Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.

Objective To compare the effects of laparoscopic surgery and open surgery of inguinal lymphadenectomy in patients with penis carcinoma.Methods A retrospective case-control study was carried out.The retrospective analysis of clinic data of 10 patients with penis carcinoma who had laparoscopic inguinal lymphadenectomy and 13 who had open inguinal lymphadeneetomy were collected from June 2007 to June 2011,with an average age of 57 (40-75 years),and the average follow-up of 18.6 months (7 days to 9 years).Preoperative clinical stage were T1 in 10 cases,T2 in 7 cases,T3 in 6 cases,with 10 patients detecting inguinal lymph nodes enlargement,while three of which have two enlarged lymph nodes.The age of patients,duration of disease,tumor stage and lymph node enlargement have no statistically significant difference between laparoscopic surgery (LS) group and open surgery (OS) group.The mean operation time,intraoperative blood loss,time of postoperative drainage,hospitalization duration,mean number of excised lymph nodes and postoperative complications were analyzed.Results The mean operative time,intraoperative blood loss,time of postoperative drainage,and hospitalization duration of LS group and OS group were (103.6 ± 15.2) min,(56.5 ±6.8) ml,(5.8±0.8) d,(8.5±1.1) d versus (156.8±18.3) min,(88.5±9.5) ml,(12.5±1.3) d,(15.7±1.9) d,respectively.There was significantly different between the two groups (P＜0.05).However,the mean number of lymph nodes and the mean number of positive lymph nodes excised were not statistically different between the two groups (P＞0.05).There was no transfusion,and no severe complications occurred in either group.With the follow-up of 12-48 months,only one case of lung metastasis detected in OS group.Conclusions Compared with the open inguinal lymphadenectomy,laparoscopic inguinal lymphadenectomy is more safe and effective.It leads to less intraoperative blood loss,less hospitalization duration,less postoperative complications and quick postoperative recovery.

Objective To summarize the causes and treatment strategies for laparoscopic vascular injuries.Methods We had retrospectively reviewed 1858 cases of laparoscopic surgeries from March 2006 to February 2011.There were 10 cases (6 males and 4 females) had intraoperative vascular injuries.The mean age of these 10 patients was 49 years (ranged from 21 to 78 years).2 cases were aortic injuries,2 cases were vena cava injuries,4 cases were renal vein injuries,1 case was iliac vein injury and 1 case was iliac artery injury.The causes of vascular injuries included 2 cases caused by lack of anatomical understanding; 1 cases occurred during establishment of the first puncture site ; 2 cases caused by forced operation during the procedure; 2 cases caused due to ectopic anatomy; 3 cases caused due to adhesions and difficulties in dissection.Treatment strategies were maintaining pneumoperitoneum pressure and rapidly increasing the pressure to 2.6Kpa if a large amount of bleeding in a short time.With the help of suction,the bleeding sites could be identified.If necessary,an additional trocar was added to help exposure.The bleeding was closed with 4-0 vessel sutures.For arterial bleeding,the upper and lower ends of blood vessel ruptures were clipped with bulldog clamp,then follow the same procedures of variceal bleeding sutures if the bleeding were controlled.Results In 7 of the 10 cases,the bleedings were successfully controlled by laparoscopic technique,while the other 3 were converted to open surgery for bleeding control.The average laparoscopic hemostasis time in the 7 cases was 14 min (range from 8 to 25 min),the average blood loss was 530 ml (range from 150 to 1600 ml).Rupture size were 0.2-1.0 cm.One aortic injury case had complication of big post operative local hematoma which was spontaneously absorbed 3 months after surgery.And the other 9 patients did not have air embolism,hemorrhage and other complications.Conclusions Laparoscopic vascular injuries can be caused by a variety of causes.The strategies of controlling the bleeding are calmness and the fine suturing to control bleeding.A skillful assistant also plays an important role in dealing with this complication.

ObjectiveTo assessment the value of strain ratio(SR) in differentiating benign and malignant breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.MethodsElastosonography was performed on 64 patients with breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.SR (strainnormal neighboring tissues /strainbreast lesion) was calculated by the software equipped with the ultrasonic machine.Pathology of the lesions after biopsy or operation was considered as standard,SRs of benign and malignant breast lesions were compared with independent-samples t test.The diagnostic value of SR was evaluated by receiver operating characteristic (ROC) curve analysis.Results SRs of 34 benign breast lesions and 30 malignant breast lesions were 2.85 ± 1.30 and 5.03 ± 2.50 respectively,there was significant difference between them( t =- 4.29,P =0.000).Area under the curve of diagnosing benign and malignant of breast lesions was 0.875 for SR( P ＜0.0001).If the cut-off point of SR was 3.26,the sensitivity in differentiating breast lesions was 83.33％,while the specificity was 82.35％.Conclusions SR is a helpful elasticity parameter for differentiating benign and malignant breast lesions of BI-RADS Ⅳ diagnosed by conventional ultrasound.

ObjectiveTo investigate the feasibility,technique and clinical effect of applying laparoscopic plastic surgery in the treatment of horseshoe kidney.Methods Eleven patients with horseshoe kidney were admitted from Mar.2006 to Mar.2011.There were 5 males and 6 females with mean age of 27years (14 to 46 years).Clinical manifestations included lower-back pain in 8 cases,lower-back pain and hematuria in 2 cases,lower-back pain and fever in 1 case.There were 6 cases accompanied with kidney calculi.All the cases with calculus were in left kidney and there was 1 case with multiple calculi.There were 11 cases accompanied with left hydronephrosis.Of which,there were moderate hydronephrosis in 6 cases,severe hydronephrosis in 5 cases.There were 3 cases accompanied with mild right hydronephrosis.There were 2 patients with renal insufficiency,1 patient with urinary tract infection.The surgery procedures included laparoscopic isthmectomy and plastic surgery in 3 cases,isthmectomy and plastic surgery and pelviolithotomy in 6 cases,isthmectomy and vascular compression release in 2 cases.ResultsAll patients had successful surgeries with the mean operative time of 145 min (95 - 190 min).The average blood loss was 250 ml ( 100 -400 ml).Average postoperative hospital stay was 10 d (7 - 15 d).One patient suffered from urinary leakage after surgery and recovered after anti-inflammatory therapy and local drainage.One patient suffered from secondary hemorrhage controlled with DSA.All the patients were followed up with a mean of 17 months (6 -28 months).In 6 cases with moderate hydronephrosis,5 patients recovered to mild hydronephrosis and 1 case improved from preoperative renal hydronephrosis 3.5 cm to postoperative 3.0 cm.In 5 cases with severe hydronephrosis,3 patients improved to moderate hydronephrosis,2 patients to mild hydronephrosis.One patient with kidney stone had 0.4 cm residual stone.Three patients complained of occasional mild backache.One patient suffered from hematuria and urinary tract infection,recovered after antiinflammatory therapy for 2 weeks.The remaining 6 patients were in good conditions during the follow-up.ConclusionTransperitoneal laparoscopic plastic surgery is able to deal with horseshoe kidney isthmus malformation and comorbidities,and is another alternative for the treatment of horseshoe kidney.

In this study,thermosensitive and repairable molecularly imprinted solid-phase microextraction fibers were synthesized using spiramycin as template molecule,methacrylic acid and N-isopropylacrylamide as functional monomers,ethylene glycol dimethacrylate as crosslinking agent,and silanized quartz capillary as carrier. The prepared molecularly imprinted solid-phase microextraction fibers were characterized by scanning electron microscope and nitrogen adsorption/desorption,and various parameters affecting the extraction efficiency were optimized. Due to high selectivity and sensitivity of the fibers for macrolide antibiotics,the quantitative analysis of four macrolide antibiotics in food matrix,spiramycin,tilmicosin,tylosin,and josamycin,was peroformed in combination with high performance liquid chromatography. In the range of 0.5 to 50 μg/mL,the chromatographic peak area showed a good linear relationship with the concentration. The spike recoveries of the samples at three different addition levels were between 81.8% and 119.1%;the inter-day precisions were less than 13.8% (n=6),and the intra-day precisions were less than 15.5% (n=3).

OBJECTIVETo assess the effect of bladder neck preservation (BNP) on postoperative continence during laparoscopic radical prostatectomy.

METHODSOne hundred and forty-five patients with localized prostate cancer (Tlb-T2c) underwent laparoscopic radical prostatectomy in our center from July 2006 to May 2010, including 59 cases treated with bladder neck preservation (BNP group) and 86 cases with bladder neck resection (non-BNP group). All cases were diagnosed as prostate cancer by transrectal ultrasonography-guided prostate biopsy preoperatively, in which localized tumors were confirmed by CT or MRI and distant metastases were ruled out by ECT bone scan. All patients had no history of incontinence and no radiation therapy preoperatively. All the 145 operations were performed by the same surgeon. The bladder neck preservation was defined as a procedure of direct suturing of the bladder neck on the urethra without repair and reconstruction of the bladder neck. Both procedures of neurovascular bundle preservation and external striated urethral sphincter preservation were carried out on all cases. Urinary continence was evaluated using the International Continence Society questionnaire at 1, 3 and 6 months postoperatively. Positive surgical margins rates were compared between the two groups. Postoperative continence was defined as the absence of need for pads or the use of one pad daily.

RESULTSAt 1, 3 and 6 months, the urinary continence rates were 42.4%, 74.6% and 86.4% in BNP group, respectively, while 25.6%, 58.1% and 80.2% in non-BNP group, respectively. There were statistically significant differences in continence at 1 and 3 months between two groups (P <0.05), while no significant differences were observed at 6 months postoperatively (P=0.331). There were no significant differences in overall rate of positive surgical margins between two groups (10.1% Compared with 10.4% P=0.954) and both groups had one case with positive surgical margins at bladder neck.

CONCLUSIONBladder neck preservation during laparoscopic radical prostatectomy is helpful for postoperative continence without increase of positive surgical margins rate.

Adult ; Aged ; Aged, 80 and over ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Retrospective Studies ; Urinary Bladder ; surgery ; Urinary Incontinence ; prevention & control

Since the first outbreak of avian influenza A(H7N9) virus in humans was identified in 2013, there have been five seasonal epidemics observed in China. An earlier start and a steep increase in the number of humans infected with H7N9 virus was observed between September and December 2016, raising great public concern in domestic and international societies. The epidemiological characteristics of the recently reported confirmed H7N9 cases were analysed. The results suggested that although more cases were reported recently, most cases in the fifth epidemic were still highly sporadically distributed without any epidemiology links; the main characteristics remained unchanged and the genetic characteristics of virus strains that were isolated in this epidemic remained similar to earlier epidemics. Interventions included live poultry market closures in several cities that reported more H7N9 cases recently.

Objective To determine the incidence and prevalence of transient ischemic attack (TIA) and to evaluate its epidemiological situation in Hunan province.Methods Seven monitoring points were randomly selected from the province,a total of 8 311 subjects aged≥50 years were then chosen by stratified sampling.The cases counted in prevalence was defined as patients diagnosed before 24:00 o'clock August 31st,2013,and the new diagnosis for incident counting was defined as those diagnosed between 00:00 September 1st,2012 and 24:00 August 31st,2013.Results Among all 8 311 screened subjects,the number of TIA patients was 24 (288.8 per 100 000 people),the incidence of TIA was 7 (85.2 per 100 000 people).Standardized prevalence and incidence were 283.2 and 82.4 per 100 000 respectively using 2010 China census population.Among them,the standardized incidence rate of female was higher than that of male (114.8 per 100 000 person-years vs.48.8 per 100 000 person-years),and the prevalence rate of males was higher than that of female (288.2 per 100 000 people vs.273.2 per 100 000 people).Hypertension is the most important risk factor for TIA (55.2％).Conclusion The incidence and prevalence of TIA in Hunan province are higher than the national average.Hypertension is the main risk factor.

Objective: Review the independent risk factors of postoperative recurrence in surgical treatment of bladder cancer patients to construct a model of bladder cancer recurrence. Methods : A total of 240 surgically treated bladder cancer patients were followed up for at least 1 year and divided into recurrence ( n = 54) and non⁃recurrence (n = 186) . The general data of patients were comparative analyzed , and the different and statistically significant data were further analyzed by ROC curve , and the statistically significant data were included in the multivariate analysis after logistic obtaining univariate analysis results. Risk factors were included in the model construction , and the model correction curve and clinical net benefit analysis were analyzed. The model could be used to predict postoperative recurrence in bladder cancer patients. Results: The ROC curves of the statistically significant continuous variables were analyzed in the general data , and the results showed that the AUC of PNI , BLCA⁃4 , BTA , NMP22 and CEA were 0. 932 , 0. 979 , 0. 998 , 0. 677 and 0. 981 , respectively , and the optimal truncation values were ≤40. 18% , > 140. 04 ng/mg , ≤7. 22 U/mg , > 7. 68 μg/mg , and > 1. 99 ng/mg, respectively. Statistically significant data from univariate analysis were incorporated into the logistic regression model , and the results showed that PNI ≤40. 18% , BLCA⁃4 > 140. 04 ng/mg , BTA≤7. 22 U/mg , NMP22 > 7. 68 μg/mg was a risk factor for recurrence in patients with bladder cancer. Subsequently , PNI , BLCA⁃4 , BTA , and NMP22 were incorporated into the construction of the model as predictors of recurrence in patients with bladder cancer. Based on the model correction curve and clinical net benefit analysis , the internal verification results showed that the C ⁃index of the model predicting bladder cancer recurrence was 0. 296 (95% CI: 0. 078 - 1. 329) . The calibration curve showed good consistency between the observed and predicted values. The model predicted a risk threshold > 0. 128 for patients with bladder cancer, and the model provided a clinical net benefit; in addition , the model had a higher clinical net benefit than PNI ,BLCA⁃4 , BTA , and NMP22. Conclusion The model correction curve and clinical net benefit analysis , the results of internal verification show that the model can be used to predict recurrence in patients with bladder cancer.