusion of both drugs (P<0.05). In the normal bed, adenosine had no effect on MBV, the decrease in MVR was the result of decreased arteriolar (plus venular) resistance, and the increase in MBF was predominately due to the increase in b (deltabeta/ deltaA=13.6). Dobutamine caused a 28% increase in MBV, responsible for 32% of the decrease in the total MVR, but the increase in MBF arose mainly from the increase in b (deltabeta/deltaA=5.9). In the abnormal bed, both the drugs caused a similar increase in MBF entirely by increasing b, and 14% and 15% of the increases in capillary resistance were associated with the capillary derecruitment during administration of dobutamine and adenosine, respectively.

CONCLUSIONThe direct effects of intracoronary dobutamine infusion on the coronary microcirculation are similar to that of adenosine, and the increase in MBF occurs mostly as the result of increased myocardial blood velocity.

Adenosine ; pharmacology ; Adrenergic beta-Agonists ; pharmacology ; Animals ; Blood Flow Velocity ; drug effects ; Coronary Circulation ; drug effects ; Coronary Stenosis ; diagnostic imaging ; Coronary Vessels ; diagnostic imaging ; Dobutamine ; pharmacology ; Dogs ; Echocardiography ; methods ; Microcirculation ; drug effects ; Vasodilator Agents ; pharmacology

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 analysis the risk factors for stricture recurrence after excision and primary anastomotic urethroplasty(EPA). Methods: 209 urethral stricture cases managed with EPA were retrospectively studied from January 2017 to December 2018 in our center. Of all the patients, 183 cases were diagnosed as posterior urethral stricture and 26 cases were diagnosed as bulbar urethral stricture. Their age ranged from 5 to 78 years(mean 42.1 years). 25 cases(12.0%) were defined as the obesity, whose BMI was more than 28 kg/m². 12 cases(5.7%) has the history of diabetes mellitus. 103 cases(49.3%) smoked at least three months before operation. 127 cases(60.8%) didn't have the history of dilation. 42 cases(20.1%)had the history of dilation once or twice. 40 cases (19.1%)had the history of dilation more than three times. The history of urethroplasty included once in 38 cases(18.2%)and more than twice in 8 cases(3.8%). The location of stricture included posterior urethral stricture in 183 cases and bulbar stricture in 26 cases. The history of stricture ranged from 1 to 360 months(mean 35.1 months). The stricture length was(3.19±0.65)cm. The causes including trauma in 190 cases, iatrogenic urethral injury in 12 cases, inflammatory in 2 cases and others in 5 cases. The standard of stricture recurrence were defined as the urination difficulty after removal of catheter and endoscopic or radiographic evidence of obstruction in the area of repair. Univariate and multivariate analysis were performed by the use of Cox′s proportional hazards regression model to identify the related factors for stricture recurrence. Result: The following up period was ranged from 3 to 32 months(average 18.78 months). Recurrence occurred in 31 cases in the period of 1.0 to 18.0 months(average 5.34 months). Factors had statistical differences in univariate analysis including stricture period(HR=1.007, P<0.001), stricture length(HR=5.334, P<0.001), history of direct vision internal urethrotomy (DVIU)(HR=2.901, P=0.003), history of urethral dilation ≥3 times(HR=6.214, P<0.001), history of urethroplasty 1 time, ≥2 times(HR=4.175, P=0.001, HR=9.885, P<0.001), 3 months smoking before surgery(HR=2.605, P=0.016), suprapubic cystostomy(HR=0.231, P=0.006), inferior pubectomy(HR=6.603, P<0.001). In multivariate analysis stricture length(HR=4.911, P<0.001), history of urethroplasty 1 time, ≥2 times(HR=2.387, P=0.045, HR=3.688, P=0.015), 3 months smoking before surgery(HR=2.730, P=0.030)were independent risk factors. Conclusion The urethral stricture recurrence mainly occurred within 6 months after surgery. The length of stricture, history of urethroplasty and 3 months smoking before surgery were the independent risk factors for stricture recurrence.

Visceral leishmaniasis is a parasitic disease transmitted by Phlebotomus chinensis that poses a great threat to human health. Historically, visceral leishmaniasis was predominantly prevalent in northwestern regions of Sichuan Province. Following the founding of the People’s Republic of China, large-scale integrated interventions had been implemented in visceral leishmaniasis-endemic areas of Sichuan Province, including identification and treatment of visceral leishmaniasis patients, elimination of infected dogs, Ph. chinensis control and health education. This review summarizes the prevalence of visceral leishmaniasis, discusses the control strategy of visceral leishmaniasis and analyzes the challenges of elimination of visceral leishmaniasis based on the One Health concept in Sichuan Province, so as to provide insights into elimination of visceral leishmaniasis in the province.

Objective:To investigate the efficacy and feasibility of urethroplasty using inner prepuce graft combined with Orandi flap for the treatment of the obliterated penile urethral atresic stricture.Methods:From January 2016 to September 2019, the clinical data of 18 obliterated penile urethral stricture cases were analyzed retrospectively. All the patients were treated using inner prepuce flap combined with Orandi Flap. The average age of the patients was 62.1 years old (range 20-81 years old). Ten cases had suprapubic cystostomy before operation. The maximum flow rate was 1.6-6.2 ml/s, with an average of 4.2ml/s. The intubation general anesthesia and lithotomy position was used. The foreskin of penis was incised longitudinally. The urethra was exposed and the segment of stricture was opened longitudinally. The range of stricture length was measured with soft ruler, ranging from 2.0 to 7.5 cm, with an average of 5.0cm. After the fibrotic tissue was completely removed, the dorsal inner prepuce was incised with needed length and width for harvesting a free skin flap in order to transplant and reconstruct the dorsal urethral. The Orandi flap was used to cover the ventral urethra, and a F14-16 silicone catheter was retained. The length range of the inner prepuce graft was 2.0-7.5 cm, with an average of 5.1cm; the width was 1.2-1.8 cm, with an average of 1.4cm. The length of Orandi flap was 2.2-7.7 cm, with an average of 6.0cm; the width was 1.0-1.5 cm, with an average of 1.3 cm. The catheter was removed 3-4 weeks after operation. The patients were then followed up after 3, 6 and 12 months postoperatively and then with annual assessments for the symptoms, urinary flow rate, and urethrography or soft urethroscopy when necessary.Results:All of the 18 operations were completed successfully. The patients were followed up for 6-36 months, with an average of 22 months. There were 5 patients with terminal dripping, 4 patients with recurrent urinary tract infection within half a year after operation, and antibiotic treatment being effective. The quality of life scores at 3 months and 6 months after operation were 0.8 (0-2) and 0.6 (0-1), respectively, which were statistically significant compared with before operation ( P<0.001). Conclusions:The use of free inner prepuce flap combined with Orandi flap is an effective treatment for the obliterated penile urethral atresic stricture, especially for the patients who are unwilling or unsuitable to harvest the oral mucosa. It has the advantages of convenient harvesting and less complications.

Objective:To identify the pathogens isolated in the subperiosteal abscesses from the pediatric patients with acute osteomyelitis and to investigate the characteristics of bacterial drug resistance.Methods:A retrospective study was conducted on children with acute septic osteomyelitis who were hospitalized in the Children's Hospital, Zhejiang University School of Medicine from January 1, 2011 to March 1, 2018. The results of bacterial cultures isolated from the subperiosteal abscesses or bone marrow fluid were collected. The Merier automatic bacterial identification system (i.e., Vitek) was used to identify the bacteria and to assess the drug sensitivity.Results:(1) A total of 104 pediatric patients were included and 60 (57.7%) were male. Sixty-six strains of pathogens were isolated from 65 patients (62.5%). Among them, 53 strains (51.0%) were Staphylococcus aureus; 3 strains were Escherichia coli; 2 strains (1.9%) were Pseudomonas aeruginosa; 2 strains (1.9%) were Streptococcus pneumoniae, 2 strains (1.9%) were Ochrobactrum anthropi, and 4 strains (3.8%) were other bacteria. Pathogens were not found in 39 patients (37.5%). (2) Staphylococcus aureus accounted for 81.5% (53/65) of the pathogen-positive cases. Among them, 23 strains (43.4%) were methicillin-resistant Staphylococcus aureus (MRSA). Aureus-positive children were statistically significantly older ( P=0.028), heavier ( P=0.040) and had higher C-reactive protein (CRP) level ( P=0.038) than the aureus-negative children. (3) All the 53 Staphylococcus aureus strains were resistant to penicillin and 56.6% of them were only sensitive to benzocillin. The resistance rates to compound sulfamethoxazole, tetracycline, clindamycin and erythromycin were 11.3%, 30.2%, 67.9% and 69.8%, respectively. The sensitivity rate of the strains to furantoin was 90.2%. All strains were sensitive to quinupristin/dalfopristin, linezolid, rifampicin, tigecycline, levofloxacin, moxifloxacin, ciprofloxacin and vancomycin. There was 69.8% of the strains resistant to three or more different types of antibiotics. Conclusions:Staphylococcus aureus is the most common pathogen that causes the acute septic osteomyelitis in children, and the resistance rate to Benzocillin is relatively high. Therefore, Benzocillin and Clindamycin, as the traditionally-used drugs, should not be considered as the first choice when empirically using intravenous antibiotics. In the present study, pathogens in 39 patients (37.5%) were not detected in their subperiosteal abscesses or bone marrow fluid, so further effort should be made to investigate the etiology of these patients.

Objective:To compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.Method:A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m 2 and (24.5±2.7) kg/m 2, the preoperative maximum urine flow rate (Q max) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant ( P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant ( P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery. Result:All 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant ( P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant ( P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Q max of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance ( P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative ( P=0.023). Conclusion:NTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU) for posterior urethral stricture.Methods From May 2012 to September 2016,62 patients with posterior urethral stricture,who were treated with NTU,were enrolled in this study.The mean age was 37.5 years old,ranging 18-48 years old.The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases.Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra,which was at the distal of verumontanum.The mean length of stricture was 2.1 cm,ranging 0.5-2.5 cm.The average period between trauma and surgery was 6.4 months,ranging 3 months-2 years.All patients had no previous history of urethroplasty.Their sexual hormones were in normal level.Among those patients,the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice.Finally,43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+ NTU.All patients had a general anesthesia.The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane.Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension.The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis.The 18-Fr indwelling catheter was inserted.Result Average follow-up was 20.2 months,ranged from 12 to 36 months.In NTU group,NPT test revealed no significant difference in number of events (2.7 ± 0.7 vs.3.0 ± 1.0,P ＞ 0.05),duration of best episode [(16.4 ± 3.5) min vs.(16.4 ± 3.8) min,P ＞ 0.05)] or tip rigidity [(31.2 ± 4.7) ％ vs.(30.8 ± 3.5) ％,P ＞ 0.05)] between pre-and post-operation,respectively.The IIEF-5 score (19.7 ± 1.9 vs.20.4±2.1,P＜0.05)and Qmax[(8.7 ±4.0)ml/s vs.(25.5 ±4.7)ml/s,P＜0.05)] increased significant pre-and post-operation,respectively.In IP + NTU group,Qmax [(8.4 ± 4.4) ml/s vs.(23.1 ± 3.5)ml/s,P ＜ 0.05)] increased significant pre and post operation.The NPT test revealed slight decrease in number of events(2.3 ± 0.6 vs.1.6 ± 1.0,P ＜ 0.05),duration of best episode [(15.6 ± 2.4) min vs.(14.5±2.4)min,P＜0.05)] or tip rigidity [(29.8±3.0)％ vs.(25.6 ±7.1)％,P＜0.05)] between pre-and post-operation,respectively.However,the IIEF-5 scores (17.3 ± 1.6 vs.16.5 ± 2.1,P ＜ 0.05) didn't show significant difference pre-and post-operation.Stricture recurrence occurred in 3 patients,the success rate was 95.2％ (59/62) during 12 months following.Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm,but also a new minimally invasive approach to preserve erectile function.

Objective:To study the clinical features, management methods, and survival of patients with urinary neuroendocrine carcinoma (NEC).Methods:A retrospective study of 22 patients with urinary NEC was performed from March 2008 to August 2019, including 21 male and 1 female. The average age was 68.2±9.9 years. Location of the lesion included left adrenal gland 1 case, right kidney 1 case, left ureter 1 case, bladder 9 cases and prostate 10 cases. 16 cases with bladder or prostate NECs had hematuria. Radiological feature was solid tumors with inhomogeneous enhancement and obvious local invasion. Clinical TNM stages included left adrenal NEC(T 2N 0M 0), right kidney(T 4N 1M 0), left ureter(T 3N 1M 0), bladder(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 3 with T 3N 1M 0, 1 with T 4N 2M 0 and 1 with T 4N 1M 1), prostate(2 cases with T 2N 0M 0, 2 with T 3N 0M 0, 1 with T 4N 0M 0, 2 with T 4N 0M 1 and 3 with T 4N 1M 1). Radical surgery was performed for 8 patients (5 with bladder NECs, 1 for renal, ureter and prostate NECs respectively). Tumor resection was performed for left adrenal NEC. 4 bladder NECs and 3 prostate NECs were managed with palliative resections and 4 prostate NECs with conservative treatment, 2 prostate NECs lost to follow up after needle biopsy. Results:Pathological results were as follows, 12 cases with primary SCNECs, 2 cases with NECs, 3 cases were bladder SCNECs combined with high grade urothelial carcinoma, 4 cases were prostate SCNECs combined with adenocarcinoma, 1 case was SCNEC combined with LCNEC. Pathological tests indicated that average Ki-67 was (60.9±16.0)%, synaptophysin(SYN)was positive in 20 cases, chromogranin A(CgA)in 10 cases and CD56 in 19 cases. The median following time was 15.5 months(8-108 months)of 20 patients, 16 were deceased, 3 were surviving with tumor and 1 with clinical cure. The 1-, 2- and 3-year overall survival rates between bladder NECs(66.7%, 22.2%, 11.1%)and NECs in other locations(90.9%, 63.6%, 42.4%) had statistical significance( P=0.038). Conclusions:Hematuria was the main symptom of bladder and prostate NEC. SCNEC is the most common pathological type, many were in advanced stage when diagnosed. Even though managed with radical surgery, most of cases had poor prognosis, overall survival rate of bladder NECs was lower than other locations. Radical surgery in early stage and multi-disciplinary therapy can improve the situation.