Objective To investigate the surgical treatment of male gynecomastia. Methods The clinical data of 116 cases(156 sites) of male gynecomastia were treated by using micro incision of areola with tumescent anesthesia in the past 4 years were reviewed. Results In this series, 50 to 150 grams mammary gland tissue were resected from the breast. There were no severe postoperative complications,such as nipple or areola necrosis and apparent scar . Follow up was done for 12 to 36 months, the scars were obscure, and the configuration of the breasts were good. Conclusions The operation for male hynecomastia via micro incision of areola with tumescent anesthesia is a good, reliable and convenient technique. It is easily performed with milder injury,less bleeding, and quick recovery.

Objective To analyze and compare the emergency therapeutic methods for renal colic,and to explore the preferable way of emergency therapies for renal colic.Methods A total of 340 cases of renal colic in emergency department were randomly divided into groups A (pethidine),B (diclofenac sodium),C (phloroglucinol),and D (diclofenac sodium + phloroglucino).The average time of therapeutic effect after given 30 min in different groups was observed.Results The average time of effect in group A [(9.53 ±3.34) min],group D[(10.49 ±2.54) min],and group B[(10.51 ±2.27)min] and they were much shorter than group C [(18.51 ±4.86) min] (P ＜0.01).There was no significant difference in the effective rate among the 4 groups(P ＞ 0.05).The relapse rate of group C (11.43％) and group D (9.00％) were much lower than group A (24.59％) and group B(23.75％).There was no adverse reaction in group C.The rates of adverse reactions in group B (2.27％) and group D (2.78％) were much lower than group A (27.27％).Conclusions Diclofenac sodium combined with phloroglucinol was preferable emergency treatment for renal colic.

Objective To examine the levels of plasma tissue factor pathway inhibitor (TFPI) in patients with acute pancreatitis (AP) to assess the clinical value of diagnosis for severe acute pancreatitis ( SAP).Methods Sixty-eight patients were divided into mild acute pancreatitis (MAP)group (n=36) and SAP group (n=32), and twenty volunteers were chosen into normal group ( n=20 ) .Clinical data of these patients were collected, including APACHEⅡscore and Ranson score.Plasma levels of TFPI were measured by ELISA.Results The plasma levels of TFPI in SAP group, MAP group and control group were (4274.25 ±639.83),(3026.81 ±465.76) and (2468.73 ±262.39)pg/ml, respectively(P<0.05).There were significant positive correlations between TFPI and WBC, AST, ALT, TBIL, Cr, PT, APTT, PCT, APACHEⅡscore and Ranson score (P<0.05).The area under the curve (AUC) of TFPI for SAP was 0.902(95%CI=0.845 -0.959, P<0.05 ) .The cutoff value was 4028.83 pg/ml for plasma TFPI with a sensitivity of 87% and a specificity of 78%.Conclusion Plasma levels of TFPI in patients with SAP are significantly increased, which maybe help diagnose SAP.

Objective To investigate the clinical value of serum procalcitonin (PCT) in the diagnosis and treatment of the patients with high fever of acute illness.Methods A total of 285 febrile patients suffered from acute illness were divided into the conventional group (n =122) and the PCT group (n =163).The routine blood examination and serum level of C-reactive protein (CRP) detection were carried out for the dignosis of these febrile patiens of two groups,and in addition,serum PCT determination was carried out in the patients of PCT group.The diagnosis was comnfirmed by etiology or immunologic assays.Routine guidelines of administrating antibiotics were used for treatment in the conventional group.Whereas the antibiotic therapy given to patients of PCT group was guided by the serum PCT levels.Two groups were compared in respect of the antibiotics costs,duration of treatment with antibiotics,percentage of patients treated with antibiotics,efficiency of antibiotics treatment and the mortality rate.The patients of PCT group were further divided as per inflammatory markers of bacterial infection into three subgroups,namely bacterial infection group,viral infection group and non-infection group.At last,the relationship between serum PCT level and the prognosis of patients was analyzed.Results The cost of antibiotics,percentage of patients treated with antibiotics,and course of antibiotics treatment were (Y) (3586.5 ± 703.3),95.08％ and (15.01 ± 11.21) days,respectively in conventional group,whereas (Y) (1871.2 ± 433.5),54.60％,(11.22 ±7.10) days in PCT group with statistically significant difference between two groups (P ＜ 0.01),but there were no significant differences in clinical efficiency and mortality between groups (P ＞ 0.05).Serum PCT (1.12 ± 0.88) ng/ml in bacterial infection group was higher than that in both virus infected group (0.21 ± 0.1 1) ng/ml and non-infected group (0.18 ± 0.13) ng/ml.There was no statistics difference in serum PCT level between virus infected group and non-infected group (P ＞ 0.05).The diagnosis of bacterial infection with serum PCT was better than other inflammatory markers because serum PCT had high sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV).Conclusions Serum PCT level was reliable to differentiate the nature of acute infection with high fever and to evaluate the prognosis by emergency physicians.There was an important significance for rational use of antibiotics by the guidance of PCT levels.

Objective To assess the left atrial early function in pilots with essential hypertension by strian rate imaging (SRI). Methods Twenty-five hypertensive pilots without left ventricular hypertrophy and expansion (LVN) were selected. Twenty-ifve healthy pilots were included as control group. At the left ventricular apical four-chamber view, three-chamber view, two-chamber view, the systolic, early and late diastolic peak strain rate (SRs, SRe, SRa) curves were acquired by SRI in the basal section, the middle section and the upper section of the wall of left atrium. The average strain rate (mSRs, mSRe, mSRa) was calculated. The LA maximal, minimal and pre-systolic volume (LAVmax , LAVmin and LAVp), LA passive ejection fraction (LAPEF), LA active ejection fraction (LAAEF) , left atrial stroke volume (LASV), E/A and E/E′ were calculated. Results The LAPEF, LAAEF, LASV, E/A, E/E′were (38.96±6.43)%, (61.11±5.86)%, (14.74±5.33)mm, 1.23±0.08, 8.63±1.77 in the control group, and were (34.18±5.72)%, (63.23±6.89)%, (10.12±3.23)mm, 1.04±0.26, 7.16±0.84 in the study group. Compared with the control group, signiifcant difference was detect in LAPEF, LAAEF, LASV, E/E′(t=4.840, 2.690, 4.801, 2.950, all P<0.05). No signiifcant difference was found in E/A between the study and control group (t=-1.424, P=0.178). There was signiifcant positive correlation between SRa and E/E′(r=0.632, P<0.05). Conclusion SRI could be applied in the evaluation of early left atrial function. In pilots with essential hypertension, the changes of strain rate in left atrial wall, which is prior to the modeling geometry of left ventricular, could be detected by SRI.

BACKGROUND:Several reports have demonstrated that metabolic disorders and physiopathologic changes accompany with urinary diversion.But these metabolic disorders caused by bladder reconstruction using intestinal tract are related to type and length of intestinal canal.OBJECTIVE:To investigate the histological change of reservoir mucosa and to assess effects on metabolic state in patients with a Roux-y sigmoid neobladder.DESIGN,TIME AND SETTING:A retrospective case analysis was performed at the Department of Urinary Surgery,the 184 Hospital of Chinese PLA between June 2000 and November 2008.PARTICIPANTS:The experimental group comprised 33 bladder carcinoma patients,21 males and 12 females,averaging 64 years of age.The control group consisted of 25 subjects who had no sigmoid colon diseases confirmed by gastroenterological endoscopy.METHODS:Patients with bladder carcinoma received radical cystectomy and bladder reconstruction using Roux-y sigmoid neobladder which controlled urination with anal sphincter.Prior to and after neobladder drainage tube removal,serum levels of electrolyte,creatinine,and urea nitrogen were detected.Before and 36 months after surgery,reservoir mucosa from 13 patients with bladder carcinoma was pathologically examined.For the control group,the thickness of sigmoid colon mucosa and the numbers of intestinal glands were determined.MAIN OUTCOME MEASURES:Electrolyte,renal function,acid-base balance,mucosal layer thickness,numbers of intestinal glands prior to and after surgery,as well as prior to and after drainage tube extraction.RESULTS:After surgery,electrolyte,creatinine,and urea nitrogen were all normal in 30 patients.There was no significant difference in serum electrolyte,creatinine,and urea nitrogen between prior to and after surgery.Mild acid poisoning was found in 3 patients.Microscopic observation results revealed that sigmoid colon mucosa in the control group did not change significantly after surgery,and it basically kept the normal tissue structure;in the experimental group,sigmoid colon mucosa that was(577.6±169.4)μm prior to surgery was thinned(412.5±114.7)μm(P＜0.05),intestinal glands were loosely arranged,interstitial substance became less,and the number of intestinal glands per high-fold visual field that was(26.4±3.5)/high-fold visual field prior to surgery was decreased(15.2±2.7)/high-fold visual field(P＜0.05),after surgery.In addition,intestinal villus in the neobladder was gradually atrophied,and no enterocyte proliferation and malignant changes were found after surgery.CONCLUSION:After Roux-y sigmoid neobladder application,colon mucosa was gradually thinned,intestinal glands were loosely arranged,interstitial substance became less,the number of glands per high-fold visual field was decreased,and body metabolism produced no changes.

Objective:To investigate the clinical efficacy of a new 3D printed guide plate in the minimally invasive treatment of fresh closed Achilles tendon rupture.Methods:From January 2019 to January 2020, 14 fresh closed Achilles tendon ruptures were treated by minimally invasive surgery at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. There were 13 males and one female, with an average age of 39.1 years (from 18 to 63 years). The rupture of the Achilles tendon body, 3 cm in length on average, was located 2 to 6 cm above the attachment of the calcaneal tuberosity. The ruptured Achilles tendon was repaired by suture with the aid of the new 3D printed guide plate. After operation, in cooperation of the Rehabilitation Department, we performed rehabilitation exercise under the guidance of the concept of Enhanced Recovery After Surgery (ERAS). The length of incision, operation time, intraoperative blood loss, ankle function at the last follow-up and follow-up complications were recorded.Results:In this cohort, incision length averaged 2.5 cm (from 2.0 to 3.5 cm), operation time 45 min (from 30 to 60 min), and intraoperative blood loss 15 mL (from 10 to 20 mL). The 14 patients were followed up for 13 to 16 months (average, 14 months) after operation. In one patient, the epidermis at the incision edge became black and necrotic, which was healed after dressing change. Follow-ups observed no such complications as suture rejection, sural nerve injury, or Achilles tendon re-rupture. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at the last follow-up averaged 98 points (from 93 to 99 points), yielding 13 excellent cases and one good case; according to the Arner-Lindholm evaluation, the efficacy was excellent in 12 cases, good in one and poor in one.Conclusion:The minimally invasive treatment of fresh closed Achilles tendon rupture with our new 3D printed guide plate has exhibited advantages of minimally invasive incision, limited complications, simple manipulation, good functional recovery of the ankle joint and strong reproducibility of surgical operations.

Objective:To summarise the experience in use of sural neurouascular flap in repair of the soft tissue defects of foot and ankle, and explore the methods in promoting the survival and appearance of the flap.Methods:Data of 10 patients who underwent sural neurocutaneous flap surgery for repairing soft tissue defects in the foot and ankle in the Department of Foot and Ankle of Xuzhou Renci Hospital from October 2019 to June 2020 were retrospectively analysed. Among the 10 patients, 8 were males and 2 were females, and the age ranged from 18 to 54 years old, with an average age of 42.5 years old; Causes of injury: 8 patients injured by traffic accident and 2 by incision necrosis after calcaneal fracture operation. The areas of soft tissue defect were 4.0 cm×6.0 cm-16.0 cm×10.0 cm. Sural neurouascular flap was used for the defect repairs. Method of optimisation: ①The small saphenous vein in the flap was separated and retained in the limb to optimise the venous circulation. ②Freed peroneal perforator vessels that entered the pedicle, and made the point where the vessels entering the pedicle as the rotation point. The pedicle contained the sural neurovascular bundle, the main trunk of the small saphenous vein and the fascia tissue, with a width about 2.0 cm. It not only increased the blood supply of the flaps, but also a good appearance of the pedicle. ③ The torsion of the pedicle was covered by an arc-shaped flap and transferred through an open channel to prevent compression. ④The donor site was covered with relay flap. According to the location of the donor site, a proximal peroneal artery perforator flap or medial and lateral sural artery perforator flap was selected. ⑤Sural nerve was anastomosed with the peripheral sensory nerve in some cases. The survival of the flap, Maryland Foot Function Score and British Medical Research Council (BMRC) sensory function evaluation were investigated in the follow-up to evaluate the functional recovery of the flap and limb.Results:All the 10 patients received the follow-up for 6 to 12 months, with an average of 8.5 months. The donor and recipient flaps survived completely with good appearance in lower limb, good soft texture, good elasticity and wear resistance. The sensation of the flap with nerve anastomosis in 3 cases was evaluated according to BMRC, and they achieved sensation recovery up to level of S 3 or above. The patients had great satisfactions. At the last follow-up, the curative efficacy was evaluated according to the Maryland scoring system. It ranged from 85 to 98 points, with an average of 91.6 point, 8 patients in excellent and 2 in good. Conclusion:Sural neurouascular flap can achieve a sufficient blood supply, a reasonable venous circulation and a high survival rate. The donor site was covered with relay flap to obtain a good appearance, and the anastomosed sensory nerve offered a good sensation. The function of foot and ankle recovered well, and the clinical effect was satisfactory.

OBJECTIVETo establish an evaluation model of peritoneal metastasis in gastric cancer, and to assess its clinical significance.

METHODSClinical and pathologic data of the consecutive cases of gastric cancer admitted between April 2015 and December 2015 in Department of General Surgery, Zhongshan Hospital of Fudan University were analyzed retrospectively. A total of 710 patients were enrolled in the study after 18 patients with other distant metastasis were excluded. The correlations between peritoneal metastasis and different factors were studied through univariate (Pearson's test or Fisher's exact test) and multivariate analyses (Binary Logistic regression). Independent predictable factors for peritoneal metastasis were combined to establish a risk evaluation model (nomogram). The nomogram was created with R software using the 'rms' package. In the nomogram, each factor had different scores, and every patient could have a total score by adding all the scores of each factor. A higher total score represented higher risk of peritoneal metastasis. Receiver operating characteristic (ROC) curve analysis was used to compare the sensitivity and specificity of the established nomogram. Delong. Delong. Clarke-Pearson test was used to compare the difference of the area under the curve (AUC). The cut-off value was determined by the AUC, when the ROC curve had the biggest AUC, the model had the best sensitivity and specificity.

RESULTSAmong 710 patients, 47 patients had peritoneal metastasis (6.6%), including 30 male (30/506, 5.9%) and 17 female (17/204, 8.3%); 31 were ≥ 60 years old (31/429, 7.2%); 38 had tumor ≥ 3 cm(38/461, 8.2%). Lauren classification indicated that 2 patients were intestinal type(2/245, 0.8%), 8 patients were mixed type(8/208, 3.8%), 11 patients were diffuse type(11/142, 7.7%), and others had no associated data. CA19-9 of 13 patients was ≥ 37 kU/L(13/61, 21.3%); CA125 of 11 patients was ≥ 35 kU/L(11/36, 30.6%); CA72-4 of 11 patients was ≥ 10 kU/L(11/39, 28.2%). Neutrophil/lymphocyte ratio (NLR) of 26 patients was ≥ 2.37(26/231, 11.3%). Multivariate analysis showed that Lauren classification (HR=8.95, 95%CI:1.32-60.59, P=0.025), CA125(HR=17.45, 95%CI:5.54-54.89, P=0.001), CA72-4(HR=20.06, 95%CI:5.05-79.68, P=0.001), and NLR (HR=4.16, 95%CI:1.17-14.75, P=0.032) were independent risk factors of peritoneal metastasis in gastric cancer. In the nomogram, the highest score was 241, including diffuse or mixed Lauren classification (54 score), CA125 ≥ 35 kU/L (66 score), CA72-4 ≥ 10 kU/L (100 score), and NLR ≥ 2.37 (21 score), which represented a highest risk of peritoneal metastasis (more than 90%). The AUC of nomogram was 0.912, which was superior than any single variable (AUC of Lauren classification: 0.678; AUC of CA125: 0.720; AUC of CA72-4: 0.792; AUC of NLR: 0.613, all P=0.000). The total score of nomogram increased according to the TNM stage, and was highest in the peritoneal metastasis group (F=49.1, P=0.000). When the cut-off value calculated by ROC analysis was set at 140, the model could best balanced the sensitivity (0.79) and the specificity (0.87). Only 5% of patients had peritoneal metastasis when their nomogram scores were lower than 140, while 58% of patients had peritoneal metastasis when their scores were ≥ 140(χ=69.1, P=0.000).

CONCLUSIONThe risk evaluation model established with Lauren classification, CA125, CA72-4 and NLR can effectively predict the risk of peritoneal metastasis in gastric cancer, and provide the reference to preoperative staging and choice of therapeutic strategy.

Antigens, Tumor-Associated, Carbohydrate ; blood ; Area Under Curve ; CA-125 Antigen ; blood ; CA-19-9 Antigen ; blood ; Female ; Humans ; Leukocyte Count ; statistics & numerical data ; Logistic Models ; Lymphocytes ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; diagnosis ; Neutrophils ; pathology ; Nomograms ; Peritoneal Neoplasms ; secondary ; Prognosis ; ROC Curve ; Retrospective Studies ; Risk Assessment ; methods ; Risk Factors ; Sensitivity and Specificity ; Stomach Neoplasms ; blood ; classification ; diagnosis ; pathology

Objective:To investigate the clinical characteristics and surgical treatment of enteric Behcet′s disease with acute abdomen.Methods:The clinical data and follow-up results of 9 patients with enteric Behcet′s disease with acute abdomen treated surgically were analyzed retrospectively.Results:All patients in this group had abdominal pain, with bloody stool in one case, failure to exhaust and defecation in 1 case. Physical examination revealed abdominal mass in 2 cases, peritonitis sign in 5 cases and tenderness of the right lower abdomen in 1 case. The causes of operation were pathological perforation of ileocecal region, pathological perforation of small intestine, acute appendicitis, ileum fistula, intestinal stenosis and obstruction and massive hemorrhage of lower digestive tract.In this group, laparotomy or laparoscopy were done in these cases, including ileocecal resection in 2 cases, partial resection of small intestine in 3 cases, laparoscopic appendectomy in 1 case and right colon colectomy in 3 cases. Incision infection occurred in 1 case, anastomotic leakage in 1 case and adhesive intestinal obstruction in 1 case occurred after operation. The median follow-up time of 8 cases was 7.5 years, and Behcet′s disease recurred in 4 cases, but no recurrence of enteric Behcet disease was found.Conclusions:Intestinal perforation, bleeding and obstruction are the main causes of intestinal Behcet′s disease with acute abdomen, and emergency surgery is an important means of treatment, moreover, nutrition support and drug therapy are the important supportive therapy to control this disease.