OBJECTIVE To evaluate the impact of mastoid obliteration withsingle-pedicle muscle flap covered by bone pate on vestibular stimulation. METHODS A retrospective study was performed on 59 patients who were treated for chronic otitis media with or without cholesteatoma by two techniques: canal wall down tympano-mastoidectomy(CWD) and subsequent mastoid obliteration(MO). The postoperative vestibular functions of all the patients in both groups were assessed by vestibular function tests and questionnaires. Finally, the data of examination a nd symptoms were a nalyzed. RESULTS After a minimum follow up period of 12 months, the rate of ear dry was 84％(22/26) for MO group and 55％(18/33) for CWD group(χ2=4.72, P <0.05). The dry ear time were 5.46±1.39 weeks for MO group and 8.67±2.3 weeks for CWD group(t =6.2529, P <0.05). When compared latent period of Caloric testing in the MO group (10.3±2.57)s and CWD group (12.7±3.33)s, significant differencewas found(t =3.1639, P <0.05). The postoperative caloric vestibular tests revealed an average nystagmus count of 52.96±20.82 beats per minute in the MO group and 69.94±18.98 beats in the CWD group(t =3.2688, P <0.05). By analyzing the questionnaire, 30％(10/33) of the patients who received CWD treatment reported vertigo by caloric stimuli such as wind, water compared with MO group(0)(χ2=7.45, P <0.05). The rate of suction cleaning induced vertigo was 48％(16/33) in CWD group and 23％(6/26) in MO group(χ2=3.17, P =0.075). CONCLUSION Our technique of mastoid obliteration with single-pedicle muscle flap covered by bone pate results in small cavities with complete epithelialization of all surfaces. Furthermore, obliteration of mastoid cavities provides protection to the labyrinthine organ and reduces postoperative vertigo to caloric stimulation.

Objective To investigate the indications and complications of onlay island flap urethroplasty in hypospadias.Methods Retrospective analysis 51 cases who received the onlay urethroplasty from Mar.2005 to Sep.2012 at the First Affiliated Hospital of Guangxi Medical University.Their ages were from 2 years to 12 years,the median age was 4 years and 3 months.Forty-three cases received the operation for the first time,8 cases were re-operation.The prepuce island flaps were implemented in all cases.Factors which contributed to the successful operation ratio were compared,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation,the size of glans.Results The operation achievement ratio was 82.4％ (42/51 cases).There were 7 cases urethrocutaneous fistula(6 cases were then cured by reoperation,1 case healed naturally).One case had urinary meatus had retraction.There was another case with persisting penile curvature.Some differences in factors had no statistical significance,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation (x2 =0.249,0.287,1.208 ; all P ＞ 0.05).The difference in glans size had statistical significance (x2 =3.393,P ＜ 0.05).Conclusions Onlay urethroplasty was suitable for the cases of coronary sulcus of penis and extremitas anterior penis,but for proximal cases,this therapy must be applied very carefully because of persisting penile curvature.For some reconstruction cases,Onlay urethroplasty was suitable,but the island flap must be designed flexibly.Urethrocutaneous fistula was the most complication,especially in some small flat glans.

Objective: To explore the safety and feasibility of transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods: Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments from November 2017 to March 2018 at Department of Pediatric Surgery, the First Affiliated Hospital of Guangxi Medical University.Clinical data were recorded including the general information, operation time, intraoperative blood loss, postoperative testicular position and postoperative complications, etc. Results: All 35 patients completed the cryptorchidopexy in one operation.Among those 35 patients, 28 patients had unilateral lesions and 7 patients had bilateral lesions, with a total of 42 sides.Twenty-six patients were of groin type(33 sides), 9 patients abdominal type(9 sides). The average operation time was (40.4±8.2) min for unilateral lesion, and (62.5±15.3) min for bilateral lesions; the average intraoperative blood loss was (3.0±1.8) mL; and the average postoperative hospital stay was (6.4±2.1) h. Testis of 32 patients (40 sides) were fixed in the middle and bottoms of the scrotum, and testis of 2 patients (2 sides) were fixed on the top of the scrotum.One case had poor healing of naval incision, which was recovered in 1 week after dressing change.There were no postoperative complications such as scrotum hematoma, infection of incision, testicular epididymitis, testicular necrosis, testicular retraction or testicular atrophy, etc.No obvious visible scar was found in the abdomen review 2 weeks postoperatively, with the incidence of complications was 2.9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma, quick recovery, low complication rate and visible scar free result, which is worthy of clinical promotion, but the operation is relatively complex and the correct procedures are required.

Background and objective It has been proven that toll-like receptor 5 (TLR5) plaied an important role in the development of tumor. In our previous study, we found that the expression of TLR5 was remarkably higher in non-small cell lung cancer (NSCLC) tissues than that in normal tissues, but the activation of TLR5 signaling pathway in NSCLC was still unknown. Te aim of this study is to investigate the expression of TLR5 in diferent types of NSCLC cell lines, and analyze the activity of the signaling pathway afer stimulated by its specific exogenous ligand fiagellin. Methods Te TLR5 protein was detected by immunofiuorescence and Western blot in three kinds of NSCLC cell lines, and the TLR5 mRNA was detected by RT-PCR. Select the cell line of TLR5 highest expression as the research object, and select the suitable concentration of fiagel-lin. NF-κB luciferase activity was detected to validate the TLR5 activation pathway through inhibitory signaling pathways by 0 μg/mL, 0.01 μg/mL, 0.1 μg/mL, 1 μg/mL, 10 μg/mL TLR5 antibody. Te chosen cell line was transfected by TLR5 shRNA plasmid, and p-IKBα, IKBα, p-ERK1/2, ERK1/2 and p-JNK of untrasfected and transfected cells were detected in the activ-ity of TLR5 signaling pathway by Western blot at 0 min, 10 min, 30 min and 60 min, respectively. Results Te expression of TLR5 was the highest in the lung adenocarcinoma cell line SPC-A-1 by immunofiuorescence, mainly expressed on the cell membrane. NF-κB luciferase activity of SPC-A-1 cells was the highest, and the activity was increased in a dose-dependent man-ner. 0.1 μg/mL fiagellin could significantly increase the NF-κB luciferase activity (P<0.05), while its activity could be inhibited by the TLR5 antibody in a negative correlation. Treated by 0.1 μg/mL fiagellin, compared with that of 0 min group, the levels of p-IKBα, p-ERK1/2, p-JNK of SPC-A-1 cells increased significantly afer 10 min, reached the peak at 30 min, and declined at 60 min (P<0.05). Compared with that of 10 min and 60 min group, the levels of p-IKBα, p-ERK1/2, p-JNK significantly increased at 30 min (P<0.05). While the levels of IKBα, ERK1/2 at 0 min, 10 min, 30 min and 60 min had no significant changes (P>0.05). SPC-A-1 cells transfected TLR5-shRNA were also stimulated by fiagellin (0.1 μg/mL). At 0 min, 10 min, 30 min and 60 min, p-IKBα and p-JNK proteins could not be detected, and the levels of IKBα and ERK1/2 had no significant changes (P>0.05), but the levels of p-ERK1/2 significantly increased as time went on (P<0.05). Conclusion Exogenous ligand fiagellin can ac-tivate TLR5 protein in NSCLC cell lines and initiate downstream signaling pathways. It may be relative to the development of NSCLC.

Objective:To explore the association of human betaine-homocysteine methyltransferase ( BHMT) and BHMT2 gene polymorphisms with non-syndromic congenital heart disease (CHD). Methods:A hospital-based case-control study was conducted, in which children with CHD who attended Hunan Children′s Hospital from January 2018 to May 2019 were enrolled as the case group, and children without any congenital deformity who attended the hospital during the same period were enrolled as the control group on a 1∶1 basis. A self-administered questionnaire survey was performed to collect information about the study subjects and their mothers, and then venous blood samples were collected from the subjects to detect BHMT and BHMT2 gene polymorphisms. Logistic regression analyses were used to evaluate the association of BHMT and BHMT2 gene polymorphisms and their haplotypes with CHD. Crossover analyses and logistic regression were used to explore the gene-gene and gene-environment interactions. Results:The case and control group both enrolled 620 children. The multivariate logistic regression showed that BHMT gene polymorphisms at rs3733890 (AA vs. GG: OR=3.476, Q FDR<0.001; GA vs. GG: OR=1.525, Q FDR=0.036), at rs1915706 (CC vs. TT: OR=3.464, Q FDR<0.001) and at rs1316753 (GG vs. CC: OR=1.875, Q FDR=0.020) increased the risk of CHD. Children with haplotype of A-G-A had an increased risk of CHD ( OR=1.468, 95% CI: 1.222-1.762). Interaction analysis showed that a statistically significant positive interaction between rs3733890 and rs1915706 on both additive ( RERI=0.628, 95% CI: 0.298-0.958) and multiplicative ( OR=3.754, 95% CI: 1.875-7.519) scales. Gene-environment interactions were found between the BHMT gene with secondhand smoke exposure before pregnancy and in early pregnancy, tea consumption before pregnancy and in early pregnancy, alcohol consumption before pregnancy, and folic acid supplementation before or during pregnancy. Conclusion:BHMT gene rs3733890, rs1915706 and rs1316753 polymorphisms may be associated with the risk of CHD. In addition, there is an association of cooperative interaction between rs3733890 and rs1915706 on both additive and multiplicative scales with the risk of CHD, and the BHMT gene interacts with multiple environmental factors.

Objective:To explore the association of human betaine-homocysteine methyltransferase ( BHMT) and BHMT2 gene polymorphisms with non-syndromic congenital heart disease (CHD). Methods:A hospital-based case-control study was conducted, in which children with CHD who attended Hunan Children′s Hospital from January 2018 to May 2019 were enrolled as the case group, and children without any congenital deformity who attended the hospital during the same period were enrolled as the control group on a 1∶1 basis. A self-administered questionnaire survey was performed to collect information about the study subjects and their mothers, and then venous blood samples were collected from the subjects to detect BHMT and BHMT2 gene polymorphisms. Logistic regression analyses were used to evaluate the association of BHMT and BHMT2 gene polymorphisms and their haplotypes with CHD. Crossover analyses and logistic regression were used to explore the gene-gene and gene-environment interactions. Results:The case and control group both enrolled 620 children. The multivariate logistic regression showed that BHMT gene polymorphisms at rs3733890 (AA vs. GG: OR=3.476, Q FDR<0.001; GA vs. GG: OR=1.525, Q FDR=0.036), at rs1915706 (CC vs. TT: OR=3.464, Q FDR<0.001) and at rs1316753 (GG vs. CC: OR=1.875, Q FDR=0.020) increased the risk of CHD. Children with haplotype of A-G-A had an increased risk of CHD ( OR=1.468, 95% CI: 1.222-1.762). Interaction analysis showed that a statistically significant positive interaction between rs3733890 and rs1915706 on both additive ( RERI=0.628, 95% CI: 0.298-0.958) and multiplicative ( OR=3.754, 95% CI: 1.875-7.519) scales. Gene-environment interactions were found between the BHMT gene with secondhand smoke exposure before pregnancy and in early pregnancy, tea consumption before pregnancy and in early pregnancy, alcohol consumption before pregnancy, and folic acid supplementation before or during pregnancy. Conclusion:BHMT gene rs3733890, rs1915706 and rs1316753 polymorphisms may be associated with the risk of CHD. In addition, there is an association of cooperative interaction between rs3733890 and rs1915706 on both additive and multiplicative scales with the risk of CHD, and the BHMT gene interacts with multiple environmental factors.

[Objective] To evaluate the effects of preoperative ureteroscopy (URS) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). [Methods] Data of 712 UTUC patients who received RNU in West China Hospital during May 2003 and Jun.2019 were retrospectively analyzed. Patients were divided into URS group (n=187) and non-URS group (n=525) according to whether URS was performed before RNU. Kaplan-Meier curves were used to analyze the overall survival (OS), cancer-specific survival (CSS), and intravesical recurrence-free survival (IVRFS). Cox proportional risk model was used for risk assessment. Subgroup analysis and interaction test were used to further verify the results. [Results] Significant differences were observed between the two groups in terms of body mass index (BMI), diabetes mellitus, surgical method, hydronephrosis, tumor location, tumor grade, lymph node metastasis, lymphovascular invasion and tumor diameter (P<0.05). Kaplan-Meier survival analysis showed that IVRFS was significantly lower in the URS group than in the non-URS group (P<0.001), and the difference was more pronounced in renal pelvis carcinoma (P<0.001); there were no differences in OS and CSS between the two groups (P>0.05). Cox multivariate regression showed that URS was an independent risk factor for intravesical recurrence (HR=2.12, 95%CI: 1.34-3.36, P<0.001). [Conclusion] Preoperative URS can increase the recurrence rate of UTUC, but it has no effect on the OS and CSS.