Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one.The average number of lymph node resected was 25.6 counts(22-31).Follow-up for 3-20 months,chest X-ray and abdominal CT revealed no evidence of recurrence or distant metastasis,and serum tumor markers were in normal range.Normal antegrade ejaculation recovered in 1 month postoperatively. Conclusions The technique through extraperitoneal approach could be applied for LRPLND.It might be an approach for diagnosis and treatment of stage Ⅰ NSGCT.

Objective:To investigate the multilocus sequence typing feature of the virulence-associated genes of Staphylococcus aureus(S. aureus) separated from the clinical specimens of a multi-center cohort children in Guangzhou area. Methods:A total number of 412 Staphylococcus aureus strains isolated from 2 059 non-repeated fecal specimens of children by three groups′ researchers in Guangzhou Women and Children′s Medical Center from August 2018 to November 2018. While collecting specimens, patient clinical information is also properly collected and preserved. After extracting the DNA of the strain, the virulence-associated genes were detected by polymerase chain reaction (PCR), including the staphylococcal enterotoxin (SE) genes ( sea, seb, sec, sed, see) and the Panton-Valentine leucocidin-encoding gene ( pvl).The multi-locus sequence typing (MLST) method was performed to reveal the MLST feature of these genes and the statistical difference were examined by the the χ 2 test. Results:Among the 412 isolates of S. aureus, 256 strains (256/412, 62.1%) contains at least one SE gene. Among the enterotoxin gens, the sec (125/412, 30.3%), seb(98/412, 23.8%)and sea (66/412, 16.0%)genes were the three most prevalent members of SEs. The frequency of pvl gene in Staphylococcus aureus was 18.7%(77/412).Among them, the frequency of Staphylococcus aureus sea gene isolated from patients with gastroenteritis (58/319, 18.2%) was significantly higher than that from the non-gastroenteritis group (8/93, 8.6%)(χ2=4.912, P=0.027). The frequency of Staphylococcus aureus pvl gene isolated from the patients with pneumonia (8/21, 38.1%) was greater than that from the non-pneumonia group (6/47, 12.8%)(χ2=4.252, P=0.039). In addition, the virulence-associated gene of S. aureus was closely related to the specific ST type, 82.4% (28/34) of ST6 carried sea gene, all ST338 and ST59 carried seb gene, 96% (48/50) ST45 carried sec gene, and the pvl gene carrying rate of ST338 was 5/5. Conclusions:The SEA toxin produced by ST6 Staphylococcus aureus may be closely related to the diagnosis of gastroenteritis in children. The frequency of pvl virulence gene in Staphylococcus aureus in children with community-acquired pneumonia was higher than that in the non-pneumonia group, and closely related to the CC59.