AIM: To study the expression of the VEGF in single and multiple superficial transitional cell bladder carcinoma and their clinical significance. METHODS: Immunohistochemical method was used to study the VEGF in 60 cases of superficial transitional cell bladder carcinoma and in 10 cases of normal bladder tissue as control. RESULTS: High expression of VEGF in bladder carcinoma cell was observed. The expression level of VEGF in multiple superficial transitional cell bladder carcinoma was higher than that in single superficial transitional cell bladder carcinoma. The recurrent rate in the patient with VEGF high expression was more than that in the patient with VEGF low expression. CONCLUSION: The expression level of VEGF was correlated to the biological behavior of superficial transitional cell bladder carcinoma.

Objective To evaluate the clinical application value of transesophageal atrial pacing (TEAP) combined with atropine load experiment in the diagnosis of the lesions of sinoatrial node and atrioventricular node.Methods One hundred and forty-four cases selected from the outpatient and hospitalized patients in the People's Hospital of Changji Hui Autonomous Prefecture from September 2009 to December 2012,who with dizziness, syncope and other clinical symptoms and electrocardiogram showe.TEAP combined with atropine load experiment were given to these patients.Results (1) The authors detected in all patients,83 cases (57.6％) were positive, among which, 48 cases (57.8％) male, 35 cases (42.2％) female.(2) The authors detected 57 cases(39.6％) non-increased vagus nerve tension cases in 83 positive cases,among which 33 cases (57.9％) male, 24 cases (42.1％) female;Among which 29 cases (20.1％) were sinoatrial node hypofunction, and 16 cases(55.2％) male;8 cases(5.6％) were atrioventricular node hypofunction,and 4 cases(50％) male;14 cases(9.7％) were double node hypofunction, and 10 cases (71.4％) male;6 cases (4.2％) were tachycardia-bradycardia syndrome, and 3 cases (50％) male;among which, a long interval of greater than 3 seconds appeared when we stimulate one 84 years old man with S1S1 stimulate way, immediately pressed protective pacemaker until his own sinus rhythm was restored, as a safety precaution, stoped further examination and classified him as sick sinus group.Conclusion Detect the common causes of slow sinus and atrioventricular block,such as the sinoatrial node dysfunction, atrioventricular node dysfunction, double node dysfunction and increased vagus nerve tension through TEAP combined with atropine load experiment.Consider that this methods have the best diagnostic value in decreasing its rate of false positivity,and should be used as a necessary check before implantation of pacemaker in such patients, suitable used in clinical, especially in basic general hospitals.

Objective To cstimnate the diagnostic performance of computer tomography (CT) and magnetic resonance imaging (MRI) for detecting metastasis in pelvic lymph nodes with normal size in patients with bladder cancer.Methods hnaging of CT and MRI and clinical data of 118 patients who underwent radical cystectomy and pelvic lymphadenectomy were reviewed.The diagnostic efficacy of CT and MRI were analyzed when taking lymph nodes short axis diameter ≥0.3 cm and ≥ 1.0 cm respectively as diagnostic criterion of metastasis with corTelation of pathological results.Results 22.7％ (27/118) of patients were confirmed lymph nodes malignancies among 118 patients based on pathology.Totally 1 705 lymph nodes were detected in surgery and 119 of them were observed malignancy according to pathological presentation.The malignant nodes were mainly distributed in the perivesical (35.4％,41/119),internal iliac (12.6％,15/119),external iliac (30.3％,36/119),obturator region (21.0％,25/119) and presarcal region (1.7％,2/119).Imaging of CT and MRI showed that when taking nodes with ≥0.3 cm in maximum short-axis diameter (MSAD) as positive,the sensitivity (Se),specificity (Sp),and positive predictive values (PPV) were 16.0％,99.2％,54.2％ and 56.5％,99.2％,86.7％ respectively.While taking MSAD≥1.0 cm as malignant,the Se,Sp and PPV of CT and MRI were 6.2％,99.9％,83.3％ and 13％,100％,100％ respectively.When taking MSAD ≥0.3 cm as positive,the Se and PPV between CT and MR were statistically different(P ＜ 0.001 and P =0.036,respectively).When taking MSAD ≥ 1.0 cm as positive,there was no statistically difference (P =0.275 and 1.000,respectively).Conclusions The incidence of normal-sized lymph node metastasis was higher in patients with bladder cancer.At this phase the MRI evaluation was superior to that of CT.When the MSAD ≥ 1.0 cm,there was no significant difference between CT and MRI.

Objective To investigate whether the proportions of Th17/Treg balance were impaired in the peripheral blood of patients in different phases of synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome.Methods We studied 22 cases diagnosed as SAPHO syndrome and 11 healthy controls.According to the scores of VAS pain,BASDAI and BASFA,the 22 patients were divided into active group and stable group.By means of flow-cytometry,the frequencies of total and different subsets of Th17 and Treg cells in peripheral blood mononuclear cell of different groups of SAPHO syndrome and healthy controls were studied.The values of Th17/Treg balance were analyzed.The relationship was analyzed with Kruskal-Wallis test,Mann-Whitney test and Pearman's test.Results The mean percentage of Th17 cells was markedly higher in the active group [(2.74±0.25)％] than in the stable group [(1.16±0.09)％] (U=0.000,P＜0.01) and healthy controls [(1.13±0.11)％] (U=0.000,P＜0.01).No differences were found among active group [(2.10±0.20)％],stable group [(2.51±0.20)％] and control group [(2.44±0.22)％] (x2=2.16,P=0.339 4).The ratio of Th17 cells to Treg cells was markedly higher in active group [(1.48±0.25)％] than in the other two groups [(0.47±0.03)％] (U=0.000,P＜0.01).We also found the positive correlation of the ratios of Th17/Treg cells with the values of VAS in SAPHO syndrome patients (r=0.752 7,P＜0.01).Conclusion The results demonstrate that the development of SAPHO syndrome is closely related to the imbalance of systemic Th17/Treg cells,Increased ratio of Th17/Treg cells may be the main factor that cause disease recurrence,and then,lead to the manifestations of high levels of inflammation and joint pain.

OBJECTIVETo introduce and evaluate the technical feasibility and anatomical and functional outcomes of one-stage vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis.

METHODSWe retrospectively reviewed our experiences with 17 patients with Mayer- Rokitansky-Kuster-Hauser syndrome treated with primary surgery from September 2010 to April 2013. All patients underwent vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis. We describe the details of this technique, observe the time of epithelization and evaluate the long- term anatomical, functional, and sexual outcomes.

RESULTSThe time of epithelization was 13 d (range: 12-15 d). At a mean follow-up of 15 months (range: 12-24 months), the mean postoperative dependence on the vaginal stent was 11.7 ± 1.64 months (range: 9-15 months), the mean depth of the neovagina was (9.0 ± 0.94) cm (range: 7-11 cm), the mean circumference was (12.3 ± 1.36) cm (range: 10.0-14.5 cm) and the mean volume was (105 ± 10) ml (range 85-120 ml). The mean female sexual function index score of the 12 sexually active patients was 29.5 ± 2.6. No spouse reported discomfort during intercourse.

CONCLUSIONSVaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis is an effective and feasible approach for patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The procedure has satisfactory long-term anatomical and functional results. The use of the acellular allogenic dermis is limited by the high price and the potential infection.

46, XX Disorders of Sex Development ; surgery ; Acellular Dermis ; Coitus ; Congenital Abnormalities ; surgery ; Feasibility Studies ; Female ; Humans ; Mouth Mucosa ; transplantation ; Mullerian Ducts ; abnormalities ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Vagina ; abnormalities ; surgery

Objective To investigate the predictive value of diffusion-weighted (DW) magnetic resonance imaging (MRI) for invasiveness of hilar cholangiocarcinoma (HC).Methods The retrospective casecontrol study was conducted.The clinicopathological data of 65 HC patients who were admitted to the Sun Yat-sen Memorial Hospital from January 2012 to November 2017 were collected.Patients received DW MRI before treatment,and 2 senior imaging doctors analyzed imaging data and measured the apparent diffusion coefficient (ADC) for the primary lesions of HC.Observation indicators:(1) MRI situations of HC;(2) relationship between ADC and clinicopathological factors;(3) receiver operator characteristic (ROC) curve analysis;(4) treatment and follow-up situations.According to patients' conditions,treatment plans were done within 2 weeks after MRI and patients underwent radical resection of HC.Follow-up using telephone interview was performed to detect tumor recurrence up to December 2017.Measurement data with normal distribution were represented as (x)±s,and comparisons between group and among group were respectively analyzed using the t test and one-way ANOVA.Spearman's rank correlation was performed to analyze the relationship between ADC and clinicopathological factors.ROC curves assessed the diagnostic efficiency of ADC.Results (1) MRI situations of HC:MRI and magnetic resonanced cholangio-pancreatography (MRCP) in 65 patients showed varying degrees of soft rattan-like dilations of intrahepatic bile ducts and truncation signs of bile tracts in hepatic port.Of 65 patients,tumors in 23,7 and 35 patients were respectively pedunculated type,polypoid type and infiltrating type.The pedunculated-type lesions of 23 patients presented as low signal on T1WI and slightly high signal on T2WI;after enhanced scans of MRI,pedunculated-type lesions of 7 patients demonstrated moderate homogenous enhancement in 3 patients,ring-like enhancement with internal liquefaction necrosis in 10 patients and moderate heterogeneous enhancement in 10 patients,respectively.The polypoid-type lesions presented as low signal on T1WI and high signal on T2WI,and moderate homogenous enhancement by enhanced scans of MRI.There were varying degrees of bile duct wall thickness and irregular nodules in the infiltrating-type lesions of 35 patients,showing moderate enhancement by enhanced scans of MRI.All the lesions of 65 patients using DW MRI demonstrated restricted diffusion,showing a clear boundary between lesions and normal surrounding bile ducts or liver tissues;heterogeneous enhancement lesions by MRI scans presented as heterogeneously high signal on DWI and heterogeneously low signal on ADC map,and necrotic area of lesions showed low signal on DWI;homogenous enhancement by MRI scans presented as homogenously high signal on DWI and homogenously low signal on ADC map.(2) Relationship between ADC and clinicopathological factors:ADC was respectively (1.382±0.165)× 10-3 mm2/s,(1.343±0.138)× 10-3 mm2/s,(1.291-±0.226)×10-3 mm2/s,(1.111±0.243)×10-3 mm2/s in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ (TNM staging) and (1.441± 0.355) × 10-3 mm2/s,(1.226 ± 0.177) × 10-3 mm2/s,(1.061 ± 0.228) × 10-3 mm2/s in highdifferentiated,moderate-differentiated and low-differentiated tumors (pathological grading) and (1.403±0.176)× 10-3 mm2/s,(1.121±0.238)× 10-3 mm2/s in Ki-67 score ≤ 10％ and ＞ 10％ and (1.115±0.241)× 10-3 mm2/s,(1.347±0.174)× 10-3 mm2/s in HC patients with and without lymph node metastasis,with statistically significant differences in the above indicators (F =4.158,9.866,t =11.607,13.464,P＜0.05).Results of Spearman's rank correlation analysis showed that ADC had a negative correlation with TNM staging,pathological grading and Ki-67 score (r=-0.532,-0.522,-0.409,P＜0.05).(3) ROC curve analysis:using 1.225×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of stage Ⅰ-Ⅱ HC and stage Ⅲ-Ⅳ HC were 70.5％ and 81.0％,and area under ROC curve was 0.705 (95％CI:0.62-0.84,P＜0.05).Using 1.100×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lowdifferentiated HC and moderate-and high-differentiated HC were 88.2％ and 64.3％,and area under ROC curve was 0.814 [95％ confidence interval (CI):0.69-0.90,P＜0.05].Using 1.243×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of Ki-67 score ≤ 10％ and ＞ 10％ were 66.7％ and 75.0％,and area under ROC curve was 0.783 (95％CI:0.62-0.90,P＜0.05).Using 1.222×10-3 mm2/s as a critical value of ADC,the sensitivity and specificity of ADC in the diagnosis of lymph node metastasis were 91.3％ and 71.4％,and area under ROC curve was 0.873 (95％CI:0.76-0.94,P＜0.05).(4) Treatment and followup situations:65 patients underwent successful radical resection of HC.Thirty-three patients were followed up for 1-24 months.Of 33 patients,5 had tumor recurrence within 6 months postoperatively,including 4 with ADC ＜ 1.100× 10-3 mm2/s,13 had tumor recurrence after 6 months postoperatively,and 15 didn't have tumor recurrence or metastasis,including 1 with ADC ＜ 1.100× 10-3 mm2/s.Conclusions There are different ADC in differentTNM staging,pathological grading,Ki-67 score and with or without lymph node metastasis of HC.ADC of DWMRI can be used as a preoperative imaging predictor for invasiveness of HC.

Objective:To explore the clinical effect of the composite reduction labiaplasty by divisional design.Methods:From January 2020 to February 2022, the clinical data of patients with complex labia minora and clitoris prepuce hypertrophy who were treated in the Medical Cosmetic Center of Beijing Friendship Hospital Affiliated to Capital Medical University were collected and analysed. The inner side of their labia minora showed no chalasis in the vertical direction, but the outer side were slack with folds, accompanied by clitoris prepuce hyperplasia. We adopted the composite reduction labiaplasty by divisional design. The outer side of the labia minora and the clitoral prepuce were considered as a whole, and a wedge-shaped incision line was designed to remove the excess tissue in the vertical direction. On this basis, an arc was projected on the inner side of the labia minora to form an arcuate incision line on the inner side. The composite reduction labiaplasty was performed with the combination of wedge resection and edge resection. The postoperative follow-up observations included: postoperative complications, the symmetry of the labia minora and clitoris prepuce, the improvement of frictional discomfort, the cleanliness of the labia minora and the clitoris prepuce, and the patient's satisfaction with the shape of the labia minora and clitoris prepuce. For patients with sexual experience, follow-up content also includes changes in sexual satisfaction.Results:A total of 17 female patients aged 20 to 35 years, with an average age of 27 years, were included in this study. Follow-up was conducted 2 months after the operation. All incisions healed by first intention with no sawtooth-like deformity at the incision margin, and had natural appearance. Patients felt that the bilateral labia minora and clitoral foreskin were completely symmetrical in 3 cases, basically symmetrical in 12 cases, and partially asymmetric in 2 cases. These 2 cases of partial asymmetry did not require further surgical repair. In all 17 patients, the frictional discomfort was completely resolved, and the labia minora and clitoral foreskin were easier to clean. The patients were very satisfied with the appearance in 5 cases, satisfied in 10 cases, and dissatisfied in 2 case. There were 15 patients with previous sexual life experience, of which 10 patients had improved sexual satisfaction, and 5 patients had no change in sexual satisfaction after the operation.Conclusions:Through the divisional design, wedge resection and edge resection are performed in the composite reduction labiaplasty, which can solve the friction and discomfort caused by the hyperplasia of labia minora and clitoris prepuce in a single operation, and achieve better aesthetic results at the same time.

Objective:To explore the clinical effect of the composite reduction labiaplasty by divisional design.Methods:From January 2020 to February 2022, the clinical data of patients with complex labia minora and clitoris prepuce hypertrophy who were treated in the Medical Cosmetic Center of Beijing Friendship Hospital Affiliated to Capital Medical University were collected and analysed. The inner side of their labia minora showed no chalasis in the vertical direction, but the outer side were slack with folds, accompanied by clitoris prepuce hyperplasia. We adopted the composite reduction labiaplasty by divisional design. The outer side of the labia minora and the clitoral prepuce were considered as a whole, and a wedge-shaped incision line was designed to remove the excess tissue in the vertical direction. On this basis, an arc was projected on the inner side of the labia minora to form an arcuate incision line on the inner side. The composite reduction labiaplasty was performed with the combination of wedge resection and edge resection. The postoperative follow-up observations included: postoperative complications, the symmetry of the labia minora and clitoris prepuce, the improvement of frictional discomfort, the cleanliness of the labia minora and the clitoris prepuce, and the patient's satisfaction with the shape of the labia minora and clitoris prepuce. For patients with sexual experience, follow-up content also includes changes in sexual satisfaction.Results:A total of 17 female patients aged 20 to 35 years, with an average age of 27 years, were included in this study. Follow-up was conducted 2 months after the operation. All incisions healed by first intention with no sawtooth-like deformity at the incision margin, and had natural appearance. Patients felt that the bilateral labia minora and clitoral foreskin were completely symmetrical in 3 cases, basically symmetrical in 12 cases, and partially asymmetric in 2 cases. These 2 cases of partial asymmetry did not require further surgical repair. In all 17 patients, the frictional discomfort was completely resolved, and the labia minora and clitoral foreskin were easier to clean. The patients were very satisfied with the appearance in 5 cases, satisfied in 10 cases, and dissatisfied in 2 case. There were 15 patients with previous sexual life experience, of which 10 patients had improved sexual satisfaction, and 5 patients had no change in sexual satisfaction after the operation.Conclusions:Through the divisional design, wedge resection and edge resection are performed in the composite reduction labiaplasty, which can solve the friction and discomfort caused by the hyperplasia of labia minora and clitoris prepuce in a single operation, and achieve better aesthetic results at the same time.

Objective:To explore the clinical effect of the composite reduction labiaplasty by divisional design.Methods:From January 2020 to February 2022, the clinical data of patients with complex labia minora and clitoris prepuce hypertrophy who were treated in the Medical Cosmetic Center of Beijing Friendship Hospital Affiliated to Capital Medical University were collected and analysed. The inner side of their labia minora showed no chalasis in the vertical direction, but the outer side were slack with folds, accompanied by clitoris prepuce hyperplasia. We adopted the composite reduction labiaplasty by divisional design. The outer side of the labia minora and the clitoral prepuce were considered as a whole, and a wedge-shaped incision line was designed to remove the excess tissue in the vertical direction. On this basis, an arc was projected on the inner side of the labia minora to form an arcuate incision line on the inner side. The composite reduction labiaplasty was performed with the combination of wedge resection and edge resection. The postoperative follow-up observations included: postoperative complications, the symmetry of the labia minora and clitoris prepuce, the improvement of frictional discomfort, the cleanliness of the labia minora and the clitoris prepuce, and the patient's satisfaction with the shape of the labia minora and clitoris prepuce. For patients with sexual experience, follow-up content also includes changes in sexual satisfaction.Results:A total of 17 female patients aged 20 to 35 years, with an average age of 27 years, were included in this study. Follow-up was conducted 2 months after the operation. All incisions healed by first intention with no sawtooth-like deformity at the incision margin, and had natural appearance. Patients felt that the bilateral labia minora and clitoral foreskin were completely symmetrical in 3 cases, basically symmetrical in 12 cases, and partially asymmetric in 2 cases. These 2 cases of partial asymmetry did not require further surgical repair. In all 17 patients, the frictional discomfort was completely resolved, and the labia minora and clitoral foreskin were easier to clean. The patients were very satisfied with the appearance in 5 cases, satisfied in 10 cases, and dissatisfied in 2 case. There were 15 patients with previous sexual life experience, of which 10 patients had improved sexual satisfaction, and 5 patients had no change in sexual satisfaction after the operation.Conclusions:Through the divisional design, wedge resection and edge resection are performed in the composite reduction labiaplasty, which can solve the friction and discomfort caused by the hyperplasia of labia minora and clitoris prepuce in a single operation, and achieve better aesthetic results at the same time.

Objective:To explore the clinical effect of the composite reduction labiaplasty by divisional design.Methods:From January 2020 to February 2022, the clinical data of patients with complex labia minora and clitoris prepuce hypertrophy who were treated in the Medical Cosmetic Center of Beijing Friendship Hospital Affiliated to Capital Medical University were collected and analysed. The inner side of their labia minora showed no chalasis in the vertical direction, but the outer side were slack with folds, accompanied by clitoris prepuce hyperplasia. We adopted the composite reduction labiaplasty by divisional design. The outer side of the labia minora and the clitoral prepuce were considered as a whole, and a wedge-shaped incision line was designed to remove the excess tissue in the vertical direction. On this basis, an arc was projected on the inner side of the labia minora to form an arcuate incision line on the inner side. The composite reduction labiaplasty was performed with the combination of wedge resection and edge resection. The postoperative follow-up observations included: postoperative complications, the symmetry of the labia minora and clitoris prepuce, the improvement of frictional discomfort, the cleanliness of the labia minora and the clitoris prepuce, and the patient's satisfaction with the shape of the labia minora and clitoris prepuce. For patients with sexual experience, follow-up content also includes changes in sexual satisfaction.Results:A total of 17 female patients aged 20 to 35 years, with an average age of 27 years, were included in this study. Follow-up was conducted 2 months after the operation. All incisions healed by first intention with no sawtooth-like deformity at the incision margin, and had natural appearance. Patients felt that the bilateral labia minora and clitoral foreskin were completely symmetrical in 3 cases, basically symmetrical in 12 cases, and partially asymmetric in 2 cases. These 2 cases of partial asymmetry did not require further surgical repair. In all 17 patients, the frictional discomfort was completely resolved, and the labia minora and clitoral foreskin were easier to clean. The patients were very satisfied with the appearance in 5 cases, satisfied in 10 cases, and dissatisfied in 2 case. There were 15 patients with previous sexual life experience, of which 10 patients had improved sexual satisfaction, and 5 patients had no change in sexual satisfaction after the operation.Conclusions:Through the divisional design, wedge resection and edge resection are performed in the composite reduction labiaplasty, which can solve the friction and discomfort caused by the hyperplasia of labia minora and clitoris prepuce in a single operation, and achieve better aesthetic results at the same time.