Objective To evaluate the efficacy of repeated internal urethrotomy as the treatment for male urethral stricture. Methods A total of 296 patients with proved urethral stricture was treated with optical internal urethrotomy and the value of repeated internal urethrotomy has been analysed. Results Of the 296 patients internal urethrotomy has been successful in 261 (88.2%),217 patients with single operation,twice or three times with successful outcome in 32 and 12 patients respectively.35 patients (11.8%) failed with more than three times internal urethrotomy,of which 26 patients was then treated with stents and 9 required open surgery. Conclusions Internal urethrotomy is an efficacious treatment for male urethral stricture,but repeated operation is of limited value especially when the course of the disease is longer than 1 year.

Objective To assess the outcome of internal urethrotomy for the treatment of urethral stricture. Metho ds In the past 10 years, a total of 203 patients with proved urethra l strictures were treated by optical internal urethrotomy.Follow-up studies wer e carried out for 157 patients. Results Of the 203 patie nts 194(96%) have undergone successful internal urethrotomy, 9 patients(4%) with long stricture more than 3 cm failed on repeated internal urethr otomy and required open surgery. Internal urethrotomy was carried out twice for 9 patients and thrice for 5 with successful outcome. Of the 194 patients 157 wer e followed up for 6 months to 8 years, in whom 143 have had satisfactory voiding and 14 needed intermittent dilation. Conclusions Endosc opic treatment shoud be considered as the procedure of first choice for the tr eatment of urethral strictuer, however repeated urethrotomy should be avoided.

Objective To observe the efficacy of radical nephrectomy plus embolectomy for the treatment of renal cell carcinoma with renal vein or inferior vena cava involvement. Methods Clinical and pathologic data of 8 patients with renal cell carcinoma extending into renal vein or inferior vena cava were summarized.The operative essentials were introduced,and survival periods were followed up. Results A total of 8 patients underwent radical nephrectomy plus embolectomy.One patient died during the operation after embolectomy with exhausted respiration and cardiovascular function.Three patients survived for 2,4 and 22 months respectively,but all died of distal metastasis later.Four patients were alive for 2,14,25 and 47 months respectively after operations till writing of this article. Conclusions Radical nephrectomy plus embolectomy is a valuable method for the treatment of renal cell carcinoma with renal vein or inferior vena cava involvement.

Objective To improve the awareness of pel vi c lipomatosis in clinical practice. Methods A 51-year- old male patient with pelvic lipomatosis was admitted. Imaging studies showed th at there was mild degree of hydronephrosis on his both sides on IVU and a typica l inverted-pear shape of bladder and extended posterior urethra were also seen on IVU.CT scan showed that low density lipid piled in the pelvic cavity.MRI show ed obvious thickened soft tissue lesion around the bladder,rectum and in the pel vic cavity. The lesions in the pelvic cavity and around the ureters were removed and the lower segments of the ureters were loosened by laparoscopic surgery. Th e clinical characteristics of lipomatosis were reviewed by combination with the literature. Results Intraoperatively,apparently increase d lipid tissue was found in the pelvic cavity and there was large amount of lipi d tissue filling the space around bladder,rectum and sigmoid colon.This finding was consistent with the imaging study findings.About 500g lipid tissue was remov ed in the laparoscopic procedure.Pathologic study showed it was mature lipid tis sue.The patient was discharged 1 week after surgery.Two weeks after surgery,B-u ltrasound showed that there was improvement of hydronephrosis on both sides.The maximum width of right renal fluid sonolucent area decreased from 2.9 cm to 2.0 cm;the width of right upper ureter decreased from 1.2 cm to 1.0 cm;the maximum w idth of left renal pelvis decreased from 1.8 cm to 1.3 cm;and the width of left upper ureter decreased from 0.8 cm to 0.5 cm. Conclusions X-ray,CT scan and MRI are the most valuable examinations in the diagnosis of lipomatosis.Removing the lipid in the pelvis and around the bladder and loosenin g the ureters by laparoscopic surgery are minimally invasive,safe and effective in the treatment of pelvic lipomatosis.

Objective: To report our prelimilary experience of laparoscopic radical prostatectomy (LRP) for clinically localized prostatic cancer.Methods:23 cases with localized prostatic cancer underwent LRP in our institution from October 2000 to August 2003. The median age was 64.5 years old, the median PSA was 13 ng/ml and median Gleason score of biopsy specimens was < 7. The operations were performed according to Montsouris technique. Briefly, operations were carried out transperitonealty, combining posterior and anterior approachs to the prostate, transecting the bladder neck, lateral dissection of the prostate, urcthrovesical anastomosis, completing the operation.Results:No death and no conversion rate were observed in this series of 23 cases of LRP. No re-intervention was needed. The median operating time was 325 minutes (range 270 to 660 min) including the lymphadenectomy phase that was considered necessary in the case whose PSA value was 51ng/ml and pathological reading was negative to thoses lymph nodes; The median intraoperative blood loss was 430 ml(rang 200 to 1100 ml). Postoperative bladder catheterization time was 20 days. Surgical positive margin was found in I case of pathlogical stage of pT2b and Casodex 50 mg had been used on this case for 3 mon after the PSA value was < 0.2 ng/ml. Postoperation follow-up of 3 to 24 mo. showed no signs of complications such as urethral stricture or urine incontinence. The PSA concentrations was < 0.3 ng/ml in all cases.Conclusions: LRP provides a clear and magnified anatomical image to allow a more precise and safer dissection.

Objective To evaluate the minimally invasive technique of laparoscopy by retroperitoneal access for the treatment of parapelvic cyst. Methods Twelve patients(7 men and 5 women;mean age,52 years;age range,34-75 years) with parapelvic cysts were included.The cyst size ranged from 2.8 cm?3.0 cm to 2.5 cm?11.5 cm.The cysts were on the left side in 6 cases and on the right in another 6 cases.Laparoscopic resection or de-roofing of the parapelvic cysts by retroperitoneal access was performed in them.The relevant parameters of the procedures were summarized.Results The success rate of the operation was 100%.The mean operative time of the first 6 patients was 190 min,while it was 86 min in the rest 6 patients.The mean intraoperative blood loss was 25 ml.No injury to the kidney pedicle or pelvis occurred.The mean hospital stay was 9 d.In 11 patients,no recurrence of the cyst occurred during a follow-up of 7-31 months.Only 1 patient with concomitant renal cyst had recurrence of the cyst found by B-ultrasound 2 years after operation.Conclusions Therapeutic laparoscopy by retroperitoneal access has advantages of minimal trauma,less blood loss,rapid recovery and better effect,therefore it is the ideal treatment choice for parapelvic cyst.

Objective To understand oral submucous fibrous (OSF) because the hair cause of disease and the quantitative corresponding measures,do a good job in OSF prevention and control work.Methods The quantitative cluster sampling,according to the diagnostic criteria of the development of the Pindborg,yuhu in Xiangtan city of different types of 57 units of 11 046 people to chew areca cause OSF epidemiological investigation.Results OSF 335 diagnosis example,the prevalence rate of 30.33‰,4 cases were oral cancer,oral cancer coexist rate was 11.94‰; All OSF patients had a history of betel nut,no chewing betel nut (containing the cigarette,wine,and spicy aficionados) were not found in patients with OSF; Of OSF prevalence in the chewing hobby was no differences in sex and age in the crowd; OSF prevalence of high and low with length of fixed number of year of average chewing betel nut dose and chewing betel nuts were closely related(r =0.28828,P ＜ 0.01) ; OSF prevalence was different from eating betel nut additive that had a very significant difference.Different hobbies compatibility with standardized test,7 incidence group had 6 group without significant difference,but people only eat chili can (in the control group,1 329) and outsiders no OSF patients (control group,698).Conclusions Survey results confirm that chewing betel nut is the main factor of Xiangtan people of OSF,and OSF carcinoma prevalence is lower than abroad.

Objective To explore the anti-tumor effects of Egr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy in mice bearing H22 hepatocarcinoma and its mechanism. Methods The recombinant plasmid pcDNAEgr-IFNγ mixed with liposome was injected into tumor. 48 h later, 370 kBq 125I-UdR was injected into tumor. The tumor growth rates at different times were observed. After 3 d gene-radionuclide therapy, the concentration of IFNγ in cytoplasm of H22 cells and cytotoxic activities of splenic CTL of the mice in different groups were examined. Results The tumor growth rates of pcDNAEgr-IFNγ +125 I-UdR group were obviously lower than those of control group, 125I-UdR group and pcDNAEgr-1 +125I-UdR group 6-15 d after gene-radionuclide therapy. IFNγ protein was found in cytoplasm of H22 cells in PcDNAEgr-1FNγ+125I-UdR group after 3 d gene-radionuclide therapy. Cytotoxic activity of splenic CTL in pcDNAEgr-IFN7 + 125I-UdR group was significantly higher than that in the other groups (P<0.01). Conclusions The anti-tumor effects in vivo of pcDNAEgr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy are better than those of 125I-UdR therapy.

Objective To investigate the relatio nship between the DNA methylation status of gluco-corticoid receptor (GR) gene promoter and mRNA expression level of GRα gene of peripheral blood mononuclear cells (PBMCs) in patients with systemic lupus erythematosus (SLE). Methods Fifteen new onset SLE patients and fifteen healthy controls were enrolled in this study. The DNA methylation status of GR gene promoter 1 of PBMCs was detected through bisulfite sequencing polymerase chain reaction (PCR). The mRNA expression of GRα, DNA methyltransferases, growth arrest and DNA damage-induced 45α (GADD45α) of PBMCs was detected using the quantitative real-time polymerase chain reaction method. T-test and χ2-test were used to detect the differences between the two groups, Pearson's correlation coefficient was used to analyze the linear correlation between two variables. Results Compared with healthy controls, the mRNA expression of GRα was signi-ficantly declined in SLE patients (10±5, 17±7, t=2.69, P<0.05), and the mRNA expression of DNMT1 and GADD45α was significantly elevated in SLE patients (t=3.11, P<0.05 and t=2.98, P<0.05). The overall mean methylation status of the 142 CpG islands of the four promoters was significantly elevated in SLE patients [(16±8)%vs (11±6)%, t=2.75, P<0.05]. The global methylation status of PBMCs in SLE patients was obviously lower than healthy controls (t=4.39, P<0.05). Conclusion Hypermethylation of GRα promoter may result in GRαgene low expression in PBMCs of patients with SLE.

[Objective]To summarize and analyze the educational quality and problems of Traditional Chinese Medicine students in Zhejiang Chinese Medical University,and provide reference for improving the teaching quality and students'clinical knowledge and skills.[Methods]Taking the students of Traditional Chinese Medicine who participated in the step-1 medical licensing examination empirical research in Zhejiang Chinese Medical University from 2018 to 2020 as the research objects,the data was analyzed by variance analysis and χ2 test.[Results]Staged examination scores could reflect students'academic performance,the average passing rate of theoretical examination was 68.64%,and the average passing rate of skill assessment was 95.27%.The average total mastery rate of theoretical examination was 65.06%,including basic medicine(55.57%)and clinical medicine(52.12%),whose comparison with the total mastery rate of theoretical examination was statistically significant(P<0.05).The total mastery rate of skill assessment was 76.57%,and the average mastery rates of stations 3～4(physical examination)were 71.24%and 72.24%,whose comparison with the total mastery rate of skill assessment was statistically significant(P<0.05).It proposed improvement measures and strategies such as establishing exam incentive mechanisms to enhance students'internal motivation in exams,strengthening clinical medicine course training to improve staged examination pass rates of theoretical part,and repeatedly training clinical skills to fill the gaps in skill assessment.[Conclusion]Traditional Chinese medicine universities can improve the clinical knowledge and skills of students by establishing examination incentive mechanisms,strengthening clinical medicine course training and repeating clinical skill training,so as to improve the quality of training for students majoring in Traditional Chinese Medicine.