Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1(n=51) underwent OUPF and group2(n= 56) underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were (103±29) min and (92±21)min respectively (P>0.05). Fistula occurred rates were 7.8% (4/51)and 14.2% (8/56) (P>0.05). Satisfied rates for the appearance of the penis post-operation were 84.8% (39/46)and 87.8%(36/41) respectively (P>0.05). 87 patients were followed up. With mean follow-ups of 15 months (range 6 to 47) , the overall complication rates were 15.7% (8/51) and 32.1 % (18/56)(P<0. 05) for OUPF and TIPU repair. Only 4 of 51 patients (7.8%) undergoing OUPF underwent re-operations, compared to 15 of 56 patients (26.8%) undergoing TIPU repair (P<0.001). A plateau uroflow curve (vs normal bell curve)was observed in 33.3% (13/39)and 67.6(25/37) ,respectively(P<0. 001). The average flow rate was 9. 4 ml per second (range 3. 2 to 17. 1) in patients undergoing OUPF repair, compared to 6. 8 ml per second (3. 3 to 15, P<0. 05) for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second (range 3.9 to 22.9) and 8. 3 mi per second (range 3.7 to 18. 1, P<0.01) for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias.

A rapid and sensitive method for the determination of trace carbaryl in water by using diallyl phthalate-europium ( Eu3+) as fluorescent probes was developed. The interaction between Eu3+ and diallyl phthalate and carbaryl was studied by high resolution mass spectrum, and the fluorescence spectra change of complexes before/after binding with carbaryl was also investigated. The influence factors of fluorescence intensity including solution pH and interferent were studied. The results showed that two diallyl phthalate molecules were complexed with one Eu3+to form stable complexes. Carbaryl could also interact with the probe to form multiple complexes, which significantly increased the fluorescent efficiency of the probe. At pH 9. 0 of solution and by using 245/615 nm as excitation/emission wavelength, the fluorescence intensity showed good linear relationship with the carbaryl concentration ranged from 6. 25í10-8 mol/L to 2. 50í10-6 mol/L, and the linear correlation coefficient was 0. 9968. The detection limit of the method was 9. 6í10-9 mol/L. Water samples were extracted by acetonitrile, and then detected by europium ( Eu3+)-diallyl phthalate fluorescent probe. The recovery of the method was 91. 8%-94. 5%, while RSD was within 6. 1%. The method is suitable for the rapid determination of carbaryl in water samples.

AIM: To compare the impacts of adriamycin(ADM) intermittent and continuous heat infusion on respiration, heart rate and temperature of the rabbit as well as the concentration of ADM in VX-2 tumor for the verification of the safety and effectiveness of intermittent heat infusion through VX-2 transplanted tumor model in rabbit liver.METHODS: VX-2 tumor models were established respectively in the thighs of 30 New Zealand rabbits. All 30 rabbits were randomly allocated into three groups with 10 rabbits each. After catheterizing into femoral artery, which was demonstrated as the supply artery of tumors by digital subtraction angiography(DSA), animals in three groups were infused with 100 mL saline at normal temperature and ADM, 100 mL saline at 60 ℃ and ADM continuously and 100 mL saline at 60 ℃ and ADM intermittently respectively. During infusion, the 43 ℃ to 45 ℃ lasting time in the tumor tissues of the two 60 ℃ groups was measured. After infusion, the respiration(time/minute), heart rate(beats/minute) and temperature(℃ )of the rabbits in each group as well as the concentrations of ADM in tumor tissue were measured immediately.RESULTS: The concentration of ADM was (7. 1 ± 2.2) mg/L in normal temperature infusion group, (17.2 ± 1.6) mg/L in 60 ℃ continuous infusion group and(16.5 ±3.4) in 60 ℃ intermittent infusion group. There were significant differences among three groups( F = 48.95, P = 0. 000), but there was no significant difference between 60 ℃ intermittent infusion group and 60 ℃ continuous infusion group( P ＞ 0. 05). 43℃ to 45 ℃ lasting time was(22.5 ±1.4) minutes in 60 ℃continuous infusion and (24.3±2.4)minutes in 60 ℃intermittent infusion group( F =4.20, P ＞ 0.05) . There were significant differences among three groups in respiration, heart rate and temperature( F = 14. 58, 33.07, 10.00, P ＜ 0.01), but there was no significant difference in the respiration, heart rate and temperature between 60℃ intermittent infusion and normal temperature infusion group ( P ＞ 0. 05).CONCLUSION: Intermittent thermochemotherapy is a more effective and safe interventional thermochemotherapy method compared with continuous heat infusion.

Against the backdrop of rapid economic development and ongoing reforms in the healthcare system,the cover-age and quality of medical services in China are steadily improving.However,this progress is also accompanied by new challen-ges,particularly the frequent occurrence of emergencies.Cultural diversity and differences in ideological concepts serve as signifi-cant catalysts,exacerbating the complexity and unpredictability of these incidents.As a cornerstone of the healthcare system,public hospitals face particularly severe challenges in responding to emergencies.Limited by inadequate medical service levels,ethical standards,doctor-patient relationship management,and crisis response capabilities,public hospitals often encounter sub-stantial difficulties in crisis resolution.In light of this,this paper conducts an in-depth analysis of the multidimensional factors contributing to medical crises in hospitals,carefully identifying the key issues in crisis management.It proposes a series of targe-ted and actionable strategies centered around critical aspects such as crisis early warning mechanisms,accurate identification,ef-ficient response,strict control,timely feedback,and comprehensive summarization.The aim is to enhance public hospitals'abili-ty to respond to emergencies through scientific planning and effective implementation,ensuring the stability and sustainable devel-opment of healthcare services.

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.

Periodontitis and rheumatoid arthritis (RA) are chronic inflammatory diseases that share similar inflammatory mechanisms and characteristics. Programmed cell death (PCD) has recently garnered attention for its crucial role in regulating inflammation and maintaining tissue homeostasis, as well as for its potential to link these two diseases. The various forms of PCD--including apoptosis, pyroptosis, and necroptosis--are closely controlled by signaling pathways such as Toll-like receptor 4 (TLR4) /NF-κB and MAPK. These pathways determine cell fate and influence inflammatory responses, tissue destruction, and repair, and they both play important roles in the pathogenesis of RA and periodontitis. In periodontitis, periodontal pathogens such as Porphyromonas gingivalis (P. gingivalis) and its virulence factors, including lipopolysaccharide (LPS), induce pyroptosis and necroptosis in immune cells such as macrophages via the TLR4/NF-κB pathway, which leads to an excessive release of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α. Concurrently, these pathogens inhibit the normal apoptotic process of immune cells, such as neutrophils, prolonging their survival, exacerbating immune imbalance, and aggravating periodontal tissue destruction. Similarly, in RA synovial tissue, fibroblast-like synoviocytes (FLS) acquire apoptosis resistance through signaling pathways such as the Bcl-2 family, JAK/STAT, and NF-κB, allowing for the consistent proliferation and secretion of matrix metalloproteinases and pro-inflammatory cytokines. Meanwhile, the continuous activation of pyroptotic pathways in neutrophils and macrophages results in the sustained release of IL-1β, further exacerbating synovial inflammation and bone destruction. Notably, dysregulated PCD fosters inter-organ crosstalk through shared inflammatory mediators and metabolic networks. Damage-associated molecular patterns (DAMPs) and cytokines that originate from periodontal lesions can spread systemically, influencing cell death processes in synovial and immune cells, thereby aggravating joint inflammation and bone erosion. By contrast, systemic inflammation in RA can upregulate osteoclastic activity or interfere with the normal apoptosis of periodontal cells via TNF-α and IL-6, ultimately intensifying periodontal immune imbalance. This review highlights the pivotal bridging role of PCD in the pathogenesis of both periodontitis and RA, providing a reference for therapeutic strategies that target cell death pathways to manage and potentially mitigate these diseases.

The many-banded krait, Bungarus multicinctus, has been recorded as the animal resource of JinQianBaiHuaShe in the Chinese Pharmacopoeia. Characterization of its venoms classified chief phyla of modern animal neurotoxins. However, the evolutionary origin and diversification of its neurotoxins as well as biosynthesis of its active compounds remain largely unknown due to the lack of its high-quality genome. Here, we present the 1.58 Gbp genome of B. multicinctus assembled into 18 chromosomes with contig/scaffold N50 of 7.53 Mbp/149.8 Mbp. Major bungarotoxin-coding genes were clustered within genome by family and found to be associated with ancient local duplications. The truncation of glycosylphosphatidylinositol anchor in the 3'-terminal of a LY6E paralog released modern three-finger toxins (3FTxs) from membrane tethering before the Colubroidea divergence. Subsequent expansion and mutations diversified and recruited these 3FTxs. After the cobra/krait divergence, the modern unit-B of β-bungarotoxin emerged with an extra cysteine residue. A subsequent point substitution in unit-A enabled the β-bungarotoxin covalent linkage. The B. multicinctus gene expression, chromatin topological organization, and histone modification characteristics were featured by transcriptome, proteome, chromatin conformation capture sequencing, and ChIP-seq. The results highlighted that venom production was under a sophisticated regulation. Our findings provide new insights into snake neurotoxin research, meanwhile will facilitate antivenom development, toxin-driven drug discovery and the quality control of JinQianBaiHuaShe.