Objective To compare the effect of different urethrovesical anastomosis methods on postoperative anastomotic complication in laparoscopic radical prostatectomy (LRP). Methods The clinical method of 121 patients with localized prostate cancer who underwent LRP from June 2012 to June 2015 was retrospectively analyzed. The patients were divided into two groups according to different urethrovesical anastomosis methods: interrupted suture group with 36 patients and continuous suture group with 85 patients. The operation time, postoperative anastomosis leakage, anastomosis stenosis and urinary control status 1, 3 and 6 month after operation were compared between two groups. Results All the operations were completed successfully without converting to open approach. The operating time of continuous suture group and interrupted suture group was (20.35 ± 3.10)min and (34.02 ± 3.94) min, the rate of postoperative anastomosis leakage was 3.53%(3/85) and 16.67%(6/36), the rate of anastomosis stenosis was 2.35%(2/85) and 13.89%(5/36), the rate of urinary incontinence after operation for 1 month was 15.29%(13/85) and 33.33%(12/36), for 3 months was 7.06%(6/85) and 25.00%(9/36), for 6 months was 2.35% (2/85) and 13.89% (5/36), there were significant differences (P<0.05). Conclusions Continuous suture can shorten operation time, decrease the risk of anastomotic leakage, anastomosis stenosis and urinary incontinence.

Objective To study the efficacy and security of solifenacin in prevention of cystospasm after radical prostatectomy. Methods The clinical data of 93 localized prostate cancer patients who had underwent laparoscopic radical prostatectomy were retrospectively analyzed. The patients were divided into solifenacin group (52 cases) and control group (41 cases) based on the condition of taking solifenacin after operation. The day and night frequency and duration of cystospasm from the first day to the third day after operation, incidence of urine extravasation, duration of bloody urine, time of pelvic cavity drainage and ureter retention, untoward reaction (dry mouth, headache and abdominal distention) was compared between two groups. Results The day and night frequency and duration of cystospasm at second day and third day after operation in solifenacin group were significantly lower than those in control group. Day frequency of cystospasm: (1.54 ± 0.42) times vs. (3.35 ± 0.43) times and (1.38 ± 0.58) times vs. (2.86 ± 0.66) times, night frequency of cystospasm:(1.66 ± 0.63) times vs. (3.58 ± 0.72) times and (1.47 ± 0.33) times vs. (3.27 ± 0.68) times, duration of cystospasm:(0.18 ± 0.11) h vs. (0.33 ± 0.18) h and (0.21 ± 0.09) h vs. (0.29 ± 0.21) h, and the incidence of urine extravasation at the third day after operation in solifenacin group was significantly lower than that in control group: 1.92% (1/52) vs. 17.07% (7/41), and there were statistical differences (P<0.05). The duration of bloody urine, time of pelvic cavity drainage and ureter retention after operation in solifenacin group were significantly shorter than those in control group:(30.2 ± 5.6) h vs. (48.3 ± 4.7) h, (50.6 ± 5.9) h vs. (70.3 ± 6.2) h and (7.6 ± 1.4) d vs. (10.4 ± 0.9) d, and there were statistical differences (P<0.05). There was no statistical difference in untoward reaction between 2 groups (P>0.05). Conclusions Solifenacin can reduce the frequency of cystospasm and shorten the duration of cystospasm effectively after radical prostatectomy. It has a positive effect on reducing the incidence of urinary extravasation and shorting the extubation time. It is helpful to improve the quality of life and the recovery of the patients.

Objective To investigate the expression of LOXL2 protein (lysyl oxidase like-2 protein) and epithelial-mesenchymal transition (EMT) related markers in cholangiocarcinoma tissues and its relation with the malignant features. Methods The expression of LOXL2、E-cadherin and Vimentin protein in 48 cases of cholangiocarcinoma tissues was detected by immunohistochemistry and compared with the clinicopathological data of cholangiocarcinoma. Results The positive expression rate in cholangiocarcinoma was 71% ( 34/48 ) for LOXL2 and 46% ( 22/48 ) for Vimentin, the absent expression rate was 52% (25/48) for E-cadherin. The positive expression rate of LOXL2 was significantly associated with the absent expression of epithelium markers E-cadherin ( r = 0. 394, P < 0. 05 ) and the positive expression of fibroblast markers Vimentin ( r = 0. 406, P < 0. 05 ). There was no correlation between the expression of LOXL2 and patients gender, age, and cancer differentiation, but a significant correlation with tumor metastasis was found ( P < 0. 05 ). Conclusions LOXL2 protein overexpression in cholangiocarcinoma may accelerate invasion of cholangiocarcinoma through induced EMT.

Objective To investigate the correlation of the expression of KAI1/CD82 and laminin receptor (LNR) in cholangiocarcinoma, and study its role in the invasion and metastasis of cholangiocarcinoma. Methods The expressions of KAI1/CD82 and LNR in 48 cholangiocarcinoma tissue samples were detected by SP immunohistochemistry, and their relationships with clinicopathological factors were analyzed. Results The positive expression rates of KAI1/CD82 and LNR in cholangiocarcinoma were 31% (15/48) and 54% (26/48), respectively. In highly differentiated cholangiocarcinoma, the positive expression rate of KAI1/CD82 was high (χ2=3.911, P<0.05), while that of the LNR was low (χ2=6.970, P<0.05). The positive expression rate of KAI1/CD82 in cholangiocarcinoma with metastasis was significantly lower than that in cholangiocarcinoma without metastasis (χ2=5.765, P<0.05), while the positive expression rate of LNR in cholangiocarcinoma with metastasis was significantly higher than that in cholangiocarcinoma without metastasis (χ2= 9.952, P<0.05). The expression level of KAI1/CD82 was negatively correlated with that of the LNR ( r = -0.462, P < 0.01 ). Conclusions The up-regulated expression of LNR in cholangiocarcinoma correlates with the decreased expression of KAI1/CD82, and plays an important role in the invasion and metastasis of cholangio-carcinoma.

Objective To explore the surgical management of chronic pancreatitis complicated with pancreatolithiasis (CPPL). Methods The clinical data of 66 patients with CPPL were retrospectively analyzed. Pancreatolithiasis was classified into 4 types according to the location of stones: stones located in the head of the pancreas (type Ⅰ, n=28), stones located in the body of the pancreas (type Ⅱ, n=30), stones located in the tail of the pancreas (type Ⅲ, n=1) and stones located from the head to tail of the main duct of pancreas (type Ⅳ, n=7). Ten patients (including 4 with type Ⅰpancreatolithiasis, 5 with type Ⅱ and 1 with type Ⅳ) received conservative treatment; 10 patients with type Ⅰ pancreatolithiasis underwent lithotomy under endoscope; pancreaticoduodenectomy and Beger procedure were carried out on 14 patients with type Ⅰ pancreatolithiasis, pancreatolithotomy+pancreaticojejunostomy on 25 patients with type Ⅱ pancreatolithiasis, resection of pancreatic tail and spleen on 1 patient with type Ⅲ pancreatolithiasis, and Puestow-Gillesby procedure, dividing of the neck of pancreas+removing stones from both ends of pancreatic duct+Roux-en-Y pancreatojejunostomy on 6 patients with type Ⅳ pancreatolithiasis. Results Sixty-two patients were followed up for 2 months to 15 years, and the number of patients with recurrence for type Ⅰ, Ⅱ, Ⅲ and Ⅳ pancreatolithiasis was 4, 2, 0 and 3, respectively. Conclusions Early surgical management according to the location of stones should be carried out after confirmed diagnosis of CPPL. Individualized management based on correct diagnosis and classification plays an important role in the prevention of pancreatolithiasis recurrence.

Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.

Atherosclerosis is a chronic disease caused by thickening of the lining of the arteries, narrowing of the lumen or hardening of occlusion, and the incidence is increasing year by year. Studies have found that the inflammatory response is involved in different pathological processes in atherosclerosis. As an important inflammatory factor, interferon-γ participates in the occurrence and development of atherosclerosis by promoting endothelial cell damage, inducing foam cell formation, and promoting plaque formation and rupture. However, studies have shown that interferon-γ can also act on lipid receptors to inhibit the formation of foam cells, inhibit the proliferation of smooth muscle cells and protect against atherosclerosis.This article will review the effect of interfron-γ of atherosclerosis in occurence and development.

In recent years, recombinant human urokinase (rhPro-UK) has been widely used in the treatment of a variety of thromboembolic diseases, with significant efficacy and no obvious adverse reactions. In addition, it has a wide range of applications in many new technology fields. This article focuses on the application of rhPro-UK in the treatment of acute myocardial infarction, cerebrovascular disease, lower extremity deep vein thrombosis, arterial thrombosis and other diseases. rhPro-UK has demonstrated good thrombolytic efficacy and safety in these diseases, especially in patients with acute myocardial infarction, and adjuvant PCI therapy can significantly increase myocardial reperfusion, improve cardiac function, and do not increase the risk of bleeding. For cerebrovascular disease, rhPro-UK can significantly improve the degree of neurological deficit and has a high safety profile. In the treatment of lower extremity deep vein thrombosis, rhPro-UK has shown superior thrombolytic efficacy and safety compared with urokinase. For arterial thrombosis and biological stents, the use of rhPro-UK has also achieved some efficacy, but more research is needed to confirm its efficacy and safety. In addition, ultrasound-mediated drug-loaded thrombolysis systems also have potential applications in rhPro-UK therapy. Future research on rhPro-UK will focus more on the development of new technologies.

Objective:To explore the application effect of modified direct observation of procedural skills (DOPS) as a formative assessment tool in clinical skills training of professional graduate students.Methods:A total of 130 professional graduate students of Batch 2019 were selected as the experimental group, and 127 graduate students of Batch 2018 were selected as the control group. Two groups of students received clinical general skills training after enrollment, the control group adopted the traditional skills teaching method, and the experimental group added DOPS as formative assessment on the basis of traditional teaching. The teaching effect of DOPS was evaluated by means of scores analysis and student self-assessment. SPSS 23.0 was used for t-test. Results:The score of the experimental group (84.35±3.41) was higher than that of the control group (77.58±2.68), which showed a statistically significant difference ( t=2.63, P<0.05). The scores of "skill operation ability" and "communication ability" were the lowest single indexes in the assessment of DOPS. The results of self-assessment showed that the scores of autonomous learning ability, clinical thinking ability, clinical practice ability and professional accomplishment of students in the experimental group were all higher than those in the control group ( P<0.05). Conclusion:Modified DOPS is helpful to improve clinical core ability, which is worth promoting for application.

Objective To explore the treatment methods and prognosis of early infection and delayed infection after intramedullary nail fixation.Methods Data of 22 cases of postoperative infections after intramedullary nail from January 2013 to August 2017 were retrospectively analyzed.There were 18 males and 4 females aged from 20 to 72 years old,with an average age of 46.8 years.14 cases were tibias and 8 cases were femurs.In the early infection group,6 cases showed swelling,heat and pain in the affected area with drainage and pus.In the late infection group,12 cases showed sinus formation and 4 cases showed no sinus tract.According to whether the infection occurred within six weeks,it was divided into early infection and delayed infection groups.Of 6 patients in early infection group,there was 1 case of septic shock which underwent removal of intramedullary nails,debridement and antibiotic bone cement stick implantation.5 cases were retained intramedullary nail and underwent local debridement treatment.Late infection occurred in 16 patients.One patient with tibia infection was given partial dressing to heal the fracture.Then the intramedullary nail was removed and intramedullary debridement was performed.Two patients with poor general condition,the intramedullary nails were removed and debridement was performed.Calcium sulphate cement was implanted and fixed with external fixation.The remaining 13 cases were treated with debridement and antibiotic cement stick implantation.We compared the differences between early and late infections of internal fixation,infection control,fracture healing,and secondary fracture fixation.Results Of the 6 patients with early infection,1 patient with septic shock removed intramedullary nails to control infection.After infection controlled,the fracture was treated with intramedullary nailing.Of the 5 patients with retained intramedullary nails,2 patients' infection were controlled and 3 were uncontrolled.After removal of the intramedullary nails the infection was control.The success rate of retaining intramedullary nails was 33.3％ (2/6).Late infection occurred in 16 cases and infection was all controlled.The fractures healed in 22 patients.The fracture healing time of 6 patients with early infection was 2-6 months,with an average of 3.67±2.08 months.The fracture healing time of 16 patients with late infection was 2-4 months (average 3.2±0.79) months.Conclusion Patients with early bone infections after femoral and tibial intramedullary nail surgery may attempt debridement therapy with retained intramedullary nails,but the failure rate is high.If the intramedullary nail fails to remain,follow the treatment of patients with delayed bone infection.For patients with delayed bone infection,because the fracture has not yet healed,thorough debridement is used after the removal of internal fixation,then calcium sulfate or antibiotic bone cement stick should be implanted and fixed with external fixation.For the second phase,we may choose plate,intramedullary nail or external fixation to fix the fractures according to the soft tissue condition.All of the fixation methods could provide good fracture healing.