Objective To investigate the possibility of urethroplasty with a free graft of colic mucosa for the treatment of complex anterior urethral stricture of long length. Methods Six dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. All the dogs were sacrificed 12 weeks after the procedure for histological examination of urethra.Besides, a patient with complex anterior urethral stricture was treated by urethroplasty with the use of a colic mucosal graft.Retrograde urethrography,urethroscopy and uroflowmetry were carried out 3 months after operation. Results Histological examination revealed that all the grafted colic mucosa have survived in the urethra of the experimental dogs and some of the glandular epithe lium has been transformed into urethelium. Clinically,the patient voided well after removal of the urethral stent.Neither necrosis of the neourethral mucosa nor stenosis at the anastomosis sites has been observed on urethroscopy. Retrograde urethrogram demonstrated a wide urethral caliber with no significant graft sacculation. Uroflowmetry examination showed the maximum flow rate was 30 ml/s. Conclusions Colic mucosa graft urethroplasty is an effective one stage procedure for the treatment of complex anterior urethral stricture. The technique is useful for urethral reconstruction when local or preputial skin and buccal or bladder mucosa are not available.

Objective To evaluate bulbourethral sling procedure in the treatment of post prostatectomy incontinence. Methods 5 patients with post prostatectomy incontinence underwent the bulbourethral sling procedure.Preoperatively 1 patient was completely incontinent and 4 patients required a mean of 3.5 pads per day.The mean duration of incontinence was 4.5 years. A sling tension of a mean of 500 g was used to correct incontinence. Results 4 patients have been completely dry,whereas postoperative difficulty in voiding occurred in the other patient and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence. Conclusions The bulbourethral sling procedure is an effective means in the treatment of post prostatectomy incontinence.

Objective To evaluate the selection of different procedures for the treatment of complex anterior urethral stricture and the key to successful operation. Methods 78 patients with complex anterior urethral strictures underwent different procedures of urethroplasty.Of them various mucosa urethral reconstruction were adopted in 40 cases,one-stage pedicle flaps urethroplasty in 26 and two-stage urethroplasty of Johanson procedure in 12. Results The patients were followed up for 6 to 36 months (mean 16.5 months).67 patients voided well and complications developed in 11. Of the 11 cases urethrocutaneous fistula occurred in 1,meatal stenosis in 2 and penile chordee in 1 for mucosal urethroplasty;urethrocutaneous fistula occurred in 2 and 1 of them was accompanied by hair bearing neourethra,urethral re-stricture in 3 for pedicle flaps urethroplasty;penile chordee developed in 2 and 1 of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure. Conclusions Selection of different procedures for treatment of complex anterior urethral strictures depends on stricture length,location and severity.Penile pedicle flap urethroplasty is an effective method for those with urethral stricture 10 cm,especially in those whose bladder mucosa is not available.

Objective To study whether the protective effects of fenofibrate on insulin resistance in mice of nonal-coholic fatty liver disease(NAFLD) are related to endoplasmic reticulum stress (ERS). Methods Male C57BL/6 mice were fed with high-calorie and high-cholesterol diet ( HCD) to induce a model of NAFLD, then one of those two groups from HCD was treated with fenofibrate 40 mg/( kg · d ) for 2 weeks ( HCF ) . Glucose tolerance test (GTT) and insulin tolerance test (ITT) were used to analyze the improvement on insulin resistance. The serum levels of triglyceride ( TG) , total cholesterol ( TC) , high density lipoprotein-cholesterol ( HDL-C) , low density lip-oprotein-cholesterol ( LDL-C) , alanine aminotransferase ( ALT) and aspartic transaminase ( AST) were detected. The pathological changes of livers were detected with HE and Oil Red O staining, the mRNA and protein expression of peroxisome proliferator-activated receptorα( PPARα) , glucose regulated protein 78 ( GRP78 ) and transcription factors GADD153 ( CHOP) were detected with real-time quantification PCR and Western blot analysis respectively. Results Compared with the SCD mice, the HCD mice showed significant insulin resistance, higher serum levels of TG, TC and LDL-C (P<0. 01, P<0. 05), lower serum level of HDL-C (P<0. 01), micro-and macrovesicular steatosis, ballooned hepatocytes and infiltration of inflammatory cells were observed in the liver, the expressions of PPARα and GRP78 at mRNA and protein levels were decreased (P<0. 05), however, the expressions of CHOP at mRNA and protein levels were increased ( P<0 . 05 ) . Fenofibrate intervention significantly improved insulin resist-ance and decreased the serum level of TG ( P<0. 05 ) . Fenofibrate also alleviated hepatic steatosis and inflammato-ry infiltration, and increased the mRNA and protein expressions of PPARα and GRP78, decreased the mRNA and protein expression of CHOP ( P<0 . 05 ) . Conclusion Fenofibrate significantly improves insulin resistance and de-creases the serum level of TG in NAFLD mice, which may be related to activating PPARα and relieving ERS.

Objective To discuss the etiology,clinical features,diagnosis and treatment of congenital pleural effusion in fetuses and neonates in order to improve the understanding of this disease. Methods Six neonate cases with congenital pleural effusion were retrospectively analyzed in neonates who were admitted to the Department of Neonatolo-gy of the First Affiliated Hospital of Zhengzhou University after birth and the etiology,clinical features,diagnosis and re-lated treatment were analyzed based on literature review. Results Among 6 patients with congenital pleural effusion, chylothorax was found in 3 cases,one of whom had chylothorax,chylous abdominal,21 trisomy syndrome and congenital hypothyroidism,and the etiology of the other 3 cases were unknown. Diagnosis mainly was depended on imaging and la-boratory tests. The number of nucleated cells of hydrothorax or ascites were(1 588 - 13 057)× 106 / L,mainly lympho-cytes. Protein qualitative was( + - + + + ),the chylothorax qualitative test was positive in 3 cases. The liver function showed that the total protein and albumin were decreased in varyig degrees. Conservative or surgical treatment was taken according to the situation of the patients. Among 6 patients,3 cases were cured after treatment,the others gave up treat-ment finally. Conclusions The etiology of congenital pleural effusion was different,and often associated with chromo-somal abnormalities or other malformations,ultrasonography was the main method to diagnose congenital pleural effusion and the patients should be dynamically observed or treated during the antepartum or intrapartum period. If the neonates are found to have pleural effusion in prenatal period early diagnosis and treatment is a best choice.

Objective To evaluate the feasibility and efficiency of endoluminal catheter-based ultrasonography on diagnosis of upper urinary tract diseases. Methods From January 1997 to December 2006,the clinical data of upper urinary tract of 68 cases who examined by endoluminal uhrasonography with a 10 MHz miniature ultrasound transducer and a 8 F outer catheter were reviewed.There were 30 males and 38 females aged 17-81 years with an average of 58 years.The renal pelvis and its surrounding structures were examined in 48 cases and the ureter and its surrounding structures were examined in 20 cases.The total of 73 sides had experienced by this technique.The accuracy of diagnosis with endoluminal catheter-based ultrasonography was evaluated by the pathology and clinical follow-up. Results The total success rate of the ultrasound probe introduced into ureter was 91%in 68 cases.In the pelvis group it was 96%(46/48)and the ureter group 80%(16/20).In renal pelvis abnomalities,the detectable rate of abnormal by ultrasonography was 89%(41/46).The total detectable rate in ultrasound probe group was significantly higher than that in other equipment groups(P＜0.01).The detectable rate of ultrasonography on ureter disease was 75%(12/16). Conclusion Endoluminal catheter-based ultrasonography is an effective,safe technique for the diagnosis of diseases in the upper urinary tract.

ObjectiveTo explore the risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage in premature infants.MethodsA total of 304 premature infants were selected who were diagnosed as sever intracranial hemor-rhage (grade III and IV) by cranial bedside ultrasound admitted to our hospital from Jun. 2013 to Sep. 2014. According to wheth-er the obstructive hydrocephalus was followed, all infants were divided into hydrocephalus group (n=59) and non-hydrocephalus group (n=185). The risk factors of obstructive hydrocephalus secondary to intracranial hemorrhage were analyzed and the lateral ventricle size was measured dynamically.ResultsThe univariate analysis showed the factors related with obstructive hydro-cephalus were as follows: gestational age≤32 weeks, birth weight< 1500g, severe asphyxia, cesarean section, RDS, neonatal infection, heart failure, PDA, acidosis, thrombocytopenia, coagulation abnormalities, and intracranial hemorrhage (gradeⅢ orⅣ) (allP<0.05). Multivariate logistic regression analysis showed that acidosis, thrombocytopenia, coagulation abnormalities, gesta-tional age≤ 32 weeks, severe asphyxia, intracranial hemorrhage (gradeⅢ orⅣ) were independent risk factors for obstructive hydrocephalus (OR: 1.76~20.46, allP<0.05). At each time point after birth, the ratio of posterior horn of lateral ventricle was signiifcantly higher in hydrocephalus group than that in non-hydrocephalus group (P<0.05). There were signiifcant differences in the changes of the posterior horn ratio of left or right lateral ventricle with time in hydrocephalus group (P=0.000), increasing at 14 days and reaching the peak at 28 days after birth.ConclusionsThe risk factors for obstructive hydrocephalus secondary to intracranial hemorrhage in neonates are important. Regular and dynamical monitoring of ventricle size by cranial ultrasound is needed in infants with sever intracranial hemorrhage.

BACKGROUND:Traditional bladder repair methods have many problems such as damage to normal organ function and many postoperative complications. Tissue engineering technology provides a new way for bladder repair.
OBJECTIVE:To explore the feasibility of constructing tissue-engineered bladder with vascular endothelial growth factor (VEGF) nanoparticle-bacterial celulose (BC) composite scaffold with rabbit lingual epithelial cels andtonguemuscle cels.
METHODS:Rabbit lingual epithelial cels andmuscle cels were successively implanted onto the BC scaffold (control group) and VEGF-BC scaffold (experimental group). Six rabbits were taken to make bladder defect models and randomized into two groups: experimental group implanted with VEGF-BC scaffold carrying autologous lingual epithelial cels andtonguemuscle cels,and control group implanted with BC scaffold carrying autologous lingual epithelial cels andtonguemuscle cels. Specimens were taken from the two groups for urographic evaluation and histological examination at 3 months after implantation. Meanwhile, the urodynamic tests were performed.
RESULTS AND CONCLUSION:The experimental group showed the relatively complete bladder, and the control group showed a smal-area filing defect of the bladder. The maximum bladder capacity and bladder compliance in both two groups were decreased after implantation, especialy significantly in the control group (P< 0.05). In the control group, it failed to build a complete epithelial cel layer, and the muscle layer and microvessels were formed a little. In the experimental group, the complete epithelial cel layer was formed, and a larger amount of muscle layers and capilaries appeared. These findings indicate that the VEGF-BC scaffold carrying lingual epithelial cels andtonguemuscle cels can be used to construct thetissue-engineered bladder.

Objective To explore the microsurgical experience of supra- and infra-tentorial meningioma of the posterior petrous bone.Methods Clinical data of 21 patients who had undergone microsurgical treatment were retrospectively reviewed.Results All patients underwent surgical treatment via a suboccipital retrosigmoid approach,and hyperostosis of the petrous bone and infiltrated cerebellar tentorium were resected intraoperatively.Tumor resection was categorized as Grade Ⅰ in 16 patients,Grade Ⅱ in 5 patients,according to the Simpson classification system.The main postoperative complications included slight facial paresis and hearing function deterioration.The mean follow-up time was 3.2 years.All patients resumed normal daily activity and no tumor recurrence happened.Conclusions Total resection for supra- and infra-tentorial meningioma of the posterior petrous bone can be achieved with an excellent prognosis by use of microsurgical technique.

Objective To develop a new continent cutaneous diversion using a tapered ileum wrapped by rectus abdominis muscular flap. Methods Ten dogs underwent a procedure in which two 6 cm ileal segments were tapered and connected to the U-shaped reservoir which was detubularized by a 30-40 cm ileal segment with end-to-side anastomosis. A continent tube was created by a 6 cm length and 3 cm width rectus abdominis muscular flap with its blood supplied which was penetrated be-tween the mesenteric vessels of one tapered ileum (study tube) and wrapped around its periphery. The other tapered ileum (control tube) was brought out into the abdominal skin directly without any extra-mural support. Urodynamic studies were carried out at 1, 3 and 6 months postoperatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) of every study and control tubes at every study phase were recorded and statistics analysis were taken. Retrograde radiograms of the ef-ferent tubes were performed prior to sacrifice and histological examinations of study group were carried out after sacrificed. Results The average MIP in experimental group was significantly higher than that in control group at 1, 3 and 6 months post-operatively (P<0.01). However, no significant differences in MIP or FPL were found in study group between empty and full reservoir. In the control group, MIP was found rising significantly (P<0.001) and FPL (P<0.05) decreased sharply com-pared with empty and full reservoir. Retrograde radiograms confirmed that all efferent tubes were pa-tent and positioned straightly beneath the abdominal wall. Histological examination of study group at 6 months postoperatively demonstrated a layer of striated muscle around the serosa of the ileum. Conclusions The continent mechanism of tapered ileum could be enhanced by extramural support from wrapped rectus abdominis muscular flap. This technique could setup a reliable, easy catheterization continent cutaneous efferent tube.