Objective To explore the clinical effect of Habib 4X bipolar radiofrequency ablation assisted laparoscopic partial nephrectomy without blockage of renal artery for treatment of renal cell carcinoma (RCC).MethodsBetween October 2010 and June 2011, 14 patients with exophytic RCC (T1N0M0) were treated with Laparoscopic Partial Nephrectomy with (LRA) or without (LPN) Habib 4X Bipolar Radiofrequency ablation assisted.The LRA group included 6 patients,and the maximum tumor diameter was 2.1 - 3.5 cm (mean,3.1 cm).The LPN group included 8 patients,and the maximum tumor diameter was 2.0 -3.7 cm (mean,3.0 cm).The operative time,average intra-operative blood loss,postoperative hospital stay and incidence of postoperative complications were recorded.Changes of hemoglobin (Hb),serum creatinine (SCr) and ipsilateral glomerular filtration rate (GFR) before and after operation were analyzed and compared. Results The 14 surgical procedures were successful without conversion to open operation.In LRA group,renal artery blocking was unnecessary,the Hb,SCr and GFR before and after operation were (127 ± 19) g/L vs.(124 ± 19) g/L、(96 ±39) μmol/L vs.(92 ±29) μmol/L and (42 ± 12) ml/min vs.(40 ± 13) ml/min,respectively,and the difference was not significant (P ＞0.05).In LPN group,the renal artery blocking time was 20-52 min (mean,32 min),the Hb,SCr and GFR before and after operations were (130±17) g/L vs.(112±15) g/L,(92 ±31) μ mol/L vs.(110±28)μmol/L and (43 ± 14) ml/min vs.(30 ± 11 ) ml/min respectively,and the difference was significant (P ＜0.05 ).The operative time was ( 86 ± 20) min and ( 112 ± 43 ) min,the estimated blood loss was (94 ± 18)ml and (256 ± 58) ml,and the postoperative hospital stay was (5.0 ± 0.8) d and (7.8 ± 1.2 ) d,respectively.The difference between the two groups was significant (P ＜ O.05).Complications such as bleeding,gross hematuria,and leakage of urine were noted in LRA group. Conclusions Habib 4X Bipolar Radiofrequency ablation assisted LPN without blockage of renal artery is a safe and effective intervention with a relatively low incidence of complications.And it is superior to LPN in operative time,intraoperative blood loss and postoperative recovery.

We investigated the students of a seven-year medical master in the bilingual teaching program in Neurology with a questionnaire.We found that the bilingual teaching program has the following problems:the students don't have a solid foundation of medical English terminology and the content of the English teaching was higher than the ability of the students.So we think that we need to impress upon the students the importance of the program.We can also raise the overall quality of this program through an improvement of teaching methods,regulation of the proportion of English content in all courses and suitable midterm and final examinations.These alterations will effectively improve the bilingual teaching program.

Limb shaking transient ischemic attack (LS-TIA) is a rare form of TIA, usually based on severe narrowing or occlusion of the internal carotid artery. Clinically, it is mainly characterized by episodic involuntary limb shaking, which generally lasts for several seconds or minutes and often occurs after exercise or standing up. At present, there are few studies on LS-TIA in China, with only sporadic case reports, and without systematic review and meta-analysis studies; and it seems to fail in attracting widespread concern from neurologists. In this paper, the pathogenesis, clinical features, imaging features and diagnosis and treatment methods of LS-TIA are reviewed as follows, in order to improve the level of early recognition and treatment of LS-TIA from clinicians.

Objective:This paper intends to explore the clinical efficacy and safety of the refined extroperitoneal intrafascial laparoscopic radical prostatectomy in patients with localized prostate cancer.Methods:The data of 107 patients with localized prostate cancer who were underwent laparoscopic radical prostatectomy in our hospital from July 2013 to January 2020 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: the refined intra fascial resection group (59 cases) and the conventional interfascial neurovascular bundle reservation group(48 cases). There was no significant different comparing the age [(61.8±8.9) years vs. (62.2±8.1) years, P=0.71], body mass index (BMI) [(24.8±1.3) kg/m 2 vs.(24.3±1.4) kg/m 2, P=0.89], preoperative total prostate specific antigen (PSA) [(6.8±0.9) ng/ml vs. (7.2±1.1) ng/ml, P=0.44], prostate volume [(47.9±18.4) ml vs. (48.3±17.9) ml, P=0.67] between the modified group and the conventional group. The clinical stage of the two groups was both in cT 1-T 2aN 0M 0, and the preoperative Gleason score was less than or equal to 7 ( P=0.76). In the improved group, the bilateral pelvic floor fascia was not dissected, the dorsal deep vein complex was not sutured, the denonvillier fascia was kept intact, the prostate was dissected by intrafascial technique, and the bilateral vascular and nerve bundles were completely preserved. After anastomosing the urethra and bladder neck, the bilateral prostate fascia, the pubic bladder-prostate ligament, DVC and the anterior wall of bladder neck were continuously sutured with 3-0 barbed wire in order to anatomically reconstructe the anterior suspension system. The preoperative data, intraoperative condition, postoperative pathological stage, positive margin rate and postoperative 6-month's follow-up, especially incontinence and erectile function were compared between the two groups. Results:There was no significant difference between the two groups in the basic clinical data, intraoperative bleeding volume[(90.6±26.4)ml vs.(105.3±34.1)ml, P>0.05], prostate-specific antigen 6 weeks after operation[(0.08±0.06)ng/ml vs.(0.09±0.07) ng/ml, P>0.05], postoperative pathological stage and positive margin rate(12.5% vs. 11.9%, P>0.05). In the early postoperative stage, patients performed a significantly better continence. Continence rate in 1 week: 16.7%(8/48) vs. 52.5%(31/59)( P<0.05), in 1 month: 29.2%(14/48)vs. 64.4%(38/59)( P<0.05), and in 3 month 52.1%(25/48) vs. 77.9%(46/59)( P<0.05). And also a better erectile function recovery rate in 1 month: 8.3%(4/48) vs. 23.7%(14/59)( P<0.05), in 3 month: 27.1%(13/48) vs. 49.2%(29/59)( P<0.05), in refined intrafascial group, but that was not significant different between the two groups 6 months after operation. Conclusion:The refined intrafascial laparoscopic radical prostatectomy can completely reconstruct the anatomic structure adjacent to urethra, and preserve utmostly the pelvic floor muscle, prostate fascia and neurovascular bundle, which are supposed to facilitate the revovery of urinary incontinence and erectile dysfunction in the early postoperative period.

Objective:To investigate the efficacy and safety of thulium laser enucleation of the prostate-pre-transection urethral mucosa at the apex of prostate and traditional three lobe enucleation of the prostate for the treatment of benign prostatic hyperplasia patients.Methods:The data of 270 patients with benign prostatic hyperplasia who were underwent ThuLEP-PAM or ThuLEP in our hospital from May 2020 to September 2021 were analyzed retrospectively. According to the operation methods, the patients were divided into two groups: ThuLEP-PAM group (120 cases) and ThuLEP group (150 cases). There was no significant difference comparing the age [(69.8±7.7) years vs. (71.4±8.0) years], prostate volume [55.5(41.0, 71.0)ml vs. 58.5(45.0, 80.3)ml], the serum PSA [3.0(1.8, 4.6) ng/ml vs. 3.3(2.1, 5.5)ng/ml], international prostate symptom scores (IPSS) [22(17, 28) vs. 22(17, 27)], the quality of life score (QOL)[5(4, 6) vs. 5(4, 6)], the maximum urinary flow rate (Q max)[5.6(3.5, 7.3)ml/s vs. 5.5(4.0, 7.1)ml/s], the residual urine volume [ 31(0, 81)ml vs. 31(0, 102)ml] between the ThuLEP-PAM group and the ThuLEP group. No significant difference was found between the two groups( P>0.05). In the ThuLEP-PAM group, the external sphincter ring was located firstly, and urethral mucosa at the apex of prostate was circumferentially incised at 5 mm proximal of the sphincter ring by laser. Then the urethral mucosa was incised at the left sulcus beside the verumontanum and the prostate surgical capsule gap was exposed. After the middle lobe was removed, the left and right lobes were removed along the urethral mucosa pre-incision line at the prostatic apex. The ThuLEP group was enucleated by traditional three lobes enucleation. Perioperative indicators and postoperative complications during short-term follow-up were compared between the two groups. Results:All patients successfully completed the operation and the symptoms of the lower urinary tract were significantly improved. Comparison the perioperative factors between ThuLEP-PAM group and ThuLEP group included the following: operative time 90(70, 103)min vs. 83(61, 102)min; enucleated tissue weight 27.0(19.3, 36.5)g vs. 27.0(19.0, 39.0)g; decrease of the hemoglobin 9.9(7.4, 12.4)g/L vs. 9.5(7.1, 12.7)g/L; catheterization time 3.5(3.0, 4.0)d vs. 3.5(3.0, 5.0)d; hospital stay 6.0(5.0, 6.0)d vs. 5.0(4.0, 6.0)d. NO significant difference in these parameters was found between the two groups( P>0.05). There also was no significant difference in PSA[1.1(0.8, 1.5) ng/ml vs. 1.0(0.8, 1.6) ng/ml], IPSS score [5(4, 6) min vs. 5(4, 6)min], QOL score [2(1, 3) vs. 2(1, 3)], Q max [20.9(17.5, 22.5) ml/s vs. 20.4(17.8, 22.7) ml/s] and PVR [0 ml vs. 0(0, 6)ml] between the two groups ( P>0.05) after more than 3 months of follow-up. The incidence of incontinence for ThuLEP-PAM(2 cases)were lower than that for ThuLEP(11 cases)( P=0.031), but there was no significant between the two groups in other complications such as blood transfusion, haematuria, post-voidalurinary retention and urethral stricture. Conclusions:ThuLEP-PAM and ThuLEP have similar effect on the improvement of lower urinary tract symptoms in patients with benign prostatic hyperplasia, both of which have good efficacy and high safety. The biggest advantage of ThuLEP-PAM over ThuLEP is that it reduces the incidence of early postoperative stress urinary incontinence.

BACKGROUND:The repair process of myocardial injury involves complex cellular and molecular mechanisms,especially mitochondrial calcium homeostasis,macrophage autophagy and pyroptosis pathways.Traditional Chinese medicine(TCM)has shown significant clinical efficacy in improving myocardial injury,but its mechanism of action needs to be thoroughly investigated. OBJECTIVE:To investigate the role of mitochondrial calcium homeostasis-mediated macrophage autophagy and pyroptosis pathways in myocardial injury,and to summarize the progress of TCM in this field. METHODS:A computerized search was performed for relevant literature from the database inception to March 2024 in the Web of Science,PubMed and CNKI.The search terms were"mitochondrial calcium homeostasis,macrophage autophagy,macrophage pyroptosis,traditional Chinese medicine,myocardial injury,myocardial injury reperfusion"in Chinese and English.Through literature review,we analyzed the relationship between mitochondrial calcium homeostasis and macrophage autophagy and pyroptosis,explored the mechanism of their roles in myocardial injury,and summarized the pathways of multi-targeted,multi-pathway effects of TCM. RESULTS AND CONCLUSION:The maintenance of mitochondrial calcium homeostasis has been found to be closely related to the normal function of cardiomyocytes.Macrophages can participate in the repair process of myocardial injury through autophagy and pyroptosis pathways.Autophagy contributes to cell clearance and regulation of inflammatory response,while pyroptosis affects myocardial repair by releasing inflammatory factors.TCM regulates mitochondrial calcium homeostasis and macrophage function through multiple mechanisms.For example,astragalosid regulates calcium homeostasis by lowering mitochondrial membrane potential and inhibiting cytochrome C,and epimedium glycoside plays a role in reducing β-amyloid deposition.In addition,herbal compounds and single drugs promote myocardial repair by activating or inhibiting specific signaling pathways,such as PI3K/AKT and nuclear factor-κB signaling pathways.Future studies should focus on the interactions between mitochondrial calcium homeostasis,autophagy and pyroptosis pathways,as well as how TCM can exert therapeutic effects through these pathways to provide new strategies and drugs for the treatment of myocardial injury.

Objective:To explore the suitable prostate cancer screening mode under the medical community for primary hospitals.Methods:From April 2021 to April 2022, a total of 16007 male population ≥50 years from 9 branches of the medical community of the second hospital of Yinzhou participated in this study. They were divided into four groups according to age with group 1 of 50-59 years old, group 2 of 60-69 years old, group 3 of 70-79 years old, and group 4 of 80 years old and above. Serum tPSA was added to the routine physical examination, and the screening positive patients were referred to the referral hospital for further diagnosis and treatment under the mode of medical community. We proposed multi-parametric MRI (mpMRI) for those with serum PSA ≥4 ng/ml and suspicious lesions should be scored according to PI-RADS V2. The ultrasound-guided transperineal targeted prostate biopsy was performed for those with PI-RADS ≥3 and those with PI-RADS < 3 but tPSA ≥10 ng/ml. The tPSA follow-up examinations were performed every 6 months for tPSA < 10 ng/ml and PI-RADS < 3 points and once a year for tPSA < 4 ng/ml.Results:Among the 16 007 male population ≥50 years, 2 007(12.54%) were found serum PSA ≥4 ng/ml, and 634(31.59%)were referred to the referral hospital through the medical community system. Combining tPSA and mpMRI, 271 patients underwent ultrasound-guided transperineal targeted prostate biopsy. Among them, 162 were finally diagnosed with PCa, with a biopsy positive rate of 59.78%. The detection rate of PCa in all the subjects was 1.01%. According to the pathological grade, 5(3.08%) were in ISUP group 1, 95(58.64%) in ISUP group 2-3, and 62(38.27%) in ISUP group 4-5. There were 102(62.96%), 39(24.07%) and 21(12.96%) with localized, locally advanced or metastatic PCa, respectively. The levels of tPSA in the four groups were (1.13±1.44)ng/ml, (1.77±3.45)ng/ml, (3.27±17.58)ng/ml, and (4.26±11.48)ng/ml, respectively, with statistically significant differences ( P<0.01). The positive number of biopsy in each group was 1 case(0.06%), 56 cases(0.79%), 81 cases(1.36%) and 24 cases(1.82%) respectively, with statistically significant differences ( P<0.01). The number of ISUP 4-5 grades in each group was 0, 17(30.35%), 29(35.80%), and 16(66.67%) respectively, with statistically significant differences ( P<0.01). Conclusions:Based on the medical community system, according to the tPSA screening results of the primary hospitals, it is feasible and effective to refer suspicious patients to the referral hospitals for mpMRI examination, and screen prostate cancer by ultrasound-guided transperineal prostate fusion biopsy.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

The composite material PLGA compounded with β-tricalcium phosphate (β-TCP) was prepared by melt blending method, and the absorbable interface screw was prepared by injection molding process. Prepare PBS buffer that simulates human body, conduct in vitro degradation experiments on interface screws according to relevant national and industry standards, then test and characterize interface screws at different time points for degradation of intrinsic viscosity, average molecular weight distribution, mass loss, mechanical properties and thermal properties. According to the degradation performance-time curve, determine the time node at which the interface screw loses the mechanical properties. In this paper, the in vitro degradation behavior of interfacial screws prepared from PLGA and β-TCP composites was studied in detail, providing a reference and basis for the degradation behavior of absorbable products prepared from PLGA and β-TCP composites.
Humans ; Polyesters ; Materials Testing ; Calcium Phosphates ; Absorbable Implants