Objective:To discuss the surgical techniques and evaluate the clinical effects of laparoscopic varicocelectomy with testicular artery preservation.Methods:In this retrospective study, we collected clinical data of 97 patients with varicocele who underwent laparoscopic varicocelectomy from January 2015 to June 2020. All operations were performed by the same experienced urologist. Conventional laparoscopic varicocelectomy without testicular artery preservation was performed in earlier 35 patients (January 2015 to December 2016), which were taken as control group. The latter 62 patients (January 2017 to June 2020) underwent laparoscopic varicocelectomy with testicular artery preservation were taken as observational group. In observational group, average age was (21.9±6.7)years, there were 47 cases on the left side, 3 cases on the right side and 12 cases bilaterally, totaling 74 sides. There were 22 sides of varicose veinsⅠ, 28 sides of varicose veinsⅡand 24 sides of varicose veins Ⅲ. Clinical manifestations such as scrotal discomfort, pain and scrotal vein masses were observed on 35 sides (47.3%), infertility was observed in 24 cases (38.7%). Average sperm density was (23.7±5.9)×10 6/ml, average sperm motility (grade a+ b) was (33.9±4.1)%. In control group, average age was (23.7±4.6) years, there were 26 cases on the left side, 2 cases on the right side, 7 cases bilaterally, totaling 42 sides. There were 10 sides of varicose veinsⅠ, 17 sides of varicose veinsⅡ, 15 sides of varicose veinsⅢ. Clinical manifestations of scrotal discomfort, pain and scrotal vein masses were observed on 19 sides (45.2%), infertility was observed in 14 cases (40.0%). Average sperm density was (22.3±6.2)×10 6/ml, average sperm motility (grade a+ b) was (32.6±4.8)%.There was no significant statistical difference in preoperative clinical data between two groups ( P>0.05). The observational group followed the procedural steps of freeing the spermatic cord, isolating the testicular artery, and ligating the spermatic vein. The testicular artery was separated by the separating forceps and the electric hook, with the separating forceps holding the spermatic cord fascia in place and the electric hook (without electricity) bluntly separating the blood vessels and lymphatic vessels in the spermatic cord. The operative time, complications, recurrence rate, improvement rate of scrotal symptoms and semen quality, spontaneous pregnancy rate of spouses within 2 years in infertile patients were compared between the two groups. Results:The mean operative time in observational group was longer than control group [(35.8±7.7)min vs.(16.5±5.5)min, P<0.001]. Occurrence of postoperative acute epididymitis was lower in observational group compared to control group [1.4% (1 side) vs. 11.9% (5 sides), P<0.05] . No testicular atrophy (0 side) occurred in observational group, however, this complication could be found in 7.1% (3 sides) of control group ( P<0.05). Improvement rate of scrotal symptoms and semen quality was higher in observational group than that in control group after operations [77.1% (27 sides) vs. 47.4% (9 sides), P<0.05; and 72.6% (45 cases) vs.51.4% (18 cases), P<0.05]. The rates of spousal natural pregnancy within 2 years in infertile patients was higher in observational group than that in control group [70.8% (17 cases) vs. 50.0% (7 cases), P<0.05]. The rates of hydrocele and scrotal edema were similar in two groups [9.5% (7 sides) vs. 9.5 (4 sides)%, P>0.05], and the recurrence rate of varicocele was similar [8.1% (6 sides) vs. 7.1% (3 sides), P>0.05), without statistically significant difference. Conclusions:Using separating forcep and electronic hook can help to separate the testicular artery when performing laparoscopic varicocelectomy. In this operation, to preserve the testicular artery can get better effects an less complications.

Objective To observe the traditional Chinese medicine (TCM) and umbilical treatment on diarrhea-predominant irritable bowel syndrome(IBS-D)with mental disorders. Methods Thirty-seven cases with IBS-D were randomized into a treatment group(33 cases) and a control group(31 cases). The treatment group was given Shugan-Jianpi TCM decoction and pepper umbilical dressing. The control group was given Pinaverium Bromide Tablets and Flupentixol and Melitracen tablets. After having been treated for 4 weeks, Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD), IBS Symptom Severity Scale(IBS-SSS), IBS quality of life questionnaire (IBS-QOL) were determined. Results After the treatment, HAMD, HAMA, IBS-SSS in the treatment group and the control group all significantly decreased (the treatment group t=14.280, 13.530, 18.847,the control group t=11.514, 9.424, 13.829, P<0.01), and IBS-QOL increased markedly(t=-16.848, -11.712, P<0.01). Compared with HAMA, IBS-SSS and IBS-QOL in treatment group, the control group showed statistical difference(t=-3.183, -2.549, 3.904, P<0.01 or 0.05). The total effective rate of the treatment group was 94%higher than 75%of the control group(χ2=4.727, P<0.05). Conclusion Shugan-Jianpi TCM decoction and pepper umbilical dressing can improve the clinical symptoms and psychological symptoms and improve the quality of life of IBS-D patients.

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.

Objective To assess the enhancement feature of intracranial atherosclerotic plaque in the vessel supplying the territory of infarction by using high-resolution MR imaging.To analyze the correlation between the degree of plaque enhancement , time elapsed and the concentration of hypersensitive C-reactive protein ( hs-CRP ).Methods The characteristics of vessel walls and intracranial vascular stenoses were retrospectively analyzed in 81 patients with ischemic strokes.All subjects were imaged with a traditional stroke MR protocol and HR-MRI scanning for plaque on a 3.0 T MRI scanner.According to the elapsed time between infarct and MR examination , all cases were classified into early stage (<4 weeks from acute stroke, n=58), middle stage (4-12 weeks, n=13) and late stage ( >12 weeks, n=10).The characteristics of vessel walls and degrees of enhancement of atherosclerotic plaques were assessed and the concentrations of hs-CRP in all patients were determined.The Kruskal-Wallis H test was used to compare the degree of enhancement and hs-CRP concentration among the early , middle and late stage.The concentration of hs-CRP was presented as median ( interquartile range ).The Spearman correlation was used to analyze the correlation between elapsed time , hs-CRP concentration and degree of enhancement.Results Fifty-five (55/81) plaques were located at the M1 segments, and the other 26 (26/81) plaques were at the basilar artery.The degree and presence of enhancement from strong to none were 29, 25 and 4 in the early stage;4, 6 and 3 in the middle stage and 0, 4, 6 in the late stage, respectively.The degree and presence of enhancement were significantly different among them (H=16.934,P<0.01).There was a remarkable trend of decreasing degree and presence of enhancement of the atherosclerotic plaque relative to increasing time after the ischemic event(r=-0.792,P<0.01).The serum hs-CRP concentration for early, middle and late stage were 7.0(3.0, 13.0), 2.27(1.0, 3.03) and 1.88(0.50, 4.0)mg/L (H=14.345,P<0.01) , respectively.There was a trend of decreasing hs-CRP concentration relative to the time elapsed ( r =-0.357,P<0.01).The degrees of enhancement of the plaques were parallel to the levels of hs -CRP( r=0.526,P<0.01).Conclusions Enhanced HR-MRI scanning may clearly demonstrate the enhancement characteristics of intracranial atherosclerotic plaques as an indicator of inflammation.It might play an important role to detect risk factors for intracranial plaque rupture and subsequent acute ischemic stroke .

Objective To evaluate the clinical efficacy and adverse effects of CAG regimen in treatment of primary, refractory and relapsed acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS), and analyse the factors influencing long-term survival. Methods Sixty-one patients with AML ( primary, n = 27; refractory, n = 18; relapsed, n = 16) and 9 patients with MDS were treated with CAG regimen. Examinations on liver and renal function, electrocardiogram and bone marrow cytology were performed before and after treatment, and adverse effects of CAG were observed. Short-term efficacy was evaluated based on clinical manifestation, peripheral blood and bone marrow cytologic examinations. Patients were followed up, overall survival ( OS) and disease free survival ( DFS) were analysed, and long-term efficacy of CAG regimen was evaluated. The factors influencing long-term survival were analysed by Log-rank test of survival curve. Results After a course of treatment by CAG regimen, the total effective rate was 71% , and 34 patients (49%) experienced complete remission. The median time of follow up was 45 months, the median OS was 28 months, and the median DFS was 23 months. Age, level of lactate dehydrogenase (LDH), remission condition after a course of treatment by CAG regimen and adoption of HD-Ara-C regimen as consolidation treatment were influencing factors for OS and DFS. The dominant clinical adverse effects were bone marrow depression, with 13 d as the median duration of agranulocytosis ( neutrophil <0.5 ×10~9/L) and 9 d as the median duration of thrombocytopenia (platelet <20 ×10~9/L). Conclusion CAG regimen may lead to favourable therapeutic effects in treatment of primary, refractory and relapsed AML and high risk MDS, and may yield less adverse effects and better long-term therapeutic effects. Age, level of LDH, remission condition after a course of treatment and adoption of HD-Ara-C regimen as consolidation treatment are dominant influencing factors for survival.

Objective To investigate expression of β-site APP-cleaving enzymel(BACE1) and Aβ in brain of diabetes mellitus of Wistar rats,to study pathophysiological mechanism of Alzheimer disease from diabetic metabolic disorder. Methods Animal model of diabetes mellitus was established by streptozocin with intraperitoneal injection. Wistar rats were randomly divided into normal group (N), sham-operation group (S), 4 weeks diabetes mellitus model group (M4), 6 weeks diabetes mellitus model group (M6) and 8 weeks diabetes mellitus model group (M8). Behaviour was tested with Morris water maze and shuttle box test. Expression of Aβ was measured by enzyme linked immunosorbent assay and BACE1 by immunohistochemistry, enzyme linked immunosorbent assay, Western blotting and RT-PCR. The absorbance value was measured by imaging analysis. Results The electric times and latancy of memory and study were more increased in model group than that in N and S group but the times of escape more decreased(P<0.01). The expression of Aβ_(1-40) increased from (64.13±6.76)pg/mg in normal group to (86.43±7.03)pg/mg in model group by ELISA(P<0.001) and Aβ_(1-42) from (67.43±5.12 )pg/mg in normal group to (89.45±5.28) pg/mg (P<0.001) in model group. The expression of BACE1 increased from (116.46±8.10)pg/mg in normal group to (158.73±6.24)pg/mg in model group by ELISA and from 0.61±0.11 in normal group to 1.52±0.16 by Western blotting absorbance valule and from 1.62±0.26 in normal group to 3.61±0.32 by RT-PCR absorbance valule and from 0.81±0.21 in normal group to 2.01±0.36 by immunohistochemistry absorbance valule (P<0.001). The expression of BACE1 and Aβ in MT group was higher than that of in N and S group (P<0.01). The level of BACE1 and Aβ had positive correlation with cognitive impairment.Conclusion The expression of BACE1 and Aβ is increased in diabetes mellitus rats. Diabetes mellitus contributes to Alzheimer diseases that.

Objective:To establish an analytical method for the identification of donkey-hide gelatin in Fufang Ejiao Buxue gran-ule.Methods:The identification of donkey-hide gelatin in Fufang Ejiao Buxue granule was established by rapid resolution liquid chro -matography (UPLC) coupled with triple quadruple mass spectrometry (QQQ-MS).Results: The characteristic molecular peaks of donkey-hide gelatin were detected in ten batches of commercial samples .Conclusion:The present method is specific , precise and reli-able, and suitable for the identification of donkey-hide gelatin in Fufang Ejiao Buxue granule .The method provides scientific reference for the study of quality control method for gelatin ingredients in Chinese patent medicines .

Purpose To reconstruct perfusion computerized tomography angiography (PCTA) images from the volume data of low-dose brain CT perfusion scan with iterative reconstruction algorithm, to analyze the capability of PCTA on the display of brain arteries, and to explore the methods to reduce the radiation dose for stroke CT examinations. Materials and Methods This was a prospective study, 55 patients (605 arterial segments) with clinical diagnosis of ischemic cerebrovascular disease underwent cranial CT scan, iterative algorithm low-dose brain CT perfusion scan and conventional cranial CTA examinations using a 256-slice spiral CT. 11 segments of the cerebral artery in each case were analyzed using conventional CTA results as the reference standard to assess the display of brain arteries in PCTA. Results Effective dose of CT perfusion scan was 2.12 mSv. Among the 580 vessel segments which CTA showed no stenosis or stenosis<30%, only one vessel segment of PCTA was inconsistent with CTA; among the 19 vessel segments which CTA showed stenosis≥30%but not occluded, results of 12 vessel segments in PCTA were consistent with CTA, while the stenosis states were exaggerated by PCTA in the other seven vessel segments;results of the two methods were consistent in six vessel segments which was found occluded by CTA. Kw values were >0.75 for the consistency test between PCTA and CTA on the display of brain arteries. Conclusion Radiation dose of iterative algorithm cranial CT perfusion scan is significantly lower, and the images reconstructed from the volume data of perfusion CT are highly consistent with the CTA results, thus are able to meet the needs of the clinical diagnosis.

Objective To analysis long-term effects and safety of arsenic trioxide (ATO)-based induction and maintenance therapy in newly diagnosed acute promyelocytic leukemia (APL). Methods Retrospective analysis induction remission and post-remission treatment of 62 newly diagnosed APL patients was performed. These cases were followed up for 5 and 7 years. Results The complete remission (CR) rate was similar in ATO/all-trans retinoic acid (ATRA) induction group and ATRA/chemotherapy induction group.However, the former group has the shorter time to CR. The negative rate of PML-RARα fusion gene after induction without ATO was less than that of ATO group (86.2 % vs 56.3 %, P ＜0.05). After CR, the 5-year overall survival (OS) between ATO-base rotation maintenance group and chemotherapy-base rotation maintenance group showed that the former was (94.4±5.4) %, the latter is (45.5±10.2) %; 7-year OS was (52.5±23.7) % and (27.3±9.3) %; 5-year disease free survivals (DFS) was (94.7±5,5) % and (41.3±10.1) %; 7-year DFS was (52.6±23.7) % and (27.5±9.4) %. There was significant different in 5-year or 7-year OS and DFS between two groups (P ＜0.05). The relapse rates of the two groups in post-remission treatment were 14.7 % and 37.0 % (P ＜0.05). Conclusion ATO combined ATRA induction therapy increased the negative rate of PML-RARα fusion gene. ATO-base rotation maintenance improved long-term outcome and decreased the rate of relapse. Furthermore, ATO appeared to be generally safe and well tolerated.

Objective:To explore the application effect of video education combined with Teach-back in the treatment of patients with chronic periodontitis.Methods:Using non-simultaneous experimental research methods, From January to August in 2019, 41 patients with chronic periodontitis who underwent implant restoration in Shanghai Tenth People′s Hospital was selected by convenience sampling method as the control group, and implemented routine oral health education. From September 2019 to May 2020, 42 patients with chronic periodontitis who underwent implant restoration in Shanghai Tenth People′s Hospital were the observation group, and implemented video education combined with Teach-back. Compare the two groups of oral health care self-efficacy, periodontal clinical indicators, and the incidence of peri-implant mucositis.Results:Comparing 6 months and 12 months after implant restoration, the total scores of oral health self-efficacy and regular oral visits, correct brushing, and balanced diet in the observation group were 66.31 ± 4.32 and 67.19 ± 4.65, 22.04 ± 1.35 and 21.69 ± 1.82, 21.73 ± 1.65 and 22.64 ± 1.82, 22.54 ± 1.62 and 22.86 ± 1.74 respectively, which were higher than the control group 53.93 ± 4.78 and 54.09 ± 5.67, 17.02 ± 2.58 and 17.43 ± 2.16, 17.65 ± 1.74 and 18.54 ± 2.36, 19.14 ± 2.13 and 18.12 ± 2.58, the difference between the two groups at the two time points were statistically significant ( t values were 6.52-12.39, all P<0.05). And the PLI, mSBI, and PIS scores of the observation group were 0.80 ± 0.17 and 0.75 ± 0.14, 0.79 ± 0.19 and 0.81 ± 0.18, 2.08 ± 0.45 and 2.10 ± 0.53, respectively, which were lower than the control group 0.92 ± 0.19 and 0.99 ± 0.21, 1.03 ± 0.17 and 1.16 ± 0.21, 2.45 ± 0.68 and 2.62 ± 0.61, the difference between the two groups at the two time points were statistically significant ( t values were 2.93-8.16, all P<0.05). 12 months after, the incidence of mucositis around implants in the observation group was 7.14%(3/42), which was lower than 26.83%(11/41)in the control group ( χ2=5.73, P<0.05). Conclusions:Video education combined with Teach-back can improve the self-efficacy of oral health care during implant restoration treatment in patients with chronic periodontitis, improve oral health care behavior, thereby improving the periodontal condition around the implant and reducing the incidence of mucositis.