Objective To discuss the method and effect of large renal staghorn calculi by anatrophic nephrolithotomy (AN).Methods Fifty-two patients with large renal staghom calculi underwent AN.Bilateral renal calculi disease was present in 3 patients,so that a number of 55 procedures were operated.Preoperative evaluation included urinalysis,urine culture,renal function,and ultragound,CT,KUB and IVU.A flank incision was between the 11th and 12th ribs and the kidney was freed.After interrupted renal pedicle in situ hypothermia,the renal parenchyma incision was made along the avascular plane which is outside in the back of the kidney.The collecting system was opened.The calculi were removed.The collecting system was reconstructed.The renal parenchyma was closed and the renal circulation was reestablished.The protected management of renal function was made intraoperative.Postoperative follow-up consisted of urinalysis,renal function,ultrasound,KUB,IVU and ECT.Results The operative time was (117±45) minutes.The renal ischemia time WaS (29±15)minutes.Five cases underwent blood transfusion.Mean amount of blood transfusion was 230 ml.Four cases had remained calculi.The stone-free rate was 92.3%.No recent complication occurred after operation.Postoperative follow-up indicated that renal function was normal.Conclusions AN is the most appropriate method for patients with large renal staghorn calculi because of the highest stone-free rate,the lowest stone-recurred rate and a safe and effective operative procedure with less complication.Renal function damages just little through a series of protected management.Nephrectomy is avoided to part of patients.

OBJECTIVETo improve the diagnosis and treatment of testicular torsion.

METHODSThe clinical data of 9 cases of suspected testicular torsion were restrospectively analyzed to summarize the diagnostic experiences.

RESULTSThe 9 patients were 12-27 (mean 15) years old, 8 treated by surgery and 1 by spontaneous detorsion under anesthesia. Among them, 7 cases were proved to be testicular torsion and 1 case was acute epididymitis. Of the 7 cases of testicular torsion, 6 were found to have 180-720-degree torsion around the spermatic cord and 1 case 180-degree around the verticality of the spermatic cord. The accuracy rate of color ultrasonic examination was 87.5%.

CONCLUSIONPatients with acute scrotum pain should have color ultrasonic examination. Not all cases of the disease had testicular torsion around the spermatic cord. Emergency operation should be performed on any suspected case of testicular torsion.

Adolescent ; Adult ; Child ; Humans ; Male ; Spermatic Cord Torsion ; etiology ; therapy

Objective:To explore the postprandial plasma low-density lipoprotein cholesterol (LDL-C) changes by various detection methods.Methods:A total of 85 subjects admitted to the Second Xiangya Hospital of Central South University from November 2017 to May 2019 were included. Serum samples were collected from fasting and the 2 nd hour and the 4 th hour after breakfast. Serum lipid levels were measured with enzymatic assays and nuclear magnetic resonance spectroscopy (NMRS), and proprotein invertase subtilisin/kexin type 9 (PCSK9) levels were measured with enzyme-linked immunosorbent assays. The differences of blood lipid components at different time points were compared by Friedman two-way rank analysis of variance and Wilcoxon signed rank test, and the correlation between PCSK9 level and lipoprotein particles was analyzed by Spearman correlation. Results:Measured by enzymatic assays, compared with the fasting state, LDL-C decreased at the 2 nd hour and the 4 th hour after the meal (2.58[2.09, 3.12], 2.47[1.92, 3.02], 2.37[1.82, 2.80] mmol/L, P<0.001). Measured by NMRS, the concentration of LDL particles (1 086[830, 1 239], 1 083[848, 1 213], 1 061[814, 1 213] nmol/L, P=0.417) did not change significantly, and cholesterol in LDL particles were 2.13 (1.56, 2.54), 2.16 (1.68, 2.50), 2.06 (1.58, 2.50) mmol/L, respectively ( P=0.047)，and postprandial cholesterol in LDL particles in the 2 nd hour and in the 4 th hour did not change significantly compared with fasting ( P>0.05). while the concentration of large LDL particles (185.2[150.6,221.6], 173.0[144.8,220.3], 178.1[144.0,233.6] nmol/L, P=0.001), and the cholesterol level in large LDL particles (0.49[0.39, 0.57], 0.47[0.38, 0.57], 0.46[0.37, 0.58]mmol/L, P<0.001) decreased after the meal. The PCSK9 level also decreased significantly after the meal (299[233, 397], 257[208, 342], 251[215, 340] ng/ml, P<0.001). There was an independent positive correlation between the decrease of PCSK9 levels and the increase of remnant cholesterol detected by MNRS after the meal ( r=0.232, P=0.035). Conclusions:The postprandial LDL-C level measured by NMRS and enzymatic assays is not consistent. The decrease of LDL-C measured by enzymatic assays is not caused by the clearance of LDL particles, but by the redistribution of cholesterol in each LDL subfraction.

Objective:To observe the effect of 3D-printed guide plate-assisted percutaneous bone cement-augmented sacroiliac screw fixation in the treatment of pelvic fragility fractures in the elderly.Methods:A total of 11 elderly patients with pelvic fragility fractures who underwent 3D-printed guide plate-assisted percutaneous cement-enhanced sacroiliac screw fixation (cemented group) in the Department of Traumatic Orthopaedics of the General Hospital of Ningxia Medical University from December 2022 to April 2024 were retrospectively analyzed. There were 3 males and 8 females, aged 73.18±4.42 years (range, 67-80 years). There were 4 cases of typeⅡand 7 cases of typeⅢ. At the same time, 10 elderly patients with pelvic fragility fractures who underwent percutaneous sacroiliac screw fixation assisted by 3D-printed guide plate (cementless group) were selected as control group, including 5 males and 5 females, aged 73.90±6.51 years (range, 67-85 years). Pelvic fragility fractures were classified as typeⅡin 5 cases and typeⅢin 5 cases. The perioperative indicators, visual analogue scale (VAS), Barthel index and postoperative complications were compared between the two groups.Results:All patients successfully completed the operation and were followed up for 17.05±5.48 months (range, 9-27 months). The operation time and fluoroscopy frequency in the bone cement group were 72.09±3.95 min and 12.45±0.93 times, which were significantly higher than those in the non-bone cement group 57.00±4.24 min and 8.50±0.97 times, the difference was statistically significant ( P<0.05). All patients' fractures healed in one stage, the healing time was 97.09±7.15 d in the cemented group and 103.00±13.14 d in the uncemented group, the difference was not statistically significant ( t=1.297, P=0.210), and there was no case of delayed healing or non-healing. The postoperative weight-bearing time of the bone cement group was 44.73±3.72 d, which was shorter than that of the non-bone cement group 59.10±7.37 d, and the difference was statistically significant ( P<0.05). The VAS scores of the bone cement group at 1 day, 1 week and 3 weeks after operation were 5.73±0.65, 4.64±0.51 and 3.27±0.65, respectively, which were lower than those of the non-bone cement group 6.80±0.42, 5.30±0.48 and 4.00±0.67. The difference was statistically significant ( P<0.05). The Barthel index of bone cement group was higher than that of non-bone cement group at 1 day, 1 week, 3 weeks, 6 weeks and 2 months after operation, and the difference was statistically significant ( P<0.05). Bone cement leakage occurred in 2 patients in the bone cement group, and they did not complain of special discomfort and were not treated. In the non-cemented group, two cases showed screw withdrawal and the sacroiliac screws were removed in a second operation; one case showed sacral plexus nerve injury, and the screws were removed and treated with oral methylcobalamin symptomatic therapy one month after the operation, and the symptoms were relieved after three months. Conclusion:3D-printed guide plate-assisted percutaneous cement-augmented sacroiliac screw fixation for the treatment of elderly pelvic fragility fracture can alleviate postoperative pain, shorten the weight-bearing time, and help to promote early recovery and improve postoperative quality of life.

Bi-specific T-cell engagers (BiTEs) show great clinical outcomes for anti-cancer purposes. However, potential cytokine release syndrome (CRS) is notorious to all BiTEs. The mechanism underlying CRS is still not fully known, even though such toxicities are considered to be cytokine release related. Assessment of CRS is a key to non-clinical de-risk programs for BiTEs therapeutic development. In the present review, possible mechanisms are discussed, especially factors contributing to CRS develop?ment. T cell activation may be just an initiation of the CRS cascade, and other cell types can greatly contribute to CRS, such as a chain reaction triggered by downstream B-cells, monocytes, and endothe?lium cells. A non-clinical de-risk program can be designed based on these components in the CRS cascade. Combination of in vitro cytokine release assay, and in vivo mouse and non-human primates studies should be reliable enough to predict and mitigate CRS risk in the clinics. Further more, a good de-risk program should be able to provide ranking for candidates for further development and provide enough confidence to select a first-in-human dose.