Objective To investigate the biocompatilility of human acellular amniotic membrane(HAM) with vascular smooth muscle cells(VSMCs) and to explore the possibility to construct tissue engineering bladder with HAM as the scaffold and VSMCs as the seed cells. Methods After physical and 1% trypsogen preparation,the HAM was mixed with VSMCs taken from rats for culture in vitro.Histological obserbation was done under inverted microscope and scanning electron microscope respectively.20 rats were divided into two groups.Hemicystectomies were performed in 20 rats,and 10 of them were repaired with HAM grafts with VSMCs on the half bladder,the other 10 were repaired with HAM grafts without VSMCs as the control group.The rats underwent postoperative assessment of bladder volume at the 2nd,4th and 8th weeks,and the grafts were observed by light microscope at the 2nd,4th and 8th weeks after surgery. Results The physical and 1% trypsogen treated HAM was pure with hollows and undamaged collagen fibers.The VSMCs could grow,adhere to and differentiate on the surface of HAM and into the hollows.At the 2nd,4th and 8th weeks after surgery, the bladder volumes of the experimental group were not different significantly compared with those of the control group.Epithelialization and smooth muscle cells regeneration occurred with the infiltration of inflammatory cells in the 2nd week after grafting,and the HAM were absorbed.In the 4th and 8th weeks,it was difficult to delineate the junction between the host bladder and grafts by histology.Conclusion HAM can be used as the scaffold to construct tissue engineering bladder as it has good biocompatibility with VSMCs without disturbing the cell form and the graft can be absorbed quickly.

Objective: To observe effectivness and safeness of self-made dentation hook plate associated with hot-air balloon technique in treating Mutch Ⅰ or Ⅱ type isolated greater tuberosity fractures of humerus. Methods: Between January 2016 and December 2018, 15 patients with Mutch Ⅰ or Ⅱ type greater tuberosity fractures were treated with self-made dentation hook plate associated with hot-air balloon technique. There were 9 males and 6 females with an average age of 45.1 years (range, 29-62 years). The injury causes included falling injury in 9 patients and traffic accident injury in 6 patients. According to Mutch classification, 4 cases were MutchⅠ type and 11 cases were Mutch Ⅱ type. There were 7 cases with anterior dislocation of shoulder. The time from injury to operation was 2-10 days (mean, 4.5 days). Results: All 15 patients were followed up 8-16 months, with an average of 13.5 months. There was no infection of incision, loss of reduction of fracture block, delayed union or nonunion. The average time of fracture union was 6.5 months (range, 4-8 months). One patient had axillary paralysis at 1 day after operation, and was treated with nutritional nerve therapy, the symptoms disappeared after 2.5 months. Three patients had slight subacromial impingement. After fracture healing, the hook plate was taken out in advance, and the pain and abnormal noise disappeared during shoulder abduction. At last follow-up, Costant-Murley score used to evaluate shoulder joint function was 88-100, with an average of 96.8; 8 cases were excellent, 7 cases were good, and the excellent and good rate was 100%. The internal fixator was removed after 8-16 months after the secondary operation with no re-fracture occurred. Conclusion: The self-made dentation hook plate associated with hot-air balloon technique is a safe and reliable method for the treatment of Mutch Ⅰ or Ⅱ type isolated greater tuberosity fracture of humerus.

Objective To explore the incidence of early complications within 72 hours among patients with six kinds of acute organophosphorus pesticide poisoning,thus to provide reference for the clinical treatment.Methods The retrospective study analyzed the clinical data of 335 cases with acute oral organophosphorus pesticide poisoning treated in Emergency Department of 307 Hospital of PLA from July 2008 to December 2015.Patients were divided into six groups according to the results of serum toxicology tests:acute phorate group (group A),acute dichlorvos group (group B),acute omethoate group (group C),acute dimethoate group (group D),acute phoxim group (group E) and acute parathion group (group F).The incidence of complications among the six groups were compared.The main analysis method was ranks test.Results There were no significant differences among the six groups in the incidence of cerebral edema,liver injury,kidney injury,myocardial injury,gastrointestinal hemorrhage and acute pancreatitis (P ＞ 0.05),while the mortality and the incidence of sudden cardiac arrest (SCA),respiratory failure,circulatory failure,multiple organ dysfunction syndrome (MODS),coagulation disorders and capillary leak syndrome (CLS) were significantly different among the six groups (P ＜ 0.05).The incidence of SCA wihin 24 hours in acutedichlorvos group reached up to 17.8％,and in other groups was as follows:acute parathion group (11.1％),acute dimethoate group (8.9％),acute phorate group (7.8％) and acute omethoategroup (1.5％).However,no one developed SCA in acute phoxim group.The total incidence of circulatory failure in all patients was 10.1％;dichlorvos group 31.1％ and dimethoate group (22.2％) had higher rates than other groups.The incidence of respiratory failure in all groups reached over 20％,while the total incidence was 36.7％,whereby,acute phorate group with a high of 46.7％,acute dichlorvos group with 44.4％,acute parathion group with 44.4％ and acute dimethoate group with 42.2％,respectively.The total incidence of coagulation disorders was 9.6％,while the incidences of the acute dichlorvos group (24.4％),acute phorate group (11.6％) and acute parathion group (11.1％) were higher than 10％.CLS confined to occur in acute dichlorvos group (11.1％) and acute phorate group (2.5％).However,MODS occurred mainly in acute dichlorvos group (28.9％) and acute parathion group (22.2％).Conclusions The incidences of early complications among the six groups are different,while acute oral dichlorvos poisoning patients tend to occur SCA.Within 72 h of poisoning,acute phorate poisoning group is more prone to respiratory failure,and acute dichlorvos poisoning group is more likely to develop coagulopathy disorders,circulation failure,CLS and MODS.Those patients in acute omethoate and acute phoxim poisoning groups have less risk to develop life-threatening complications except respiratory failure.

OBJECTIVETo clarify the frequency, presentation, associated factors, treatment and outcome of hyponatremia after transphenoidal surgery of pituitary adenomas.

METHODSRetrospectively reviewed the database of 183 patients who underwent transphenoidal surgery of pituitary adenoma between January 1999 and June 2000 in our department.

RESULTS38.8% (71/183) had postoperative hyponatremia. Among them, 59.2% (42/71) appeared on the 4th to 7th day postoperatively. 59.2% (42/71) presented with nausea, vomiting, headache, dizziness, confusion and weakness. Hyponatremia was related to age, tumor size and adenoma type, but not related to sex and degree of resection. Treatment consisted of salt replacement and mild fluid restriction in 4 patients and salt and fluid replacement in 67 patients. Hyponatremia resolved within 16 days in all the patients.

CONCLUSIONSHyponatremia often appeared about 7 days after transsphenoidal surgery of pituitary adenomas, especially in elderly and patients with macroadenomas and huge pituitary adenomas. The principle of treatment was salt and fluid replacement.

Adenoma ; pathology ; surgery ; Adult ; Age Factors ; Female ; Humans ; Hyponatremia ; etiology ; therapy ; Hypophysectomy ; methods ; Male ; Middle Aged ; Pituitary Neoplasms ; pathology ; surgery ; Postoperative Complications ; therapy ; Retrospective Studies

Three cases of pituitary metastases were reported. They all had operations and the pathological examination confirming the diagnosis. The clinical features of diabetes insipidus and extraocular nerve palsy were presented. In two cases, the original tumors were bronchioloalveolar carcinoma; in the other one, the original tumor was unknown. All three cases had poor outcome. These cases illustrate the fact that a pituitary metastasis can closely mimic a pituitary benign tumor, such as pituitary adenoma. Especially in the presence of suggestive symptoms such as diabetes insipidus and/or cranical nerve paralysis, the possibility of metastatic disease in the differential diagnosis of a pituitary mass should always be considered.
Adenocarcinoma ; secretion ; surgery ; Adenocarcinoma, Bronchiolo-Alveolar ; secondary ; surgery ; Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Neoplasms, Unknown Primary ; Pituitary Neoplasms ; secondary ; surgery

Objective To explore whether the pattern of neuron's auditory response to a sound stimulus affects the characteristics of stimulus-specific adaptation (SSA) in awake mice. Methods The auditory responses of the neurons in the inferior colliculus to sound stimuli were recorded using microelectrodes in awake mice. The sequence of sound stimuli consisted of random combinations of pure tones of two different frequencies (f1 and f2) with different repetition rates. The auditory responses of the neurons to standard and deviant stimuli were calculated, namely s(f2)/s(f2) and d(f1)/d(f2), respectively. Three indexes of the responses were also calculated, including the firing difference index (FDI), frequency-specific index (SI), and common SSA index(CSI). Results The CSI of neurons with a greater FDI was significantly higher than that of neurons with a smaller FDI (P<0.05). The primary-like neurons showed different characteristics of SSAs in different time periods; SSA was significantly increased in the phase of sustained response compared with that at the onset of response (P<0.05). Conclusion The auditory response pattern to sound stimuli is also an important factor that affect SSA of inferior colliculus neurons in awake mice.

Objective To explore whether the pattern of neuron's auditory response to a sound stimulus affects the characteristics of stimulus-specific adaptation (SSA) in awake mice. Methods The auditory responses of the neurons in the inferior colliculus to sound stimuli were recorded using microelectrodes in awake mice. The sequence of sound stimuli consisted of random combinations of pure tones of two different frequencies (f1 and f2) with different repetition rates. The auditory responses of the neurons to standard and deviant stimuli were calculated, namely s(f2)/s(f2) and d(f1)/d(f2), respectively. Three indexes of the responses were also calculated, including the firing difference index (FDI), frequency-specific index (SI), and common SSA index(CSI). Results The CSI of neurons with a greater FDI was significantly higher than that of neurons with a smaller FDI (P<0.05). The primary-like neurons showed different characteristics of SSAs in different time periods; SSA was significantly increased in the phase of sustained response compared with that at the onset of response (P<0.05). Conclusion The auditory response pattern to sound stimuli is also an important factor that affect SSA of inferior colliculus neurons in awake mice.

Objective To analyze the feasibility and safety in application of resectoscope combined with laparoscopy in the operation treatment of paraganglioma of urinary bladder.Methods 7 cases patients with paraganglioma of urinary bladder treated in our hospital from November 2014 to August 2018 were analyzed retrospectively.There were 5 males and 2 females,average age of 31.1 years (22-37 years),average body mass index was 22.3 kg/m2 (18.3-22.5 kg/m2).All the 7 cases patients complained of dizziness and palpitation after urination,average basal systolic blood pressure was 111.8 mmHg (97-124 mmHg),the average fluctuation of systolic blood pressure before and after urination was 64.9 mmHg(28-91 mmHg),the CT and cystoscopy prompt bladder tumor,the average diameter was 2.7 cm(2.1-3.5 cm).The average of plasma norepinephrine was 706.3 pg/ml(330-997 pg/ml);the average of plasma dopamine was 101.1 pg/ml(44-145 pg/ml);the average of 24h urinary vanilmandelic acid was 13.4 mg/24h (10.3-16.1 mg/24h).All the patients has controlled the blood pressure and dilate the blood vessels with phenoxybenzamine hydrochloride,accepted the operation of resectoscope combined with laparoscopy partial cystectomy and bladder sutura per abdomen after ample dilatancy.The patients had lithotomy position with trendelenburg,preparation of gas peritoneal cavity by transabdominal,inside the resectoscope by transurethral at the same time,mutilated bladder mucosa beside 1cm at the edge of the tumor,and cut full thickness bladder wall,take the extraperitional fat as the standard procedure;we could see the cutting edge clear at this time by laparoscopy,cut off the pelvic peritoneum,extraperitional fat and the tumor.The sample placed in bladder,close the bladder with absorbable or barbed wires,take out the sample by resectoscope.Results All the 7 cases patients operation was successfully completed,no cases has been transfered to open.The average time of operation is 85.3 min(65-100 min),the average amount of bleeding is 27.9 ml(10-50 ml).The average fluctuation of systolic blood pressure is 8.7 mmHg(6-15 mmHg).Bladder washout was stopped 24h after operation,catheter was removed 1 weeks after operation.There is no obvious complications occurred.The average hospital stay is 3.7 days (3-5 days).The average pain score of 4 cases 4h after operation is 3.8 (2-5),reevaluation 24h after operation is 2.3 (1-4).The average follow-up time is 7.9 months(2-15 months).All the 7 cases patients clinical symptoms disappeared,there is no fluctuation of systolic blood pressure before and after urination,there is no recurrence of the tumor.Conclusions To the paraganglioma of urinary bladder in fundus of bladder or anterior wall of bladder,we can accurate resection tumor by resectoscope combined with laparoscopy,reduce blood pressure fluctuations,reduce the surgical trauma and the distress of patients.It is a safety and effective minimally invasive surgery.

Objective:To investigate the rationality and surgical errors in countermeasures against difficult removal of screws so as to provide reference for standardization of technical procedures.Methods:A retrospective study was conducted to analyze the data of 99 patients who had encountered difficult removal of screws in operative removal of internal fixation at Department of Orthopaedics, Wuxi NO.9 People's Hospital Affiliated to Suzhou University from January 2018 to May 2022. There were 62 males and 37 females with an average age of 38.8±14.7 years. Their internal fixation time ranged from 7 months to 11 years. The irrationality was defined as insufficient preoperative preparation or a countermeasure that failed to follow the surgical indications or scientific principles of minimal injury or priority of simplicity. A surgical error was defined as unnecessary injury, failed removal or complications related to operation. Cases of irrationality and surgical errors were analyzed to find associations between them.Results:The operative removal was successful in 92 cases and failed in 7 cases. Of the patients who experienced difficult removal of screws, irrationality was found in 26.3% (26/99) and a surgical error or errors occurred in 28.3% (28/99). In the patients with countermeasure irrationality, the incidence of surgical errors was 53.9% (14/26) while in those without countermeasure irrationality, the incidence of surgical errors was 19.2% (14/73), showing a statistically significant difference ( χ2=11.360, P<0.001). In the patients with surgical errors, the incidence of countermeasure irrationality was 64.3% (18/28) while in the patients without surgical errors, the incidence of countermeasure irrationality was and 11.3% (8/71), showing a statistically significant difference ( χ2=29.148, P<0.001). In the patients with failed removal, the rate of countermeasure irrationality was 85.71% (6/7) while in those with successful removal, the rate of countermeasure irrationality was 21.7% (20/92), showing a statistically significant difference ( χ2=13.748, P<0.001). Conclusions:Close relationships exist between countermeasure irrationality, surgical errors and failed removal. The higher proportion of countermeasure irrationality, the higher possibility of surgical errors. Therefore, following the rationality principle may avoid or reduce surgical errors in difficult removal of screws.

【Objective】 To establish a nomogram model for predicting the risk of positive prostate biopsy in MRI-negative patients, and to perform the internal validation. 【Methods】 We retrospectively analyzed the clinical data of 197 MRI-negative patients who underwent prostate biopsy at our hospital, analyzed the independent predictors of positive prostate biopsy with univariate and multivariate logistic regression analysis, constructed the nomogram model and conducted internal validation. 【Results】 Multivariate logistic regression analysis showed age (P=0.003), digital rectal examination (DRE)(P=0.005), total prostate-specific antigen (tPSA) (P=0.001) and prostate volume (PV)(P<0.001) were independent risk factors of MRI-negative but prostate biopsy-positive results. The nomogram model based on all variables was established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.862, which was greater than that of tPSA (AUC=0.739), PV(AUC=0.711) and DRE(AUC=0.666) (all P<0.05). The average absolute error of the model was 1.1% after 500 internal resampling, indicating that the prediction of positive prostate biopsy was consistent with the actual situation. 【Conclusion】 The age, DRE, tPSA and PV were independent predictors of positive prostate biopsy in MRI-negative patients. The nomogram model has a good prediction performance.