BACKGROUND: How to solve the source of material substitute for repair of urethral dcfoct and improve the blood supply of new urethra has become a critical problem in the urethral repair and reconstruction.OBJECTIVE: To investigate the effects of endothelial progenitor cells (EPCs) on improving blood circulation in the new urethra following urethral defect repair.DESIGN,TIME AND SETTING: In vivo tissue engineering experiment,performed at the Laboratory of Deparanent of Surgery,First Affiliated Hospital of Zhengzhou University between January 2006 and February 2008.MATERIALS: Thirteen 3-5-month-old male Japanese rabbits were included for this study.Of them,one was used for preparation of bone marrow mononuclear cells,and the remaining twelve rabbits were divided into EPC repair group (n=8) and model group (n=4).METHODS: Under the aseptic condition,bone marrow was taken from the rabbit bilateral anterior superior lilac spine.Mononuclear cells isolated by Percoll method were induced in vitro using medium supplemented with vascular endothelial growth factors (VEGFs) and bovine basic fihroblast growth factors.When covering the whole bottom of culture flask,the mononuclear cells were digested with trypsin for passage.Animal models of urethral defect were developed in the two groups.One piece of aseptic fresh acellular human amnion (1 cm2) was sutured to each defected urethra using 0/6 DG suture for forming urethra.In the EPC repair group,1010/L passage 3 rabbit bone marrow mononuclear cell suspension was injected to two anastomotic stomas of the new urethra,0.1 mL for each stoma.The subcutaneous tissue was interruptedly sutured to the formed urethra using 0/6 DG suture.In addition,0.5 mL bone marrow mononuclear cell suspension was added to the region between each anastomotic stroma and newly repaired urethra.The same procedure was performed in the model group except that bone marrow mononuclear cell suspension was replaced by cell-free medium.At weeks 4 and 12 after surgery,paraffin sections of urethral tissue were made.MAIN OUTCOME MEASURES: Identification of cellular morphology; vascular regeneration of urethral tissue after urethral defect repair.RESULTS: After surgery,rabbit bone marrow mononuclear cells adhesively grew in vitro.Four days later,these cells exhibited rapid clone-like growth.Ten days later,they had typical slabstone-like change,presenting with strip-shaped and bundle-shaped growth.The phenotype of cultured cells gradually turned from CD34+/CD 133+/CD31+ to CD34+/CD 1337CD31+.At weeks 4 and 12 after surgery,the number of regenerate,d blood capillaries in the urethral tissue was significantly greater in the EPC repair group than in the model group (t=-9.034 to 5.985,P ＜ 0.01).CONCLUSION: Rabbit bone marrow mononuclear cells-differentiated EPCs can apparently improve local blood circulation in the urethral defect repair.

Objective To study the effects of Huazhi Rougan granule in treatment of nonalcoholic fatty liver disease and its effect on level of adiponectin, interleukin-6 and tumor necrosis factor-α.Methods 88 patients with nonalcoholic fatty liver disease from October 2014 to September 2015 in our hospital were selected,and divided into observation group and control group according to the order of admission.The control group were taken silibinin meglumine tablets for treatment on the basis of aerobic exercise , dietary guidance.The observation group on the basis of aerobic exercise , dietary guidance were given Huazhi Rougan granule for treatment.The observation group were taken aerobic exercise and metformin for treatment.Two groups of patients with clinical efficacy were evaluated, blood parameters, adiponectin, interleukin-6 and tumor necrosis factor-αwere measured before and 30 days after treatment between the two groups of patients.Results After treatment, the total clinical efficacy of the observation group was significantly higher than the control group ( P<0.05 ) .The levels of adiponectin in the observation group were significantly higher than those in the control group (P<0.05).The level of IL-6, TNF-αin the observation group were significantly lower than those in the control group (P<0.05).Low density lipoprotein cholesterol and triglyceride in the observation group were significantly lower than those in the control group (P<0.05).Conclusion Huazhi Rougan granule can effectively reduce the levels of TNF-αand IL-6 and increase the level of adiponectin in nonalcoholic fatty liver patients, and the clinical curative effect is good.

Objective To observe the effect of buspirone on ataxia symptom after stroke.Methods 30 patients with ataxia after stroke were treated with buspirone,other 30 patients without buspirone as controls.Before and after treatment,they were assessed with ataxia-scale.Results The buspirone can significantly improve the ataxia of patients with stroke compared with the controls(P<0.01).Conclusion Short-term treatment with buspirone can improve the ataxia symtoms after stroke.

Objective To observe the effect of fluoxetine on the depression neurologic impairment and activity of daily living after cerebral infarction.Methods 80 patients with acute cerebral infarction following depression were randomly divided into treatment group and control group, 40 cases in each group. Two groups were assessed with Modified Edinburgh-Scandinavia Stroke Scale(MESSS), Hamilton Depression Scale(HAMD) and Modified Barthel Index(MBI) before and after treatment.Results There were no significant difference between the two groups before treatment in HAMD, MESSS and MBI（P＞0.05）, while there were significantly different between the two groups in HAMD, MESSS and MBI 6 weeks after treatment（P＜0.01）. Conclusion Fluoxetine can alleviate depression of patients with acute cerebral infarction and improve the symptom of neurological function and the activity of daily living.

Objective To explore the diagnosis, treatment and prognosis of testicular benign tumors in children.Methods The clinical data of 26 boys ( aged between 17 days to 12 years and average age was 2.5 years) with testicular benign tumors treated in our center between January 2008 and December 2015 were retrospectively analyzed.The tumors were on the left side in 17 cases, on the right side in 9 cases. Twenty patients presented with painless scrotal mass.3 with cryptorchidism, 2 cases with hydrocele, and 1 case with varicocele.These boys underwent ultrasound or CT examination, results the enlarged tests with space-occupying lesions in 20 cases,3 cases were presented as scrotal empty,3 cases were showed as cystic masses.Twenty-four boys had taken tumor marker detection,which including 3 cases of AFP rised, 2 cases of Neuron-specific enolase slightly higher, 1 case of Ferritin increased.26 patients were performed surgical treatment, 23 cases have taken testicular tumor resection, and 3 cases underwent orchiectomy because of abnormal morphology, according to the intraoperative findings and quick frozen pathological examination results.Results Postoperative pathological diagnosis showed of maturity teratoma in 14 cases, not maturity teratoma in 3 cases, gonadoblastoma in 3 cases, interstitial cell tumor in 2 cases, epidermoid cyst in 2 cases, fibrocellular tumor and testicular inflammatory granuloma in 1 case respectively.The 23 cases were followed up for 3-70 months.All respondents children were alive, and no complications were found such as residual tumor atrophy or tumor recurrence and metastasis.Conclusions Early diagnosis and treatment is the key to obtaining a good effect of testicular tumors. Detailed specialist examination, preoperative ultrasound, CT and determination of tumor markers are important ways to diagnose testicular cancer; rapid intraoperative frozen check may manifest nature of the tumors.For pediatric testicular benign tumor, testis-sparing surgery should be considered.

Objective:To investigate the efficacy of robot-assisted laparoscopic surgery in heminephrectomy in children.Methods:The clinical data of 54 children with heminephrectomy in the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2019 was analyzed retrospectively, of which 42 cases underwent laparoscopic heminephrectomy (LH group) and 12 cases underwent robot-assisted laparoscopic heminephrectomy (RALH group). In LH group, there were 17 males and 25 females, with an average age of (71.74±34.57)months, 29 on the left and 13 on the right. In RALH group, there were 4 males and 8 females, with an average age of (76.83±37.33) months, 9 on the left and 3 on the right. There was no significant difference in age, sex composition and deformity side between the two groups ( P > 0.05). The clinical indexes such as operation time, intraoperative blood loss, postoperative drainage time, hospital stay and postoperative complications were compared between the two groups. Results:There were significant differences in operation time[(196.48±21.92)min vs.(171.50±24.91)min], intraoperative blood loss[(34.14±8.63)ml vs.(18.50±5.92)ml], postoperative drainage time[6.0(5.0, 7.0)d vs. 4.5(3.0, 6.5)d] and postoperative hospital stay[(8.93±1.70)d vs.(7.33±1.37)d] between LH and RALH groups ( P < 0.05). During the follow-up from 3 months to 2 years, the lower kidneys of the two groups developed well and the symptoms before operation such as urinary tract infection, intermittent voiding leakage and dysuria caused by ureterocele were gradually relieved and disappeared after operation. In the LH group, 2 cases were complicated with the symptoms as ureteral stump effusion, cyst formation and recurrent ureteral stump infection after operation, which were cured after reoperation. There was no case of ureteral stump effusion and cyst formation in the RALH group. Conclusions:Robot-assisted laparoscopic heminephrectomy in children has shorter intraoperative blood loss, postoperative drainage time and hospital stay, lower incidence of postoperative complications, and has better efficacy and safety.

Objective To analyze the relationship between clinical features and age of operation on children with hypospadias,and to explore and determine the factors for hypospadias associated with age at surgery.Methods Retrospective study was conducted in children with hypospadias undergoing operation at the First Affiliated Hospital of Zhengzhou University between January 2011 to December 2016.The demographics,the degree of hypospadias,complications,age at first urethroplasty and the other factors in patients were recorded,t-test was used to determine the factors associated with surgical timing and the difference was significant when P ＜ 0.05.Results A total of 1 051 cases were included in the study.Among these patients with hypospadias 268 cases (25.5％) were of mild cases,525 cases (50.0％) of moderate,and 258 cases(24.5％) of severe.Nine hundred and forty-six cases(90.0％) did not have complications,while 105 cases(10.0％) had complications.The median age at first urethroplasty was 5.3 years old and 66.22％ of them were operated after 3 years,and 4.09％ of them were after 18 years old.Insurance types,household income,race did not influence with surgical timing statistically (P ＞ 0.05).Multivariate analysis showed that the several factors were significantly associated with time of surgery:the severity of hypospadias (t =28.10,P =0.000),with or without complications (t =64.17,P =0.000),urban-rural gap (t =7.49,P =0.000),parental education level (t =36.90,P =0.000) and the age of receiving advice from pediatric surgeon (t =5.00,P =0.000).Conclusions The age of surgery in children with hypospadias were significantly affected by the severity of hypospadias,the presence of complications,differences between urban and rural areas,the degree of parental education,and the time of medical advice in the pediatric department of urology.,and the education of hypospadias knowledge for children's parents and related medical personnel at the grass-roots level will advance the age of surgery in children with hypospadias.

Objective:To analyze the influence of factors before initiation of extracorporeal cardiopulmonary resuscitation (ECPR) on the prognosis of patients, so as to explore the intervention timing and improvement strategy of ECPR.Methods:A retrospective analysis was performed on 29 patients who underwent ECPR in the First Affiliated Hospital of Hunan Normal University (Hunan people's Hospital)from July 2018 to April 2021. Patients were divided into the survival group ( n = 13) and death group ( n = 16) according to whether they survived at discharge. The duration of conventional cardiopulmonary resuscitation (CCPR), initial heart rate before ECPR, the ratio of out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), and the ratio of transported cases outside the hospital were compared between the two groups. According to different CCPR time, the patients were divided into the ≤45 min group, 45-60 min group and >60 min group to compare the hospital survival and sustained return of spontaneous circulation (ROSC) rate . According to the location of cardiac arrest, the patients from emergency department and other department were divided to compare the survival of IHCA. Results:The total survival rate was 44.83%, the average duration of extracorporeal membrane oxygenation (ECMO) was 114 (33.5, 142.5) h, and the average duration of CCPR time was 60 (44.5, 80) min. The duration of ECMO was longer in the survival group than in the death group ( P = 0.001). The duration of CCPR (the time from CPR to ECMO) in the survival group was significantly shorter than that in the death group ( P = 0.010). Patients with defibrillatory rhythm had higher hospital survival rate ( P = 0.010). OHCA patients had higher mortality than IHCA patients ( P = 0.020). Mortality of patients transferred from other hospitals was higher ( P = 0.025). Hospital survival and ROSC decreased in turn by CCPR duration ≤ 45 min, 45-60 min, and > 60 min ( P = 0.001). The location of CA occurrence had no impact on the hospital survival rate of IHCA patients ( P=0.54). Conclusions:Hospital survival of ECPR is higher than that of CCPR. ECPR is effective for refractory cardiac arrest. The prognosis of ECPR is significantly related to the duration of CCPR, initial heart rate, and location of CA. Education and team training should be strengthened to improve the survival rate of ECPR.

OBJECTIVE: To analyze the predictors of successful weaning off extracorporeal membrane oxygenation (ECMO) after extracorporeal cardiopulmonary resuscitation (ECPR). METHODS: The clinical data of 56 patients with cardiac arrest who underwent ECPR in Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from July 2018 to September 2022 were retrospectively analyzed. According to whether ECMO was successfully weaning off, patients were divided into the successful weaning off group and the failed weaning off group. The basic data, duration of conventional cardiopulmonary resuscitation (CCPR, the time from cardiopulmonary resuscitation to ECMO), duration of ECMO, pulse pressure loss, complications, and the use of distal perfusion tube and intra-aortic balloon pump (IABP) were compared between the two groups. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for weaning failure of ECMO. RESULTS: Twenty-three patients (41.07%) were successfully weaned from ECMO. Compared with the successful weaning off group, patients in the failed weaning off group were older (years old: 46.7±15.6 vs. 37.8±16.8, P < 0.05), higher incidence of pulse pressure loss and ECMO complications [81.8% (27/33) vs. 21.7% (5/23), 84.8% (28/33) vs. 39.1% (9/23), both P < 0.01], and longer CCPR time (minutes: 72.3±19.5 vs. 54.4±24.6, P < 0.01), shorter duration of ECMO support (hours: 87.3±81.1 vs. 147.7±50.8, P < 0.01), and worse improvement in arterial blood pH and lactic acid (Lac) levels after ECPR support [pH: 7.1±0.1 vs. 7.3±0.1, Lac (mmol/L): 12.6±2.4 vs. 8.9±2.1, both P < 0.01]. There were no significant differences in the utilization rate of distal perfusion tube and IABP between the two groups. Univariate Logistic regression analysis showed that the factors affecting the weaning off ECMO of ECPR patients were pulse pressure loss, ECMO complications, arterial blood pH and Lac after installation [pulse pressure loss: odds ratio (OR) = 3.37, 95% confidence interval (95%CI) was 1.39-8.17, P = 0.007; ECMO complications: OR = 2.88, 95%CI was 1.11-7.45, P = 0.030; pH after installation: OR = 0.01, 95%CI was 0.00-0.16, P = 0.002; Lac after installation: OR = 1.21, 95%CI was 1.06-1.37, P = 0.003]. After adjusting for the effects of age, gender, ECMO complications, arterial blood pH and Lac after installation, and CCPR time, showed that pulse pressure loss was an independent predictor of weaning failure in ECPR patients (OR = 1.27, 95%CI was 1.01-1.61, P = 0.049). CONCLUSIONS Early loss of pulse pressure after ECPR is an independent predictor of failed weaning off ECMO in ECPR patients. Strengthening hemodynamic monitoring and management after ECPR is very important for the successful weaning off ECMO in ECPR.
Humans ; Extracorporeal Membrane Oxygenation ; Blood Pressure ; Retrospective Studies ; Perfusion ; Cardiopulmonary Resuscitation