Objective:To compare the efficacy of internal limiting membrane (ILM) flip coverage with ILM multilayer tamponade in the treatment of highly myopic macular hole-associated retinal detachment (MHRD).Methods:A retrospective clinical study. From November 2019 to June 2022, 53 cases and 53 eyes of MHRD patients who were examined and diagnosed at the Eye Centre of Renmin Hospital of Wuhan University were included in the study. Among them, 21 cases and 21 eyes were male and 32 cases and 32 eyes were female. The age was (55.28±11.40) years. The patients were categorized into two groups: the ILM coverage group (from November 2019 to September 2020) and the ILM multilayer tamponade group (from October 2020 to June 2022) based on their surgical procedures. The ILM coverage group comprised of 11 cases involving 11 eyes, while the ILM multilayer tamponade group comprised of 42 cases involving 42 eyes. Best-corrected visual acuity (BCVA) and optical coherence tomography were conducted. BCVA was measured using standardized international visual acuity charts and transformed to logarithmic minimum angle of resolution (logMAR) visual acuity for statistical analysis. The affected eyes were all treated with standard transciliary flattening three-channel 23-gauge vitrectomy. The inverted ILM flap technique was combined with flap coverage in the inverted group, while the ILM multilayer tamponade group used circular ILM stripping to preserve the ILM in the macular area and ILM flap around the macular hole with multilayer ILM tamponade. Postoperative follow-up was carried out for a minimum of 6 months. Relevant examinations were conducted during the follow-up using the same equipment and methods as those used before surgery. The BCVA, as well as the closure of macular hole, resurfacing of the retina, and development of macular hyperplasia, were observed.Results:In the ILM-covered group, the macular hole was closed in 7 out of 11 eyes after 1 week of surgery. At 1 month after surgery, the macular hole was closed in all treated eyes. At 6 months after surgery, the macular hole was closed in 9 eyes, while 2 eyes were reopened. In 42 eyes from the ILM-multilayer tamponade group, the macular hole closed after surgery in 41 eyes. At 6 months postoperatively, best corrected visual acuity (BCVA) of eyes in ILM-covered and ILM-multilayer tamponade groups was 0.91±0.29 and 1.05±0.39, respectively, with no statistically significant difference between the two groups ( t=1.140, P=0.260). The BCVA of the eyes in both groups showed a significant improvement compared to the preoperative period with a statistically significant difference ( t=8.490, 13.840; P<0.000 1); 6 months after surgery, 10 out of 11 eyes in the ILM coverage group had a restored retina with no detectable macular hyperplasia; 42 eyes in the ILM multilayer tamponade group had a restored retina, but 19 of these eyes had detectable macular hyperplasia. Conclusions:Either ILM flap coverage or ILM multilayer tamponade contributes to high myopic MHRD closure and improved visual acuity. Compared to ILM flap coverage, ILM multilayer tamponade results in higher and earlier rates of macular hole closure and lower rates of macular hole reopening. However, ILM multilayer tamponade may lead to a higher proportion of macular hyperplasia formation without affecting visual acuity recovery at 6 months after surgery.

Objective:To investigate the clinicopathologic features and differential diagnosis of ureteral fibroepithelial polyps.Methods:The clinicopathologic features and prognosis of ureteral fibroepithelial polyps with complete data retrieved from the pathology database of the Institute of Urology, Peking University from January 2013 to December 2021 were collected and analyzed. All HE staining sections were reviewed by a senior urologic pathologist. Immunohistochemical analysis was done in some cases for differential diagnosis. The clinical, imaging and outcome data were collected, and discussed together with relevant literature.Results:There were 45 patients with complete clinicopathologic data, including 34 males and 11 females (male: female=3.1∶1.0), with a median age of 36 (range 13-80) years. Preoperative diagnosis included polyp in 23 cases, tumor in 19 cases and calculi in 3 cases. The main clinical symptoms were hematuria (13 cases), low back and abdominal pain (9 cases) and no symptoms (9 cases). There were 29 cases of multiple polyps, 16 cases of single polyp; 32 cases were on the left side, 13 cases were on the right side; 29 cases of upper polyps, 9 cases of middle polyps, and 6 cases of lower polyps. Twenty-seven patients had no related urologic history, 10 patients had history of urolithiasis, and the rest had history of stents, strictures or tumors. Local ureteral resection and anastomosis were the most common treatment (20 cases), followed by ureteroscopic polypectomy (12 cases). The patients were followed up from the pathological diagnosis to the cut-off time: 4 cases were lost to follow-up, and the remaining 34 cases were followed up for 3 to 85 (mean 60 months). One case had polyp recurrence after 3 months, and the other case had polyp recurrence after 2 years. Fibroepithelial polyps had a variety of gross manifestations, ranging from elongated polyps or small papillary and polypoid to large papillary masses. Microscopically, they were divided into type 1, type 2 and type 3, and the type 3 was the most common type (28 cases). In this study, there were 41 cases of simple fibroepithelial polyp, 2 cases of malignant transformation of polyps into urothelial carcinoma, one case of polyps with urothelial carcinoma, and one case of polyp with surface urothelial carcinoma in situ; the stroma showed myofibroblastic proliferation.Conclusions:The clinical manifestations and morphologic characteristics of ureteral fibroepithelial polyps are diverse. The three microscopic types are easily confused with many benign and malignant ureteral diseases, such as inflammatory polyps, adenocystitis, papilloma, etc. Awareness of the key differentiation points and judicious use of immunohistochemistry will be helpful for the diagnosis and differential diagnosis.

ObjectivesTo introduce the progress in neurological classification of spinal cord injury (SCI) with complications. MethodsThe literatures in recent ten years were reviewed and summarized. ResultsIn January, 2022, a new neurological classification of SCI with complications in the International Standards for Neurological Classification of SCI (ISNCSCI) was published by the focus group of the American Spinal Injury Association (ASIA) International Standards Committee, with the extended "*"-tag concept, sensory and motor examination results impacted by SCI complication above, at, or below the neurological level of injury (NLI) could be consistently documented, scored, and classified. ConclusionThis new taxonomy in neurological classification of SCI with complications has overcome the shortcomings of the previous ISNCSCI versions and benefits the accuracy of ISNCSCI classifications, it could be tried in the clinical application.

Objective To evaluate the effect of α7 nicotinic acetylcholine receptor (α7nAChR) agonist on inflammasome of NOD-like receptor pyrin domain containing 3 ( NLRP3) during brain injury in-duced by cardiopulmonary bypass ( CPB) in rats. Methods Twenty-four clean-grade adult male Sprague-Dawley rats, weighing 350-450 g, were randomly divided into sham operation group (group S), group CPB, and CPB plusα7nAChR agonist PHA568487 group (group CP) after 5-day Morris water maze train-ing, with 8 rats in each group. Group S was mechanically ventilated for 60 min without receiving CPB. Group CPB received CPB for 60 min. PHA 5684870. 8 mg/kg was intraperitoneally injected at 30 min be-fore CPB in group CP. Water maze test was performed on 3rd day after operation to record the escape laten-cy and times of crossing the original platform. The rats were sacrificed at 2 h after the behavioral test, and their hippocampi were harvested for determination of cell apoptosis ( by TUNEL) and contents of interleukin-1beta ( IL-1β) and IL-18 ( by enzyme-linked immunosorbent assay) , caspase-1 activity ( by using spectro-photometry) , expression of NLRP3, apoptosis-associated speck-like protein containing a CAR ( ASC) and pro-caspase-1 ( by Western blot or real-time polymerase chain reaction) , and expression of NLRP3, ASC and caspase-1 mRNA (using real-time polymerase chain reaction). Apoptotic index (AI) was calculated. Results Compared with group S, the escape latency was significantly prolonged, the times of crossing the original platform were decreased, the AI, contents of IL-1β and IL-18 and caspase-1 activity were in-creased, and the expression of NLRP3 and ASC protein and mRNA, pro-caspase-1 and caspase-1 mRNA was up-regulated in CPB and CP groups (P＜0. 05). Compared with group CPB, the escape latency was significantly shortened, the times of crossing the original platform were increased, the AI, contents of IL-1β and IL-18 and caspase-1 activity were decreased, and the expression of NLRP3 and ASC protein and mRNA, pro-caspase-1 and caspase-1 mRNA was down-regulated in group CP (P＜0. 05). Conclusion The mechanism by whichα7nAChR agonist alleviates CPB-induced brain injury may be related to inhibiting NLRP3 inflammasome and reducing inflammatory responses in brain tissues of rats.

Objective: To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction(UPJO) complicated with renal calculi. Methods: From January 2018 to September 2018, eight patients, including five males and three females, were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University. The age ranged from 14 to 50 years(mean 28 years). Four patients had flank pain and one patient had flank pain with hematuria, while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m²(mean 22.0 kg/m²). The lesion located on the left side in 4 cases and on the right side in 4 cases. One patient suffered with multiple pelvis stones. Four patients suffered with multiple lower calyceal stones, and 3 patients had solitary lower calyceal stone. The stone size ranged from 2 mm to 10 mm (mean 6.4 mm). 3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis. Two patients combined with crossing vessels. All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy. In cases with left lesion, an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum . A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle. Then, a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle. Another 12 mm operative trocar was inserted at the opposite McBurney point. The last 5 mm operative trocar was placed at the veress needle point. After visualizing the pelvis and the proximal ureter at the lower pole of the kidney, a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made. The Sun’s ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus. Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port. After the pyelo-nephroscopy, a modified transperitoneal laparoscopic pyeloplasty was made. A F6 double-J stent was inserted into the ureter during the surgery. Result: All surgeries were finished successfully without conversion. The surgical duration ranged from 111 to 185 min(mean 135 min). The estimated blood ranged from 10 to 50 ml(mean 38.8 ml). The hospital stay ranged from 3 to 7 days(mean 4 days). The intraoperative stone free rate was 100%(8/8). No perioperative complications occured. With the follow-up from 6 to 14.4 months(mean 8.9 months), there was no evidence of obstruction in all patients, as confirmed by symptoms or radiological improvement of hydronephrosis, and two patients found recurrence of renal calculi. Conclusions Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun′s ureteroscope) is a safe, effective method to manage ureteropelvic junction obstruction with renal calculi.

Objective To explore the prevention for hip dysplasia after pediatric spinal cord injury. Methods From March, 2017, the families of 47 children with spinal cord injury accepted education for preventing improper posture of sitting and sleeping and other interventions, and 23 of them were followed up for three months or more. Results New hip dislocation was found in one child, and 18 children developed almost normally in hip, the other four children with old hip dislocation did not worsen.Conclusion Intervention in time may prevent the hip dislocation in children with spinal cord injury.

Objective To compare the apparent diffusion coefficients (ADC) between healthy people and patients with early cervical spi nal cord injury (SCI). Methods 18 patients with early cervical SCI and 5 healthy controls were examined with MRI T1WI, T2WI and DWI, and the ADC values and ADC maps were obtained. Results and Conclusion ADC values were less in the patients than in the healthy con trols, and the cut-off point was 800.0×10-6 mm2/s. ADC values also reduced in some patients without obvious abnormal MRI finds.

Objective To investigate the correlation between Semmes-Weinstein monofilament test and light touch exam of international standard for spinal cord injury (SCI). Methods 84 inpatients with SCI were assessed with Semmes-Weinstein monofilament test and light touch exam of international standard to determine the SCI level. The results were recorded as right-side and left-side of the body respectively. Results The normal tactual level of monofilament test and the normal light touch level of International Standard of Spinal Cord Injury (ISSCI) was consistent in 36% result to the unilateral level of SCI. For the 45 cases with ASIA A injury, 71% of the key points below the SCI level lost the tactual sensation in monofilament test, and 84% lost in light touch exam of ISSCI. Conclusion The result of monofilament test is poorly consistent with light touch exam of SCI, which may result from tactile sensitization after SCI. It is recommended to combine these exam in practices.

Objective To study the modification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) worksheet (2013 version) and the significance for clinical practice. Methods The latest English version of ISNCSCI worksheet- 2013 was compared with the previous version to find the advantages of current version and analyze its significance according to the experience from using the worksheet-2011. Results 11 modifications were found in ISNCSCI-2013, in which some were just discrimination, some were for emphasis, and the others were detailing. Conclusion The ASIA International Standards Committee made prudent modifications according to the practical experience of the ISNCSCI-2011 to make the worksheet more scientific and clear for recording. The modification will be more beneficial to record and determine the evaluation results of neurological examination of spinal cord injury in clinical practice.

Objective To analyze the epidemiological characteristics of pituitary apoplexy and investigate the changes and features of endocrine hormones caused by pituitary apoplexy.Methods A retrospective analysis of the clinical and laboratory data of pituitary tumor and pituitary apoplexy was carried out.Results (1) The incidence of pituitary apoplexy was 31.78％,patients were 15-75 (47.5 ± 11.7) year old,most patients were female.(2)Diabetes,coronary heart disease,menopausal hormone therapy,radiotherapy,surgery,and bromocriptine administration may be related to pituitary apoplexy.(3) There was high incidence of apoplexy in nonfunctioning adenoma.(4) According to the relationship between apoplexy and pituitary tumor,cases with pituitary apoplexy were divided into 5 types.(5) Pituitary apoplexy was associated with low serum creatinine,hypernatremia,hyperchloremia,hypoeosinophilia,and hypobasophilia.(6) 61.61％ of the patients had pituitary hormone deficiency,especially the GnH deficiency.(7)98.10％ of the patients were treated by surgery.Conclusion Pituitary apoplexy has its own clinical characteristics,and more attention should be paid in clinical practice.