Objective: To evaluate the efficacy of ultrasound-guided caudal epidural block for postoperative analgesia in the infants undergoing lobectomy under general anesthesia. Methods: Sixty American Society of Anesthesiology physical status Ⅱ or Ⅲ pediatric patients of both sexes, aged 1-3 yr, weighing 10-16 kg, scheduled for elective lobectomy under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: control group (group C) and epidural block group (group E). Caudal epidural block was performed under ultrasound guidance after induction of general anesthesia and at 15 min before surgery in group E. An epidural catheter was inserted at T_{6, 7} interspace, 0.1% ropivacaine 1 mg/kg was injected at 5 min after injecting 1% lidocaine 3 ml, the diffusion of epidural fluid was controlled at T_3-10, and the epidural catheter was then removed.An analgesia pump was connected at the end of the surgery in two groups.Pain was evaluated using Face Legs Activity Cry Consolability scale.When Face Legs Activity Cry Consolability scale score>3, the pump was pressed.When pain was still unrelieved 5 min later, sufentanil 0.1-0.2 μg/kg was intravenously injected.The patients were followed up for 48 h after operation, and the requirement for additional remifentanil and sufentanil, and the occurrence of postoperative nausea and vomiting, respiratory depression, hypoxemia and over-sedation was recorded.The number of pressing times, extubation time and duration of intensive care unit stay were also recorded.Pain at 1 and 2 days after operation was evaluated using the Postoperative Pain Measure for Parents. Results: Compared with group C, the consumption of remifentanil, the number of pressing times and requirement for additional sufentanil were significantly decreased, the incidence of each index of the Postoperative Pain Masure for Patients was decreased at 1 day after surgery, the extubation time and duration of intensive care unit stay were shortened, and the incidence of nausea and vomiting and over-sedation was decreased in group E (P<0.05). Conclusion Ultrasound-guided caudal epidural block provides better efficacy and fewer side effects for postoperative analgesia in the infants undergoing lobectomy under general anesthesia.

Objective: To evaluate the clinical effectiveness of combining electrical stimulation with manual massage in treating women′s myofascial pelvic pain (MPPS). Methods: A total of 93 MPPS patients were recruited and randomly divided into an infrared irradiation group (n=30), an electrical stimulation group (n=31) and a combination group (n=32). Those in the infrared group and the electrical stimulation group were given 30 minutes of infrared irradiation or electrical stimulation daily for 10 days, while the combined group was given a manual massage with electrical stimulation. The response to treatment was evaluated using a visual analogue scale (VAS) to rate discomfort, plus a physical examination, and surface electromyography results using Glazer′s protocol. The treatments′ efficacy and the recurrence of pain were evaluated 1 month after the treatment. Results: The average VAS ratings, resting potentials and their variability of the three groups all improved significantly after the treatment. The average VAS scores of the combined and electrical stimulation groups after the treatment were significantly lower than that of the infrared group. Moreover, the total effective rates of the combined group (96.87%) and the electrical stimulation group (80.65%) were significantly higher than that of the infrared group (56.67%), and the resting potential and variability of the former two groups were also significantly better. All of the above measurements among the combined group after the treatment were significantly better, on average, than in the electrical stimulation group. A month later the recurrence rate in the combined group (6.25%) was significantly lower than in the electrical stimulation group (25.81%) and the infrared group (56.67%). Conclusion Electrical stimulation combined with manual massage is effective in relieving myofascial pelvic pain.

AIM: To observe the efficacy of fundus photocoagulation combined with triamcinolone acetonide(TA)in the treatment of diabetic retinopathy(DR).

METHODS: The clinical data of 94 patients(112 eyes)in our hospital from September 2016 to September 2017 were analyzed retrospectively. According to the treatment regimen, the patients were divided into fundus photocoagulation with TA group(study group, 54 cases 64 eyes)and fundus photocoagulation group(control group, 40 cases 48 eyes). The treatment conditions \〖best corrected visual acuity(BCVA), macular retinal thickness\〗 were monitored before treatment(T1)and after 7d, 1, 3 and 6mo of treatment(T2, T3, T4, T5), and the efficacy was assessed at T5, and the improvement times of clinical manifestations(fundus hemorrhage, exudation, retinal edema)were recorded, and the serological markers \〖intercellular adhesion molecule(ICAM-1)and vascular endothelial growth factor(VEGF)\〗 were measured at T1 and T5.

RESULTS: At T1 to T5, there were statistically significant differences in the between-group effects, time-point effects and interaction effects of between-group and time-point of BCVA and macular retinal thickness(P<0.05). At T2 to T5, the BCVA was improved in the two groups with time while the macular retinal thickness was decreased with time(P<0.05). The efficacy in study group was better than that in control group, and the improvement times of fundus hemorrhage, exudation and retinal edema were less than those in control group(P<0.05). At T5, the serum levels of ICAM-1 and VEGF in the two groups were lower than those at T1, and the levels were lower in study group than those in control group(P<0.05).

CONCLUSION: Fundus photocoagulation combined with TA can effectively improve the visual acuity and retinal edema in patients with DR, and it has significant efficacy, and it can help promote the recovery of clinical symptoms, reduce the vascular endothelial injury, and inhibit the neovascularization.

Objective To evaluate distribution features of disrupted carotid plaque. Methods Forty-three subjects with duplex ultrasound evidence of 50% to 99% stenosis were retrospectively analyzed. Plaques were categorized as disrupted if there was MRI evidence of fibrous cap rupture. Quantity measured areas of the lumen (LA), wall (WA), and plaque components. The morphological parameters used were total vessel area, vessel burden index, eccentricity index. Mann-Whitney test and Chi-square test appropriate used SPSS (v. 12.0 ). Results There were 17 disrupted and 26 undisrupted lesions identified for comparison. Disrupted plaques showed a predominance of longer longitudinal length of large lip nucleus along the vessel wall (6 mm vs. 0 mm, U = 126, P <0.05 ), a large vessel burden (0.67 vs. 0.59, U =105, P <0.05), and high prevalence of thrombus (82.4% vs. 42.3 %, U = 132,P <0.05). In addition, disrupted plaques showed a different pattern of plaque distribution, having a more eccentric position of the lumen (3.68 vs. 2.79, U = 126, P < 0.05 ), a smaller lumen area (23.97 mm2 vs. 30. 18 mm2, U = 138, P<0.05) and a longer segment of stenosis when compared with the intact plaques. Conclusions Disrupted plaques have significantly different characteristics in terms of both axial and longitudinal distribution. A combination of multi-plane and multi-contrast high resolution MRI may provide valuable information about overall lesion morphology and its association to vulnerability.

Male infertility microsurgery represents the fastest growing sub-specialty in urology and clinical andrology over the past two decades. The importance of microsurgery for male infertility has risen as a part of the urologist's armamentarium in the medical and surgical management of male infertility. Despite the advances in male infertility microsurgery in China, the lack of standardized and well-organized training programs for male infertility microsurgery remains a serious problem affecting its development. In this article, Zhao and Peng have shared their experience with the learning curve of male infertility microsurgery at the Center for Male Reproductive Medicine and Microsurgery, Weill Medical College of Cornell University, which centers on how to pay attention to the details and basic principles of microsurgery. Male infertility microsurgery is physically, technically and mentally challenging, and must be first learned in the laboratory. Clinical success depends heavily upon appropriate training in a microsurgical laboratory. Good training can significantly reduce operation time and surgical errors as well as improve the quality of outcomes.
Andrology ; education ; Humans ; Infertility, Male ; surgery ; Male ; Microsurgery ; education

AIM: To investigate the repeatability and agreement of Pentacam Front Section Analyzer and Keratron Scout Corneal Topographer in measuring Kappa angle.

METHODS: Totally 69 patients were randomly selected from Ophthalmology Department of Leshan People's Hospital. Three readings were taken by the same examiner. Results were recorded in(X, Y)coordinates format and assessed by intraclass correlation coefficient(ICC), Cronbach's Alpha Coefficient, t-test, Pearson correlation analysis and bland-altman analysis.

RESULTS: Both instruments showed excellent repeatability in Kappa angle assessment. The results significantly correlated(X value: r=0.90, P<0.01; Y value: r=0.91, P<0.01), however, no significant difference were found between the two instruments. The widest 95% LoA was -0.11-0.14mm for X coordinate and -0.10-0.11mm for Y.

CONCLUSION: Pentacam and Keratron Scout showed excellent repeatability and agreement in Kappa angle assessment. The two instruments could aid and verify each other.

AIM:To compare the efficacy of anti-VEGF combined with Ahmed valve implantation with phacoemulsification or not for neovascular glaucoma(NVG)with cataract.

METHODS: Totally 47 patients(47 eyes)of NVG with cataract were given intraocular injection of anti-VEGF before the surgery, and then treated with Ahmed valve implantation. 19 cases(19 eyes)combined with phacoemulsification, and single Ahmed valve implantation in 28 cases(28 eyes). The vision, IOP, anti-glaucoma medicines and complications of the two groups were recorded and compared with 6mo postoperatively.

RESULTS:The IOP of all cases at all time points after surgery was significantly decreased after surgery(P <0.05). 6mo after surgery, in the combined group, the vision was improved in 10 cases(10 eyes)(53%), unchanged in 8 cases(8 eyes)(42%)and decreased in 1 case(1 eye)(5%). The complete success rate was 84%(16/19), the conditional success rate was 11%(2/19), and the failure rate was 5%(1/19). In the single Ahmed valve group, the vision was improved in 11 cases(11 eyes)(39%), unchanged in 17 cases(17 eyes)(61%), decreased in 0 case(0 eye)(0%), complete success rate in operation was 61%(17/28), conditional success rate was 25%(7/28), and the failure rate was 14%(4/28).

CONCLUSION: Compare with anti-VEGF with Ahmed vlave implantation, combined with phacoemulsification can effectively control the postoperative IOP, improve the BCVA of the patient as much as possible, reduce the amount of the postoperative glaucoma medicament use, and facilitate the follow-up of the fundus of the patient. It is a efficacy treatment for NVG with cataract.

The choroidal neovascularization(CNV)secondary to pathological myopia is a common cause of irreversible central vision loss, with high incidence and serious impact on the quality of life of the patients. The traditional therapeutic modalities for CNV secondary to pathologic myopia include thermal laser photocoagulation, transpupillary thermotherapy, and photodynamic therapy with verteporfin. However, the long-term outcome of these treatments are disappointing. Recently, the intravitreal injection of anti- vascular endothelial growth factor(VEGF)treatment can improve the visual acuity and reduce the central retina thickness more effectively than the traditional method. Therefore, these anti-VEGF agents may become first-line drugs for the treatment of CNV secondary to pathological myopia. This review is aim to discuss the pathogenesis of myopic CNV, the molecular structure and mechanism of anti-VEGF drugs, and compare the therapeutic efficacy and safety of anti-VEGF drugs to CNV secondary to pathologic myopia.

Objective: To assess the role of T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) in regulation of interleukin (IL) -12 secretion by CD14⁺ peripheral blood monocytes from patients with psoriasis vulgaris. Methods: From November 2017 to March 2018, a total of 47 patients with psoriasis vulgaris (psoriasis group) and 19 healthy volunteers (control group) were enrolled from Shanxi Provincial People′s Hospital. Peripheral blood mononuclear cells (PBMC) were isolated, and stimulated with Toll-like receptor (TLR) ligands. TIM-3 expression and IL-12 secretion by CD14⁺ monocytes were measured by flow cytometry. After blockade of TIM-3 pathway by anti-TIM-3 neutralizing antibody, changes in the downstream signaling pathway molecules in and IL-12 secretion by CD14⁺ monocytes were investigated. Two independent samples t-test was used for comparison between two groups, and Pearson correlation test for correlation analysis. Results: Under the unstimulated condition, the level of IL-12 secreted by CD14⁺ monocytes was very low, and the proportion of CD14⁺ TIM-3⁺ cells was significantly higher in the psoriasis group (12.20% ± 2.83%) than in the control group (9.91% ± 1.77%, t = 3.270, P = 0.001 7) . After the stimulation with TLR ligands, the proportion of CD14⁺ IL-12⁺ cells was significantly lower in the psoriasis group (13.49% ± 2.80%) than in the control group (28.97% ± 8.97%, t = 10.71, P < 0.000 1) , but the proportion of CD14⁺TIM-3⁺ cells was still higher in the psoriasis group (6.80% ± 1.11%) than in the control group (4.85% ± 1.37%, t = 6.064, P < 0.000 1) . The proportion of CD14⁺TIM-3⁺ cells was negatively correlated with that of CD14⁺ IL-12⁺ cells in both the control group and psoriasis group (r = -0.473, -0.371 respectively, both P < 0.05) . The TIM-3 pathway blockade could induce the decrease of suppressor of cytokine signaling 1 in CD14⁺ monocytes, increase the phosphorylation of signaling transducers and activators of transcription 1, and promote IL-12 secretion by CD14⁺ monocytes induced by keratinocytes isolated from psoriatic skin lesions. Conclusion TIM-3 plays a crucial role in the negative regulation of CD14⁺ monocyte-induced innate immune response in psoriasis.

Objective: To explore the clinical characteristics of multiple magnetic digestive tract foreign bodies ingested by mistake, to review the previous literature and provide reference for clinical treatment. Methods: The clinical data, treatment process and outcome of 8 cases of children with multiple magnetic foreign bodies admitted to Shanxi Children′s Hospital were retrospectively analyzed, and relevant literatures were reviewed. Results: Eight children with multiple magnets were aged 1 to 9 years old, and their medical history ranged from 5 hours to 2 months.Number of magnets ingested was 2-25.During the operation, 6 patients were found with multiple intestinal perforations, 1 with internal fistula and 2 with internal abdominal hernia, with at least 2 perforations and at most 6 perforations.The perforation sites located in the distal esophagus, stomach, duodenum, jejunum, ileum and colon.Seven cases were treated by emergency surgery, and 1 case was removed by colonoscopy and discharged after conservative treatment.One case underwent simple repair, 1 case underwent gastrojejunostomy, intestinal perforation repair; partial intestinal resection was performed in 2 places in 2 cases; partial intestinal resection was performed in 1 place and simple repair in the other places in 2 case; 1 case of fistula in child with intestinal anastomosis laparoscopic exploration, incision bowel resection.Seven cases recovered after surgical treatment.The child with intestinal obstruction after colonoscopy was discharged uneventfully 9 days later by conservative treatment, no complications occurred by followed-up.Combined with experience and literature, we developed a management algorithm for digestive tract magnet foreign body. Conclusion Accidental ingestion of multiple magnets can cause multiple digestive tract perforations, internal hernia, intestinal obstruction and other serious diseases, which should be treated as soon as possible.Therefore, it is necessary to strengthen the understanding of multiple magnet foreign bodies in children, early detection and early treatment.