Objective To explore selection of the procedures in one stage urethroplasty for treatment of the coexistence of urethral strictures in anterior and posterior urethra.Methods Between January 2008 and December 2014, a total of 27 patients with coexist strictures simultaneously in anterior urethra and posterior urethra were treated in our hospital.The mean age was 38 years old (ranging 13-83 years old.Stricture etiology was secondary to lichen sclerosus in 2 patients, iatrogenic in 3 and posttraumatic in 22.The mean length of urethral stricture was 11cm (ranging 6-14cm).Two procedures for treatment of anterior urethral stricture, including augmentation of urethroplasty using penile skin flap was performed in 20 patients and augmentation of urethroplasty using lingual mucosa in 7.Three procedures for treatment of posterior urethral stricture, including non-transecting spongiosum end to end anastomosis of the two urethral ends was performed in 3 patients, end to end anastomosis of the two urethral ends was performed in 17 and substitution urethroplasty using different tissues was performed in reminder 7 patients.Of them, pedicle scrotal skin urethroplasty was performed in 2 patients and lingual mucosal graft urethroplasty in 5 patients.Results The patients were mean followed up 2.6 years (ranging 0.545.0 years) with an overall success rate of 88.9％ (24 of 27 cases).Complications developed in 3 patients (11.1％).Of the 17 patients with end to end anastomosis, urethral stricture developed respectively 4 and 6 months in 2 patients and voiding well after pedicle scrotal skin urethroplasty.Urethral pseudodiverticulum developed 9 months after pedicle penile flap urethroplasty in another patient and voiding well after urethroplasty.Urethrography showed patent urethra with adequate lumen in the remaining patients and mean urinary peak flows was 21.3 ml/s (ranging 14.2-37.9 ml/s).Conclusions Substitution urethroplasty using penile skin or oral mucosa was more good procedure for anterior urethral stricture during the treatment of the coexistence of urethral stricture in the anterior and posterior urethra.The treatment of posterior urethral stricture was based on the length of the stricture, local condition to make a choice between anastomotic urethral reconstruction and substitution urethroplasty using other tissue.

BACKGROUND:Traditional bladder repair methods have many problems such as damage to normal organ function and many postoperative complications. Tissue engineering technology provides a new way for bladder repair.
OBJECTIVE:To explore the feasibility of constructing tissue-engineered bladder with vascular endothelial growth factor (VEGF) nanoparticle-bacterial celulose (BC) composite scaffold with rabbit lingual epithelial cels andtonguemuscle cels.
METHODS:Rabbit lingual epithelial cels andmuscle cels were successively implanted onto the BC scaffold (control group) and VEGF-BC scaffold (experimental group). Six rabbits were taken to make bladder defect models and randomized into two groups: experimental group implanted with VEGF-BC scaffold carrying autologous lingual epithelial cels andtonguemuscle cels,and control group implanted with BC scaffold carrying autologous lingual epithelial cels andtonguemuscle cels. Specimens were taken from the two groups for urographic evaluation and histological examination at 3 months after implantation. Meanwhile, the urodynamic tests were performed.
RESULTS AND CONCLUSION:The experimental group showed the relatively complete bladder, and the control group showed a smal-area filing defect of the bladder. The maximum bladder capacity and bladder compliance in both two groups were decreased after implantation, especialy significantly in the control group (P< 0.05). In the control group, it failed to build a complete epithelial cel layer, and the muscle layer and microvessels were formed a little. In the experimental group, the complete epithelial cel layer was formed, and a larger amount of muscle layers and capilaries appeared. These findings indicate that the VEGF-BC scaffold carrying lingual epithelial cels andtonguemuscle cels can be used to construct thetissue-engineered bladder.

Objective To investigate the efficacy of percutaneous transhepatic variceal embolization (PTVE) with Cyanoacrylate (TH glue) in treating large gastric fundal variceal bleeding.Methods PTVE was performed on 24 patients with TH glue injected into the main stem of left gastric vein and its fundic branches.The degree of varices in gastric fundus,rebleeding rate and survival rate after the procedure were compared with those before.Results Varices in gastric fundus were all embolized successfully with TH glue.The diameter of varices was reduced to below 5mm or disappeared in 20 patients (83.3％),and reduced to 5-10mm in the other 4 ( 16.7％ ) During the follow-up period of 3-36 months(mean 16.6 months),the rebleeding rate and mortality were 12.5 ％ ( 3/24 ),and 12.5 ％ (3/24),respectively.One patient died of liver cancer,and two others died of chronic liver failure.Conclusion PTVE with TH glue is of ideal therapeutic effect to block the feeding veins of large gastric fundal varices.

A hybrid segmentation algorithm is proposed for automatic segmentation of blood cell images based on adaptive multi-scale thresholding and seeded region growing techniques. Firstly, an adaptive and scale space filter (ASSF) is applied to image histogram and a scale space image is built. According to the properties of the scale space image, proper thresholds can be obtained to separate the nucleus from the original image and the white blood cells are located. Secondly, the local color similarity and global morphological criteria constrain seeded region growing in order to finish the segmentation of the cytoplasm. The detection accuracy of white blood cell is 98% and the segmentation accuracy based on the subjective evaluation is 93%. Test shows that this algorithm is effective for automatic segmentation of white blood cells.
Algorithms ; Automation ; Blood Cells ; Cell Nucleus ; ultrastructure ; Color ; Cytoplasm ; ultrastructure ; Humans ; Image Enhancement ; Leukocytes

Objective:To explore the effect of family history of cancer on clinical features and prognostic factors in nasopharyngeal car-cinoma (NPC) patients. Methods:The clinical data of 89 NPC patients with a family history of cancer and 388 NPC patients without a family history of cancer were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possi-ble prognostic factors. Results:The clinical characteristics of NPC patients with and without family history of cancer were compared. The gender, age, TNM stage, pathological type, and hemoglobin radiotherapy concentration before treatment did not significantly dif-fer between the two groups (P>0.05). NPC patients with a family history of cancer had better 3-year overall survival than those with-out family history of cancer (91.6%vs. 85.5%), but no statistically significant difference was observed (P=0.211). Both univariate and multivariate analyses showed that T, N, and TNM stages were the important prognosis factors affecting 3-year overall survival (OS), progression free survival (PFS), and distant metastasis-free survival (DMFS) of NPC (P<0.05). However, neither family history of cancer nor family history of NPC in 3-year OS, PFS, LRFS, and DMFS was significant in NPC patients (P>0.05). Conclusion:NPC patients with family history of cancer had better 3-year OS than those without family history of cancer, but no statistically significant observation was found. Large T stage or high lymph node stage contributed to poor survival of NPC. Family history of cancer had no significant in-fluence on the survival of NPC patients.

Objective To evaluate the prognostic value of the extracapsular spread (ECS) of regional lymph nodes in nasopharyngeal carcinoma (NPC) based on magnetic resonance imaging.Methods A retrospective review was performed for 477 previously untreated patients with NPC who were treated in Yuebei People′s Hospital from January 2009 to December 2013.Univariate and multivariate survival analyses were performed to identify the prognostic value of ECS in NPC.Results There were 216 patients with ECS and 261 patients without ECS,and the median survival of the two groups of patients was 38.5 months and 39.0 months,respectively.The 3-year overall survival (OS),progression-free survival (PFS),local recurrence-free survival (LRFS),and distant metastasis-free survival (DMFS) rates of the patients with ECS versus those without ECS were 81.9% versus 90.7%,65.8% versus 85.0%,87.8% versus 95.8%,and 80.3% versus 92.9%,respectively (all P=0.000).The univariate analysis showed that N stage and ECS were important prognostic factors for OS,PFS,LRFS,and DMFS in NPC patients (P=0.000-0.004),and T stage and TNM stage were associated with OS,PFS,and DMFS (all P=0.000).The multivariate analysis using the Cox regression model showed that T stage was an independent prognostic factor for the survival of NPC patients,and ECS was an important prognostic factor for PFS,LRFS,and DMFS.Conclusion ECS of regional lymph nodes is a risk factor for local recurrence or distant metastasis in patients with NPC.

Objective To explore the clinicopathological features and prognostic significance of human epidermal growth factor receptor 2 (HER2) in gastric carcinoma. Methods Pathological data of 127 patients with gastric carcinoma were retrospectively analyzed. HER2 expressions of all patients were detected by immunohistochemistry (IHC). 119 (93.7 %) patients were undergone R0 dissection and 123 (96.9 %) cases received D2 lymph nodes dissection. 51 (40.2 %) patients received adjuvant chemotherapy. The proportional differences of clinicopathological features for patients between HER2-positive and HER2-negative were compared, including the patients' survival. Results HER2 overexpression rate was 8.7 % (11/127) in gastric carcinoma patients. For the patients with HER2-positive and HER-negative, the lymph node metastasis rates were 100.0 % (11/11) and 81.9 % (95/116), respectively (P= 0.041). The 3-year overall survival (OS) rates for HER2-positive and HER2- negative patients with gastric carcinoma were 32.7 % and 42.9 % (P=0.413), and the 5-year progression free survival (PFS) rates were 27.3 % and 42.2 % (P = 0.354), respectively. Among patients with HER2-negative, 3-year OS rate for patients with surgery plus adjuvant chemotherapy was 55.3%, compared with 35.4%for patients with surgery alone (P=0.015), and the 3-year PFS rates were 53.3 % and 35.3 % (P= 0.038), respectively. Among patients with HER2-positive patients, 3-year OS rate for patients with surgery plus adjuvant chemotherapy was 0, compared with 75.0%for patients with surgery alone (P=0.002), and the 3-year PFS rates were 0 and 60.0% (P=0.004). Conclusions HER2 is expressed in gastric carcinoma tissue, related to lymph node metastasis. HER2 status are not correlated with the prognosis for gastric carcinoma patients, however, it is likely to be a predictive marker for adjuvant treatment after surgery for patients with gastric carcinoma.

Objective To explore the procedure selection and outcomes of treatment for the patients with severe panurethral strictures secondary to lichen sclerosus ( LS ) and evaluated the bulbar urethral specimens histologically . Methods Seventy-eight patients with severe panurethral strictures of LS underwent one-stage urethroplasty using different mucosal grafts between January 2003 and December 2014. The mean age was 48 years (range 38-72).The mean stricture length was 14.3 ±2.6 cm (range 11.0-22.0).Midline perineal incisions or circumcoronal and midline perineal incisions were used and two procedures were chosen as follow:①the strictured urethras were dissected from the corpora cavernosa only along the left side and the stricture urethras were opened by a dorsal longitudinal incision which extended about 1.5 cm into the proximal healthy urethras .The strictured urethras were augmented using oral mucosal grafts(1.5 to 2.0 cm in width and an appropriate in length ) ( n=50); ② for the patients whose urethras were very narrow or obliterated , the urethras were reconstructed using colonic mucosal graft ( 3 cm in width and an appropriate in length)after the severe strictured urethras were excised (n=28).Biopsies were taken separately from the urethral meatus and bulbar urethral specimens .Results All of the 78 patients were followed up for 6-110 months (mean of 48.3 months).Sixty-nine patients (88.5%) urinated well, with the mean urinary peak flow rate of 23.4 ml/s ( range 15.2-47.0 ml/s ) , and urethrography showed that each had a patent urethra with adequate lumen .Complications associated with urethra occurred in 9 patients (11.5%) . Three patients developed urinary fistula secondary to infection , which required surgical correction;6 patients developed meatal stenosis 3 -11 months postoperatively , and all voided well after meatoplasty.The incidence of LS-positive biopsies was 100.0%in the glans and 88.5%in the meatus.In the bulbar urethral mucosa , the histological alteration in all biopsies was squamous metaplasia of the hyperplasia , and no histological evidence of typical LS was documented .However , homogenization of the collagen with diffuse lymphocyte infiltration was observed in the bulbar urethral specimens of 2 patients, and squamous metaplasia of the hyperplasia with serious orthokeratosis that was similar to its cutaneous counterpart was found in another 2 patients.Conclusions Our study suggests that urethroplasty with oral mucosal grafts is effective to treat panurethral stricture associated with LS .Urethroplasty with a colonic mucosal graft is suitable for repairing very severe strictured or obliterated urethra .No histological evidence of typical LS is observed in the bulbar urethral specimens .

Objective:To analyze the application effect of quality management of diabetes special nursing based on index orientation in geriatric hospital.Methods:The evaluation index of diabetes special nursing quality management was established based on PDCA cycle management and Donabedian model. This index was applied to conduct training, supervision and assessment of diabetes special nursing in 25 nursing units of Beijing Geriatric Hospital from January to December 2019, and the homogenized management of diabetes special nursing in the whole hospital was finally realized. The knowledge and skills of diabetes of in-hospital nurses and patients at 3, 6, 9 and 12 months before and after the implementation were compared, as well as the quality management examination of diabetes special nursing in 25 nursing units. SPSS 17.0 software was used in statistical analysis.Results:The constructed evaluation index of diabetes special nursing quality management included 2 first-level indexes, 7 second-level indexes and 11 third-level indexes. After the implementation of homogeneous management, the scores of nurses and patients in diabetes specialist knowledge and skills were higher than those before implementation, and the differences were statistically significant ( P<0.01) . The scores of quality examination of diabetes special nursing (insulin management, insulin pen management, glucose meter management, hypoglycemic drug taking method) were higher than those before the implementation, and the differences were statistically significant ( P<0.01) . After 12 months of implementation, the scores of quality examination of diabetes special nursing (quality management manual writing, nurse training) were all higher than those after 3 months of implementation, and the differences were statistically significant ( P<0.01) . Conclusions:Establishing evaluation index of quality management of diabetes special nursing in geriatric hospitals and adopting homogeneous management can effectively promote non-endocrinology department nurses to master the knowledge and skills of diabetes special nursing and help improve the management quality of diabetes special nursing.

Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally,121 male patients,suffered with urethral strictures,were enrolled in this study between January 2012 and June 2017.Their age ranged from 17 to 63 years old.The etiology included pelvic fracture in 71 cases,straddle injury in 16 cases,iatrogenic injury in 25 cases,infection in 9 cases.All patients accepted the routine antegrade and retrograde urethrography.The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture.The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures.The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination.The length of stricture was compared between that in traditional urethrography and in 3D dimensional image,based on the results from anastomotic procedure and substitution.Result Among patients,71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture.In those patients with posterior urethral stricture,no statistical significant difference of stricture length was noticed between traditional urethrography and 3 D dimensional image [(2.30 ± 1.60)cm vs.(2.18 ± 1.55)cm,P =0.91)].In patients who complained about the urine leakage from anus,higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination (87.9％ vs.77.6％).To patients with anterior urethral strictures,no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile:(2.13 ±0.34) cm vs.(2.24 ± 0.31) cm,P =0.13;Bulbar:(1.98 ± 0.47) cm vs.(2.13 ± 0.32) cm,P =0.23)].However,the advantage of 3D image could be shown in detecting the lesion of navicular fossa and periurethral pathologic fibrosis.In the fly-through mode,the effect of 3D CT image seems to be superior to that in the 3D ultrasound image,which could show more smooth urethral wall and longer urethral segment.The limitation of those 3D image reconstructive technology was that long time consuming was needed during the 3D image reconstruction.Conclusion Our study showed that the multi-modality three dimensional imaging reconstructive technology can improve the sensitivity and specify in diagnosing the urethral stricture.After some modification,it will become the alternative method in diagnosing the urethral stricture.