Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.

OBJECTIVE: To explore the indications and the effective treatment methods of laryngeal function preserva tion in aged patients with hypopharyngeal carcinoma. METHOD: Clinical data about 41 patients with hypopharygeal carcinoma were analysed. These patients were more than or equal to 60 and were treated from January 2006 to December 2011. Among them, 25 cases were treated with laryngeal functions preserved and the hypopharynx defect was immediately re paired by the adjacent tissue flap or (and) the pactoralis major myocutaneous flap according to the size of defect after tumor resecting. The survival rate was calculated by Kaplan-Meier method. RESULT: In 25 patients with laryngeal function preservation, 16 cases were 60-69 years old, 6 cases were 70-79 years old and 3 cases were 80-88 years old. The tumour located at lateral wall of pyriform sinus in 14 cases, at anterior wall of pyriform sinus in 3 cases, at inside wall of pyriform sinus in 3 cases, at upper side wall of hypopharynx invading tonsil or tongue base in 3 cases, at posterior hypopharyngeal wall in 2 cases. The average length of post-operation stay was 22.2 days. Eight cases suffered from post-operative complications (32%), including of pharyngeal fistula in six cases and pulmonary infection in two cases. The respiratory function and pronunciation were all restored, in 25 cases, among which 20 cases removed tracheostomy tube about 3 months after surgery. 2 cases were missed after 1-year followed up. 2 cases died of local tumor recurrence. 4 cases died of neck recurrence. 8 cases died of pulmonary matastasis. The 1-year and 3-year survival rate of the disease in the group was 67.5% and 43.9% respectively. CONCLUSION As the aged cases of hypopharygeal carcinoma are choosed appropriately and repaired feasibly, surgery for the disease with laryngeal function retention may be safe and effective.
Aged ; Aged, 80 and over ; Female ; Humans ; Hypopharyngeal Neoplasms ; physiopathology ; surgery ; Larynx ; physiology ; surgery ; Male ; Middle Aged ; Organ Sparing Treatments ; methods

Objective We aimed to explore the therapeutic mechanism of electroacupuncture at Yintang(EX-HN3),Neiguan(PC6)and Zusanli(ST36)on the Hypothalamic-Pituitary-Adrenal axis(HPA)of functional dyspepsia(FD)rats.Methods Forty SD rats were randomly divided into blank group,model group and EA group.The FD model was replicated by tail clamping,irregular diet,and filling the stomach with ice of Saline Solution.After modeling,the EA group received acupuncture treatment for 1 time day,30 minutes time,for 14 days.Recording the general state of the rat.Detection of locomotion and catatonia in rats by open field test.HE staining to observe the morphology and inflammation of gastric mucosa in rats.PCR detection of mRNA expression of 5-hydroxytryptamine3 receptor and corticotropin-releasing hormone in rat hypothalamus.Detection of corticotropin-releasing hormone receptor-2 and NOD-like receptor protein 6 inflammasome protein expression in rat duodenum by Western blotting.Alcian blue staining was used to detect the expression of rat duodenum goblet cells.Results Compared with the blank group,the general state,distance,speed,duodenum CRHR2 and NLRP6 proteins in the model group were significantly decreased(P<0.05),the hypothalamic 5-HT3R and CRH mRNA were significantly increased(P<0.05).Compared with the model group,the general state,distance,speed,expression of CRHR2,NLRP6 protein and goblet cells in the duodenum of rats in the EA group were significantly increased(P<0.05),the 5-HT3R and CRH mRNA in the hypothalamus were significantly decreased(P<0.05).In the model group,the connective tissue of the gastric mucosa was loosely arranged,the submucosa had mild edema,and there were some lymphocytes.The connective tissue of the gastric mucosa of the rats in the blank group and the electroacupuncture group was closely arranged,and there was no obvious proliferation of interstitial cells and no inflammatory cells.Conclusion EA can increase the expression of CRHR2,NLRP6 protein and goblet cells in the duodenum,and inhibit the expression of 5-HT3R and CRH in the hypothalamus.EA can improve gastrointestinal motility and locomotion,relieve anxiety,repair the mucosal barrier of the defective intestine,and restore the function of the Hypothalamic-Pituitary-Adrenal axis.

Objective To explore the diagnostic value of serum neuronal Per-Arnt-Sim domain protein 4(NPASDP-4)and myelin basic protein(MBP)expression in patients with Parkinson's disease in relation to cognitive impairment(CI)and severity.Methods Selected and 138 Parkinson's disease patients admitted to the 909th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China as the Parkinson's disease group,and 69 healthy people in the physical examination center of the hospital were in the healthy control group.Patients with Parkinson's disease were divided into normal cognitive function group(n=55),mild CI group(n=51)and dementia group(n=32)according to whether CI occurred and its severity.General data of subjects was collected,the serum levels of NPASDP-4 and MBP were detected by ELISA,correlation analysis was adopted by Spearman rank correlation or Pearson linear correlation,diagnostic value was analyzed by ROC curve,and influencing factors were analyzed by multivariate Logistic regression.Results Compared with the healthy control group,the levels of serum NPASDP-4(6.75±0.48 ng/ml vs 2.38±0.31 ng/ml)and MBP(8.34±0.65 μg/L vs 3.54±0.42 μg/L)in the Parkinson's disease group were increased with statistical significance(r=68.751,55.761,all P＜0.05).There were significant differences in H-Y stage among the normal cognitive function group,mild CI group and dementia group(x2=7.788,P＜0.05).Compared with the group with normal cognitive function(47.92±11.63 score),the mild CI group(50.78±13.69 score)and the dementia group(41.95±10.36 score)showed an increase in UPDRS-Ⅲ scores,and the differences were statistically significant(H=6.672,all P＜0.05).In normal cognitive function group,mild CI group and dementia group,the course of disease,and serum NPASDP-4(5.89±0.40,6.83±0.55,8.12±0.54 ng/ml)and MBP(6.65±0.56,8.94±0.69,10.27±0.70μg/L)levels were significantly increased(H=207.950,355.594,allP＜0.05),while MMSE score(28.47±0.94,24.51±1.35,17.09±2.57 score),MoCA score(27.45±1.03,20.18±1.92,11.75±2.53 score)and GPCOG total score(13.47±0.69,10.25±1.04,8.97±0.82 score)were significantly decreased,and the differences were statistically significant(H=515.005,775.933,327.584,all P＜0.05),respectively.The serum levels of NPASDP-4 and MBP in Parkinson's disease patients were significantly positively correlated with the course of disease(r=0.316,0.358),H-Y stage(r=0.345,0.384)and UPDRS-Ⅲ score(r=0.371,0.396),and significantly negatively correlated with MMSE score(r=-0.468,-0.517),MoCA score(r=-0.504,-0.569)and GPCOG total score(r=-0.527,-0.538)(all P＜0.05),respectivey.The areas under the curve(AUC)of the serum levels of NPASDP-4,MBP and their combination in diagnosing of Parkinson's disease were 0.850,0.930 and 0.960,respectively.The AUC of the serum levels of NPASDP-4 and MBP and their combination in diagnosing the severity of CI in patients with Parkinson's disease were 0.866,0.803 and 0.933,respectively.H-Y stage metaphase[OR(95％CI):4.725(1.742～12.814)],H-Y stage advanced[OR(95％CI):5.083(1.919～13.464)],UPDRS-Ⅲ score[OR(95％CI):3.257(1.464～7.246)],NPASDP-4[OR(95％CI):5.324(1.516～18.701)]and MBP[OR(95％CI):5.769(2.459～13.533)]were the influential factors for CI in patients with Parkinson's disease(all P＜0.05).NPASDP-4[OR(95％CI):4.768(2.382～9.543)]and MBP[OR(95％CI);5.846(3.141～10.882)]were the influential factors for the severity of CI in patients with Parkinson's disease(all P＜0.05).Conclusion The serum levels of NPASDP-4 and MBP in patients with Parkinson's disease were high,and they were closely related to CI and its severity,which may have certain clinical diagnostic value.

Objective:To analyze the risk factors for postoperative pathological upgrade of prostate cancer patients with single core positive biopsy,and to attempt to build a mathematical model for predic-ting postoperative pathological upgrade in these cancer patients with single core positive biopsy.Methods:A retrospective analysis was conducted on 1 349 patients diagnosed with prostate cancer and undergoing radical prostatectomy at Peking University First Hospital from January 2015 to August 2020.The pa-tients'age,body mass index,clinical stage,prostate imaging reporting and data system(PI-RADS)scores,prostate volume in magnetic resonance imaging(MRI),Gleason score of biopsy,serum prostate specific antigen(PSA)before biopsy and operation,surgical method and pathological stage were inclu-ded in the analysis.The variables with P＜0.1 in univariate analysis were included to construct multi-variate Logistic regression and the nomogram was drawn.The model was evaluated using the receiver operating curve.Results:A total of 71 patients were included in this research,with 34 patients in the upgraded group and 37 patients in the non-upgraded group.There were no significant differences in the pa-tients'age(P=0.585),body mass index(P=0.165),operation method(P=0.08),prostate volume in MRI(P=0.067),clinical stage(P=0.678),PI-RADS score(P=0.203),difference of PSA density(P=0.063),Gleason score in biopsy(P=0.068),PSA before puncture(P=0.359)and operation(P=0.739)between the two groups.However,there were significant differences in the proportion of tumor tissue(P=0.007),postoperative pathological stage(P＜0.001)and postoperative Gleason score(P＜0.001)between the two groups.The preoperative variables with a P value of less than 0.1(prostate volume in MRI,difference of PSA density,proportion of tumor tissue and Gleason score in biopsy)in univariate analysis were included in the Logistic regression,and the nomogram was drawn.Only the prostate volume in MRI had a P value of less than 0.05.The area under the curve of the model was 0.773.Conclusion:In patients with sin-gle core positive biopsy,if the prostate volume is small or the proportion of tumor in positive core is small,clinicians should be alert to the possibility of postoperative pathology upgrading,preoperative risk stratifica-tion should be carefully considered for patients with possible pathological upgrading.This model can be used to predict the pathological upgrade of patients with single core positive biopsy.