Objective To evaluate the application of preserved urethral plate urethroplasty to treat urethral fistula after hypospadias repair. Methods Two hundred and twenty-four cases with u-rethral fistula after hypospadias repair were treated by preserved urethral plate urethroplasty from 2001 to 2006.Follow-up data were reviewed and analyzed.All of these cases had big(>1 cm)ure-thral fistula.One hundred and two failed hypospadias cases were repaired by tubularized incised plateurethroplasty(Snodgrass).The patients were 2-16 years old and mean age was 3.7 years old.In thesame time period,86 failed hypospadias cases were repaired by Duplay urethroplasty.The children were 2-14 years old and mean age was 3.5 years old.Twenty failed hypospadias cases were repaircd by Onlay island flap urethroplasty and another 1 6 failed hypospadias cases were repaired by Flip-Flap urethroplasty. Results Fistulas were successfully repaired in 86(84.3%)cases out of 102 tubular-ized incised plate urethroplasty procedure.There were 1 3 urethral fistulas and 3 urethral strictures.Seventy-five(87.2%)cases were successful out of 86 Duplay procedure.There were 9 urethral fistulas and 2 urethral strictures.There was no significant difference between these tWO groups of results(P>0.05).Nineteen cases were successful out of 20 Onlay urethroplasty procedures and there was only l urethral fistula.Fourteen cases were successful out of 1 6 Flip-Flap procedures and there was onlv 2 u-rethral fistulas. Conclusions Surgical procedure for urethral fistula repair should be chosen accord-ing to the condition of penis.Tubularized incised plate urethroplasty can get same satisfactory result comparing with Duplay method for failed hypospadias repair.More Snodgrass should be used to assure the cosmetic penis.

Objective To discuss the management of urethral duplication in children. Methods The clinical data of 1 8 children(all are males)with urethral duplication were retrospectivelv ana-lyzed. All the 18 patients were sagittal plane included epispadias in 6,hyposPadias in 4 and Y type in the remaining 8. In 6 cases with epispadias,3 patients underwent excision of the accessorv dorsal ure-thra,3 patients without operation.Urethroplasty was necessary in the patient with a duplicated hypo-spadiac urethra. Of 8 patients with Y-type urethral duplication,7 patients underwent 2 stage repair including displacement of the urethra from the anal canal to the perineum at stage 1 and subsequent urethral reconstruction at stage 2.The ventral urethra which was hypospadias had been excised in the other one. Results All the patients were followed-up. Good cosmetic and functional resuIts were a-chieved in the 3 boys who underwent excision of the accessory dorsal urethra.In the hypospadiac du-plication,2 patients could void spontaneously through a normally positioned granular meatus.One boy presented with urethral stenosis after operated. One boy had a vesicostomy for neuropathic bladder. In Y-type urethral duplications,only 1 patient was successful after 2-stage urethroplasty,3 patients de- veloped urethra stricture or fistula,3 boys need the 2-stage operation,the other 0ne who underwent excision of the ventral urethra could void spontaneously. Conclusions Urethral duplication is a rare congenital anomaly.The clinical presentation varies because of the different anatomical Datterns of this abnormality. Commonly the ventral urethra is most functional and maintained after surgical correc-tion.Surgical management should be individual and depend on the anatomical configuration of the du-plicated urethras.

BACKGROUND: Osteoblasts derived from bone marrow stromal stem cells are the main force of the cells In bone marrow cavity.In the artificial joint replacement cases, their life situation is closely related to conductive pressure of prosthesis.OBJECTIVE: To observe the continuous pressure on the proliferation of rabbit's bone marrow stromal stem cells, and to reveal the biomechanism of continuous pressure causing loosening and sinking of prosthesis and its activity after replacement.DESIGN, TIME AND SE'I-I'ING: A randomized study based on cytology was performed at the Institute of Othorpaedics, the Fourth Military Medical University of Chinese PLA from February 2004 to October 2007.MATERIALS: One New Zealand rabbit aging 1 month and weighing 0.5 kg was used to extract the bone marrow stromal calls.METHODS: The third-passaged bone marrow stromal stem cells were inoculated in seven 24-well culture plates at the density of 1 × 104 cells/well. After 14 hours, cells were adherent completely and cultured in DMEM culture media containing 10% fetal bovine serum. Thereafter, the four culture plates were randomly divided into 4 experimental groups, including control group without any pressure, and continuous pressure (20, 60, and 100 kPa) groups. The continuous pressure was performed for 3 hours every day.MAIN OUTCOME MEASURES: Absorbance was detected at day 1, 3, 5, and 7 after culture using MTT assay.RESULTS: Absorbance of the three pressure groups after 3, 5 and 7 days was significantly lower than the control group (P < 0.01). There was no significant difference in absorbance between 20 kPa continuous pressure group and 60 kPa continuous pressure group on the third day (P >0.05); but the absorbance was significantly higher than 100 kPa continuous pressure group (P < 0.05). On the fifth day, there was significant difference in absorbance between paired continuous pressure groups (P < 0.05),i.e., the higher the continuous pressure was, the lower the absorbance was. On the seventh day, the absorbance of the 100 kPa continuous pressure group was significantly lower than 20 kPa continuous pressure group (P < 0.05).CONCLUSION: Patients with eady post-joint replacement had better not stand on the ground; otherwise, a continuous stress will be caused so as to induce the restrain of bone marrow stromal stem calls in the bone marrow cavity, which is not helpful for bone healing and easily causes subsidence and loosening of prosthesis.

Objective To establish a stable and repeatable experimental partial bladder outlet obstruction(p-BOO)rat model and to figure out the impaction of p-BOO on detrusor biomechanical properties.Methods P-BOO animal model was established by partialligation of the bladder neck of male Wistar rats,a urethra stricture by laying a trochar outside of bladder neck.The rats were divided into sham-operation group,P-BOO 6 weeks group(P-B006W)and P～BOO 12 weeks group(PBOO12W)by time.Cystomety was performed in P-BOO6W and the rats were divided into detrusor instability group(DI)and destrusor stability group(DS)on the basis of destrusor stability.The active contraction of detrusor muscle stripes to Carbachol was recorded with tensile foree transducer.The compliance and maximum volume of bladder,bladder leak point pressure were examined by filling cystometry.Results The bladders of P-BOO animal model demonstrated typical post obstruction alterations after P-BOO.The maximum volume increased significantly in DI group(10.8±3.0)ml,DS group(10.3±1.9)ml and P-B0012W group(9.5±2.3)ml as compared with that in sham-operation group(2.1±0.3)ml(P＜0.05).The bladder leak point pressures were significantly higher in DI group(39.4±7.1)cm H2O,DS group(35.9±6.2)cmH2O and P-B0012W group(48.6±9.5)cm H2O as compared with that in sham-operation group(16.2±2.1)cm H2O(P＜0.05).The bladder compliances were significantly higher in 13I group(0.27±0.08)ml/cm H2O,DS group(0.29±0.05)ml/cm H2O and P-BOO12W group(0.21±0.05)ml/cm H2O as compared with that in sham-operationgroup(0.13±0.03)ml/cm H20(P＜0.05).The detrusor contractile force of DI group was significantly lower than that in the sham-operation group and DS group(P＜0.05).No definite contraction wave was detected in the detrusor muscle of P-BOO12W group(amplitude＜0.05g).Conclusions There are 2 different types of the detrusor contraction after P-BOO:DI group with impaired contraction and conversely DS group with compensatory contraction.The contractility of detrusor muscle will be damaged and even irreversible contractile function incapacitation will occur if the obstruction is not removed.The effect of bladder stability tO bladder compliance is inconspicuous and there is close correlation between bladder compliance and bladder capacity.

Objective To investigate the prevalence of anxiety and depression among the persons with disabilities in Shanghai and the factors related to them. Methods From November to December, 2014, 731 persons with disabilities were consecutively enrolled in this cross-sectional study. They were assessed with Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS). Binary Logistic regression analysis was employed to reveal potential related factors of anxiety and depression. Results The prevalence rates of anxiety and depression among the disabled in Shanghai were 9.58%and 8.48%, respectively. The duration (OR=0.967, P<0.05) and severity (OR<1, P<0.05) of disability were associated with depression, whereas retiral (OR=2.047, P<0.05), living alone or in care unit (OR=3.073, P<0.01) and duration of disability (OR=0.956, P<0.01) were associated with anxiety. Conclusion The frequency of anxiety and depression is mild among the persons with disabilities in Shanghai, and a special intervention is needed.

Objective To summarized the experience of simultaneous aortic operation and coroanry artery bypass graft (CABG).Methods Ninety seven patients who underwent combined aortic operation and CABG were reviewed from January 2009 to December 2011.All patients are divided into four groups according to etiology,63 aortic aneurysm,other 25 aortic dissection,7 coarctation of aorta or occlusion of main branch,and the other two aortic ulcer.Mean age of all patients is(57.6 ±9.5) years.The rate of preoperational diagnosis of coronary disease (CAD) were respectively 93.7％ (59/63),40.0％(10/25),100.0％,100.0％.The patients made the preoperative diagnosis of CAD were performed selective simultaneous CABG with aortic procedures.The others without diagnosis of CAD had to receive urgent CABG during the aortic procedures.Results The aortic procedures with simultaneous urgent CABG had signilicant higher mortality than with selective CABG,16.7％,3.8％,Fisher's exact test P =0.078.Conclusion Selective simultaneous CABG with aortic procedures is safely.In aortic surgery,patients with risk factors of CAD should undergo preoperative coronary artery angiography or spiral computed tomography.

Objective To summarize the experience in surgical management of hilar cholangiocarcinoma.Methods The clinical data of 88 patients with hilar cholangiocarcinoma who received surgical treatment at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were diagnosed by imaging examination.According to the severity of jaundice and predictive remnant liver volume,19 patients received percutaneous transhepatic cholangial drainage (PTCD) and 4 received portal vein embolization.The fundamental operation consisted of hilar cholangiocarcinoma resection,skeletonization of hepatoduodenum ligament and Roux-en-Y cholangiojejunostomy,and the transanastomotic stent was placed for 6 months.The count data were analyzed using the chi-square test; the survival rate was analysed using the Kaplan-Meier method; the survival was analyzed using the Log-rank test.Results Of the 88 patients,58 patients (including 11 patients who received PTCD) received hilar cholangiocarcinoma resection.Of the 58 patients,43 (including 4 patients who received portal vein embolization preoperatively) received R0 resection,and 15 received palliative resection.Thirty patients received internal and (or) external drainage.Commitant partial hepatectomy was performed on 22 patients (including 9 received left hemihepatectomy,2 received extended left hemihepatectomy,7 received left hemihepatectomy + caudate lobectomy,4 received right hemihepatectomy).Commitant pancreatico-duodenectomy was performed on 7 patients,commitant hepatic artery resection on 3 patients,and commitant portal vein resection on 2 patients.According to the modified Bismuth-Corlette classification,there were 17 patients with type Ⅰ,19 with type Ⅱ,21 with type Ⅲa,20 with type Ⅲb,and 11 with type Ⅳ.Of the 58 patients who received hilar cholangiocarcinoma resection,19 had postoperative complications,and 2 patients died within 30 days after operation.Seventy-three patients were followed up,and the overall 1-,3-,5-year survival rates were 68.5％,28.8％,11.0％,respectively.The 1-,3-,5-year survival rates of patients who received R0 resection were 94.6％,43.2％,18.9％,respectively,which were significantly higher than 78.6％,35.7％ and 7.1％ of patients who received palliative resection (x2=4.77,P ＜0.05).The 1-,3-,5-year survival rates of patients who received palliative resection were significantly higher than 18.2％,0,0 of patients who received biliary drainage (x2 =13.26,P ＜ 0.05).Conclusions R0 resection is the best choice for patients with hilar cholangiocarcinoma,and biliary drainage with no resection is the last choice.Sufficient preoperative treatment,optimized choice of surgical procedure and exquisite surgical techniques are important for the improvement of the prognosis.

Objective To analyze the research status of childhood unintentional injury and provide a foundation for the development of targeted intervention strategies. Methods Bibliometrics were used to analyze 429 literatures of childhood unintentional injury published during 2000~2011. Results The quantity of research literatures didn't form a stable growth. The object, type and location of childhood unintentional injury were non- specific. The research contents mainly involved epidemiological characteristics, affecting factors and prevention methods, but overall designs of research had flaws. Conclusion The research should be carried out targeted and systematically.

Humans ; Forensic Medicine ; Poisoning/diagnosis*

AIM: To study the process of Radix Rehmannia Preparata and find “the proper processing end point”, then standardize the slice. METHODS: Monolithic surveillance to the process and analyzing the change of the characteristic peaks between dried Radix Rehmannia and Radix Rehmannia Preparata by FT IR spectroscopy. RESULTS: We can know the dynamic change in Radix Rehmannia Preparata during the convenient processing course by the FT IR spectroscopy. CONCLUSION:FT IR is a powerful measure to standardize processing techniques, standardize the slice on the base of traditional processing experiences.