Objective To evaluate the curative effect of laparoscopic radical gastrectomy combined with Roux-en-Y reconstruction of the digestive tract in treatment of advanced gastric cancer complicated with type 2 diabetes mellitus.Methods 73 advanced gastric cancer complicated with type 2 diabetes mellitus patients between May 2014 to May 2016 underwent distal partial gastrectomy or total gastrectomy with Rouxen-Y GI reconstruction.Results Compared with preoperative data,postoperative level at after 1 month and 3 months were respectively for FPG (14.9 ± 1.9 vs.8.7 ± 0.9,8.8 ± 0.9) mmol/L,OGTT 2 h PG (15.4±1.8 vs.8.68±0.9,8.7 ±0.9) mmol/L,HbA1 (10.4％ ±0.8％ vs.7.4％ ±0.6％,7.4± 0.6),BMI (29.9±1.2vs.25.4±0.7,25.2±0.6) kg/m2,TC (8.4±0.6 vs.6.7±0.6,6.7±0.4) mmol/LandTG (2.53±0.53 vs.1.86±0.27,1.91±0.33) mmol/L(withallP＜0.05).Conclusion Laparoscopic radical gastrectomy combined with Roux-en-Y reconstruction of the digestive tract for advanced gastric cancer significantly improves patients' co-occurring.

Objective:To analyze risk factors for the rupture of basilar tip aneurysms (BTA) using morphological parameters assessed on CTA.Methods:The clinical data and CTA imaging characteristics of 62 patients with BTA from March 2016 to November 2020 in Huanhu Hospital of Tianjin were analyzed retrospectively. The patients were divided into un-rupture ( n=44) and rupture ( n=18) groups according to whether the BTA ruptured. The morphological parameters of aneurysms were measured and recorded. The number, shape and orientation of aneurysms were analyzed by χ 2 test between the two groups. The length (H max), height (H p), neck width (N D), aspect ratio (AR), size ratio (SR), angle of aneurysms (AA), flow angle (FA), basilar vessel angle (BVA), the angle between the proximal long axis of bilateral posterior cerebral artery P1 segment (P1-P1 angle), the angle between the proximal long axis of bilateral superior cerebellar arteries and bifurcation angle (the sum of the angle between the basilar artery and the bilateral posterior cerebral arteries) were analyzed by independent-sample t test between the two groups. On the basis of univariate analysis, logistic regression was used to identify the independent risk factors for BTA rupture. ROC curve analysis was further performed. Results:BTA with irregular shape was more likely to break (χ 2=5.412, P<0.05). The H max[(4.18±2.11)mm], N D [(3.06±1.75)mm], P1-P1 angle (148°±18°) in the rupture group were smaller than those in the un-rupture group [(6.38±2.21)mm, (5.20±1.59)mm, 178°±25°], with statistically significant difference ( P<0.05). While AR (1.19±0.13), BVA (82°±11°), and bifurcation angle (212°±18°) in the rupture group were larger than those in the un-rupture group (1.05±0.18, 70°±10°, 181°±27°), with statistically significant difference ( P<0.05). The logistic regression analysis showed that the shape of aneurysms (β=4.878, OR=11.418, P=0.019), BVA (β=0.165, OR=1.177, P=0.043), and P1-P1 angle (β=-0.223, OR=1.080, P=0.029) were independent risk factors for BTA rupture. The ROC curve analysis showed that the cut-off value of BVA and P1-P1 angle to predict the BTA rupture were 76.7° and 158.5°, and area under curve (AUC) were 0.79 and 0.86, respectively. The AUC of combined BVA with P1-P1 angle was 0.89. Conclusion:The shape of aneurysms, BVA and P1-P1 angle are independent risk factors for BTA rupture. BTA are prone to rupture when the shape of aneurysm is irregular, BVA>76.7 ° and P1-P1 angle<158.5 °.

Objective To investigate the prevalence of sexual dysfunction in aged men and associated risk factors in Beijing. Methods A cross-sectional study was performed in communities of Beijing involved 1656 men aged over 50 years.The International Index of Erectile Function-5 (IIEF-5),Brief Male Sexual Function Inventory for Urology ( O'Leary 1995 ) and the International Prostate Symptom Score (IPSS)questionnaires was recorded.The body mass index (BMI),prostate size was measured.The survey was conducted to make sure if the patients had diabetes,high blood pressure,hyperlipidemia,cerebrovascular history,and smoking and drinking situation.Pearson's X2 test and unconditional logistic regression were used to investigate the factors associated with sexual dysfunction. Results 1644 subjects were enrolled.The incidence of ED,reduction of sexual desire and defective ejaculation was 90.45％,60.04％ and 38.81％ respectively,and significantly different according to age ( P ＜ O.05 ). Age was positively correlated with ED (3 =0.12,P＜0.05),reduction of sexual desire (β =0.10,P＜0.05) and defective ejaculation (β =0.10,P ＜ 0.05 ) ; ED was significantly associated with BMI (β =0.07,P ＜ 0.05 ).Hypertension and prostate size were risk factors for reduction of sexual desire and defective ejaculation; There was correlation between drinking and defective ejaculation ( β =- O.31,P ＜ 0.05 ). Conelusions Compared with high prevalence of ED and lower sexual desire,the incidence of defective ejaculation were lower; this may reflect the sexual activities of aged male were more active compared with the less success of really erection.The prevalence of ED,reduction of sexual desire or defective ejaculation increased with age.BMI was the risk factor for ED.Enlarged prostate and hypertension was associated with reduction of sexual desire,and drinking was the risk factor for defective ejaculation.

Objective To evaluate the efficacy of interventional therapy for advanced pancreatic carcinoma. Methods 33 cases of advanced pancreatic carcinoma accepted interventional therapy from April 2005 were retrospectively analyzed. All patients were unoperable and accepted one or more times of celiac and superior mesenteric arterial chemotheraputics perfusion with dosage of 2:1. The embolization was further introduced with the addition of liver invasion. The repetition interval was kept at 6 weeks with no severe complications. Results The one with follow-up CT imagings showed obvious decrease of the lesion size, together with release or disappearance of the sensation of abdominal pain and abdominal distention. The life span prolonged with average survival of 13 months, including the longest of 22 months and the life quality improved. Conclusions The interventional therapy could be the first method of choice in the management of advanced pancreatic carcinoma.

BACKGROUND:The blood loss and the need of blood transfusion after bilateral total knee arthroplasty are very high. Therefore, the use of medicine such as tranexamic acid in total knee arthroplasty is overheated in recent years. Tranexamic acid has been proved to be able to decrease the blood loss after total knee arthroplasty, while the study of its use in bilateral total knee arthroplasty is seldom. OBJECTIVE:To observe the effect and safety of tranexamic acid on perioperative blood loss and the change of hemoglobin in patients undergoing bilateral total knee arthroplasty. METHODS: We selected 69 patients who received bilateral total knee arthroplasty and divided them into two different groups randomly. The patients in the experimental group were given 1 g of tranexamie acid dissolved in 100 mL of 5% glucose solution through intravenous infusion. Those in control group were only given 5% glucose solution 100 mL. Total blood loss, intraoperative blood loss, the hidden blood loss, amount of postoperative drainage, the ratio of blood transfusion, hemoglobin, D-dimer, prothrombin time and activated partial thromboplastin time were studied and compared between the two groups. We also observed the incidence of thrombotic events between the two groups. RESULTS AND CONCLUSION:The blood loss of the experimental group was significantly lower compared to the control group (t=2.194-2.908,P < 0.05). The blood transfusion rate of experimental group was significantly lower compared to the control group (χ2=5.219,P=0.022). The hemoglobin of the experimental group was significantly higher than that of the control group at 3 and 5 days after replacement (t=-3.481, 2.319,P < 0.05). No significant difference in prothrombin time and activated partial thromboplastin time was detectable between the two groups before and after replacement (P > 0.05). Thrombotic events were not visible in both groups. Venous ultrasonography in the lower extremity did not reveal deep venous thrombosis. Above results suggest that tranexamic acid can significantly reduce intraoperative blood loss in patients undergoing bilateral total knee arthroplasty, decreases the requirement of blood transfusion and the dynamic change of hemoglobin, and does not increase the risk of thrombosis.

Objective To evaluate the feasibility of multi-parameter MRI in diagnosing ovarian endometrial cysts. Methods Pelvic MRI of 68 patients with confirmed pathological diagnosis were retrospectively reviewed. The patients were divided into ovarian endometriosis (35 patients with 42 lesions, group A) and other cystic lesions (33 patients with 38 lesions , group B).The signal intensity value of T1WI, T2WI of cyst fluid and iliopsoas, ADC value, phase values and R2*values were obtained, cyst fluid/iliopsoas ratios (T1R and T2R) were calculated. The non-parametric Mann-Whitney U test was employed to compare parameter values between the two groups. The values of diagnostic performance were analyzed by using receiver operating characteristic curve (ROC). Use the Logistics regression parameters of diagnostic efficacy to select the highest Youden index for the best parameter association after combining the parameters step by step. Results The median of T1R, T2R, ADC, phase, T1R and R2*values for group A were 3.39, 5.28, 1.20×10-3 mm2/s,2.19×10-2, 15.08 Hz respectively, and that of group B were 0.91, 10.85, 2.64×10-3mm2/s,2.67×10-2, 3.01 Hz, respectively. There were statistically significant difference between the two groups (P<0.01).The AUC of T1R, T2R, ADC value, phase values and R*2 value were 0.930, 0.874, 0.891, 0.685 and 0.924 respectively, and there was no difference among them (P>0.05). When combining T1R, ADC value, R2*value together, the Youden index (0.849 7) was highest. Conclusion Combining T1R, ADC and R2* values can provide an effective way to discriminate endometrial ovarian cyst from other ovary cystic lesions.

ObjectiveTostudytheprotectiveeffectsofpreconditioningoncryopreservationinjuryofrat liver.MethodsThemodelofisolatednonrecirculatedperfusionratliver (IPRL)wasestablished .Thegrafts werepreconditionedwithischemia (IPC)anddexorubicin (DPC)respectively .ResultsThelevelsofaspartate transaminase (AST)andalaninetransaminase (ALT)inthesolutionsinIPCgroup (40 1? 6 3、17 1? 0 5 )U L andDPCgroup (43 6? 3 7、19 4? 0 8)U Lwerelowerthanthoseofnon preconditioning (NPC)group (6 4 5? 8 2、2 3 8? 3 96 )U L (P 0 0 5 ) .ConclusionsPreconditioninghasobviousprotectiveeffectsoncryopr eservationinjuryofratliver.MedicinepreconditioningmightimitatetheeffectofIPC .Medicinepreconditioning cansupplyclinicaltreatmentasasafeandeffectivepreconditioningmethod .

Objective To study the effect of Ro60 on migration and invasion of lung adenocarcinoma A 549 cells. Methods We knocked down Ro60 and analyzed the ability of migration and invasion of A 549 cells.Quantitative real time ( RT)-PCR and Western blotting were performed to detect mRNA and protein levels of selected molecules associated with migration and invasion of neoplasm .Results When Ro60 was downregulated , the migration and invasion of A 549 cells decreased markedly.Meanwhile,the mRNA expression of matrix metalloproteinase (MMP)9,c-Src etc was observably reduced.Furthermore, downregulation of Ro60 diminished the expression of Src protein and the activation of MMP-9 protein.Conclusion Downregulation of Ro60 inhibits migration and invasion of A549 cells by regulating Src protein and activating MMP-9 protein.

Objective To evaluate the application of preserved urethral plate urethroplasty to treat urethral fistula after hypospadias repair. Methods Two hundred and twenty-four cases with u-rethral fistula after hypospadias repair were treated by preserved urethral plate urethroplasty from 2001 to 2006.Follow-up data were reviewed and analyzed.All of these cases had big(>1 cm)ure-thral fistula.One hundred and two failed hypospadias cases were repaired by tubularized incised plateurethroplasty(Snodgrass).The patients were 2-16 years old and mean age was 3.7 years old.In thesame time period,86 failed hypospadias cases were repaired by Duplay urethroplasty.The children were 2-14 years old and mean age was 3.5 years old.Twenty failed hypospadias cases were repaircd by Onlay island flap urethroplasty and another 1 6 failed hypospadias cases were repaired by Flip-Flap urethroplasty. Results Fistulas were successfully repaired in 86(84.3%)cases out of 102 tubular-ized incised plate urethroplasty procedure.There were 1 3 urethral fistulas and 3 urethral strictures.Seventy-five(87.2%)cases were successful out of 86 Duplay procedure.There were 9 urethral fistulas and 2 urethral strictures.There was no significant difference between these tWO groups of results(P>0.05).Nineteen cases were successful out of 20 Onlay urethroplasty procedures and there was only l urethral fistula.Fourteen cases were successful out of 1 6 Flip-Flap procedures and there was onlv 2 u-rethral fistulas. Conclusions Surgical procedure for urethral fistula repair should be chosen accord-ing to the condition of penis.Tubularized incised plate urethroplasty can get same satisfactory result comparing with Duplay method for failed hypospadias repair.More Snodgrass should be used to assure the cosmetic penis.

Objective To discuss the management of urethral duplication in children. Methods The clinical data of 1 8 children(all are males)with urethral duplication were retrospectivelv ana-lyzed. All the 18 patients were sagittal plane included epispadias in 6,hyposPadias in 4 and Y type in the remaining 8. In 6 cases with epispadias,3 patients underwent excision of the accessorv dorsal ure-thra,3 patients without operation.Urethroplasty was necessary in the patient with a duplicated hypo-spadiac urethra. Of 8 patients with Y-type urethral duplication,7 patients underwent 2 stage repair including displacement of the urethra from the anal canal to the perineum at stage 1 and subsequent urethral reconstruction at stage 2.The ventral urethra which was hypospadias had been excised in the other one. Results All the patients were followed-up. Good cosmetic and functional resuIts were a-chieved in the 3 boys who underwent excision of the accessory dorsal urethra.In the hypospadiac du-plication,2 patients could void spontaneously through a normally positioned granular meatus.One boy presented with urethral stenosis after operated. One boy had a vesicostomy for neuropathic bladder. In Y-type urethral duplications,only 1 patient was successful after 2-stage urethroplasty,3 patients de- veloped urethra stricture or fistula,3 boys need the 2-stage operation,the other 0ne who underwent excision of the ventral urethra could void spontaneously. Conclusions Urethral duplication is a rare congenital anomaly.The clinical presentation varies because of the different anatomical Datterns of this abnormality. Commonly the ventral urethra is most functional and maintained after surgical correc-tion.Surgical management should be individual and depend on the anatomical configuration of the du-plicated urethras.