Objective To study the clinical and electrophysiological features of the patients with hereditary neuropathy with liability to pressure palsy ( HNPP) diagnosed by gene analysis.Methods Seven patients from two HNPP families were assessed on medical history, physical examination, electrophysiology findings and gene analysis.Results A clinical manifestation of acute, painless, recurrent peripheral nerve palsies was typical for HNPP.Median, ulnar and peroneal nerves were usually affected.Electrophysiology study revealed that prolonged distal motor latency and slowing nerve conduction velocity were prominent.Gene studies exhibited a deletion of the peripheral myelination protein 22 gene in all the seven patients.Conclusions HNPP usually affects areas where nerves are subject to entrapment, and many episodes are preceded by minor compression on the affected nerve.As a reliable screening tool in detecting HNPP, the electrophysiological study shows that segmental demyelination is most commonly seen at common nerve entrapment sites.

Objective To compare the accuracy of placement of ventricular shunt tube,the efficacy and complications of the neuronavigation-assisted ventriculoperitoneal shunt (group A) and traditional ventriculoperitoneal shunt (group B).Methods A retrospective study was made on 40 cases of hydrocephalus managed with neuronavigation-assisted ventriculoperitoneal shunt or ventriculoperitoneal shunt from January 2012 to June 2016.There were 18 cases [12 males,6 females;(47.5 ±8.5) years of age] in group A and 22 cases [14 males,8 females;(44.5 ± 7.5) years of age] in group B.Therapeutic effect and complications were analyzed postoperatively.The accuracy rate in ventricular end shunt placement that was free from the frontal horn of lateral ventricle and flush the Moro hole had also been studied.Results The position of ventricular shunt of all the patients were postoperative timely review of the CT view,and hospital outpatient follow-up periodical for 3-24 months after discharge from hospital.Patients with postoperative timely review of head CT and found that group A of ventricular end of the shunt tube position reach a set position in 16 cases,2 cases had not reached the set position,the accuracy rate was 88.89％.There were 8 cases in group B reach to the set position and 14 cases did not and the accuracy rate was 36.36％.After the statistical analysis there were significant differences (P ＜ 0.05).The total efficiency of A and B groups (excellent + effective) were 94.4％ and 86.4％ (P ＞ 0.05).Postoperative complications included bleeding,infection,obstruction of the shunt,excessive shunt,shunt insufficiency and so on.During follow-up,group A appeared excessive shunt in 1 case;group B incision infection in 1 case,4 cases of shunt obstruction,excessive shunt in 1 case,2 cases of deficiency of shunt.Two groups of patients were recovery well through the drainage tube pressure adjustment or set it once again.The incidence of complications in group A was 5.56％,group B was 36.36％.There was no significant difference between group A and group B (P ＞ 0.05).In group A,there was no obstruction of shunt tube,ventricular end of the shunt tube blockage occurred in 4 cases in group B,the incidence rate was 18.18％ (P ＞ 0.05).Conclusion Neuronavigation guided ventriculoperitoneal shunt placement to the accuracy of position setting has significant advantages over traditional ventriculoperitoneal shunt in the ventricular end of the shunt tube and it has some advantages in reducing postoperative complications.

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route.

Objective To explore the association between body mass index(BMI)/waist circumference (WC)and blood triglyceride(TG)level in adults. To evaluate the value of the BMI and WC in diagnosing the hypertriglyceridemia by the receiver operating characteristic(ROC)curve.Methods A total of 1 093 adults(707men and 356 women)were examined in our hospital from July to September in 2008.Height,weight,WC and blood triglyceride were measured and analyzed.The ROC curve was drawn to evaluate the sensitivity and specificity of the threshold values.Results The hypertriglyceridemia rate was 33.5%among men and 8.3%among women.The BMI and WC of hypertriglyceridemia group were significantly higher than those of normal TG group for both men and women(P<0.01).The area under ROC curve was 0.728±0.041 for men and 0.708±0.021 for women when using BMI to predict hypertriglyceridemia.The optimal threshold value was 24.5 for men and 22.5 for women.The area under ROC curve was 0.790±0.042 for men and 0.714±0.020 for women when using WC to predict hypertriglyceridemia.The optimal threshold value was 86 cm for men and 77 cm for women.Conclusions Both BMI and WC are associated blood triglyceride level. WC and BMI are useful parameters in predicting hypertriglyceridemia.

Objective To understand the current situation of adversity quotient (AQ) of senior nursing students,then to provide reference for nursing educators to conduct AQ education and improve the comprehensive quality of nursing students.Methods 474 senior nursing students in Fuzhou were investigated with the Lusi Scale.Results AQ of senior nursing students was (67.84±5.62),the five dimensions were between 50 and 89.Gender,education qualifications,grades and academic performance had a significant impact on AQ of nursing students,among which gender and grade had certain prediction effect for nursing students' AQ.Conclusions AQ level needs of senior nursing students need to be further improved; Nursing educators should take targeted interventions and personalized measures to enhance the ability of anti-frustration,lay the foundation for better adaptation of clinical care.

Objective:To investigate the typing and clinical value of posterior group renal calyces.Methods:From April 2020 to June 2021, 640 patients (320 men and 320 women) who underwent CTU examination in our hospital with kidneys on both sides and normal or only mild hydronephrosis in the collecting system were analyzed. A total of 1 280 renal CTU three-dimensional reconstructed images were counted.The patients aged 52.4±11.9 years. The patients' CTU images were reconstructed in three dimensions using the spine as a marker to rotate the collecting system images in stereoscopic space to simulate a prone position. A two-person review was taken to observe the imaging morphology of the renal calyces in the prone position, and the 640 renal calyces in the posterior group of the left and right sides were counted for staging. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group of renal calyces was divided into 3 major types. Pot-belly type: the renal pelvis is shaped like a pot-belly, and the renal pelvis is directly connected to the cup-shaped minor calyces without a distinct major renal calyces. Classically branched: 2 or more major renal calyces are branched and converge to form the renal pelvis. Elongated branched: the major calyces are branched, with at least one major calyces having an axis length ≥0.9cm and a neck width ≤0.3cm.The classic branching type is divided into three types, a, b, and c, including seven subtypes, based on the relationship of the posterior group of the minor calyces to the major calyces. Type a is derived from group 1 major calyces only, type b is derived from group 2 major calyces at the same time, and type c is derived from the upper, middle and lower groups of major calyces at the same time. Type a contains 3 subtypes.Type a1 is derived from the upper group of major calyces only, type a2 is derived from the middle group of major calyces only, and type a3 is derived from the lower group of major calyces only. Type b is also divided into 3 subtypes. Type b1 is derived from the upper and middle groups of major calyces at the same time, type b2 is derived from the middle and lower groups of major calyces at the same time, and type b3 for the upper and lower renal major calyces. Type c had no corresponding subtype.Results:Statistical findings revealed that all kidneys had posterior group calyces. The morphological typing of the posterior group of calyces was 8.83% (113/1 280) for the pot-bellied type, which had the highest occurrence of 2 minor calyces (5.63%, 72/1 280). 71.25% (912/1 280) had the classically branched type, which had the highest occurrence of 3 minor calyces (31.17%, 399/1 280). 19.92% (255/1 280) had the elongated branched type, with the highest percentage of 3 occurring in the calyces (9.92%, 127/1 280). The anatomical typing of the classical branching type occurred in 20.50% (187/912) for type a, 66.45% (606/912) for type b, and 13.05% (119 /912) for type c. The percentage of occurrence of type a1/a2/a3 was 4.06% (37/ 912), 6.14% (56/ 912), and 10.31% (94/912). b1/b2/b3 types occurred in 2.03% (21/912), 7.46% (68/912), and 56.69% (517/912), respectively.Conclusions:The posterior group of calyces is structurally complex and extremely variable. In this study, the posterior group calyces were found to be present in all patients, and the posterior group calyces were morphologically divided into 3 types, with the highest percentage of occurrence of the classical branching type and the highest percentage of 3 posterior group minor calyces. The classical branching anatomical typing was highest in type b with the highest percentage of type b3, which combined with stone distribution, made it easy to choose the puncture location. The typing of the posterior group of calyces can provide an anatomical basis for PCNL puncture from the posterior group.

Objective:To Investigate the postoperative sexual function outcomes in patients with bladder cancer who underwent robot-assisted radical cystectomy (RARC)or laparoscopic radical cystectomy(LRC)followed by orthotopic neobladder reconstruction.Methods:We performed a retrospective review of 84 bladder cancer patients having undergone laparoscopic radical cystectomy(LRC)and robotic-assisted radical cystectomy(RARC)with≥21 IIEF-5 in our institution from Jan 2014 to Jan 2019. All of them were diagnosed as high grade urothelial carcinoma by biopsy or TURBT. Biopsy of the posterior urethra and bladder neck reveal negative result of tumor invasion. Their PSA level was less than 4.0 ng/ml with negative result of DRE. All patients undergone laparoscopic radical cystectomy and orthotopic neobladder reconstruction by one medical team. 45 patients underwent robotic assistant radical cystectomy(RARC group), and the rest of patients 39 were treated with laparoscopic radical cystectomy(LRC group). In RARC group, the mean age were 53 years old(ranging 50-67 years old)and clinical stage of the tumor was cT 1 in 10 patients, cT 2 in 21 patients and cT 3 in 14 patients. In the LRC group, the mean age were 56 years old(ranging52-65 years old) and the clinical staging of the tumors was 6 patients in cT 1, 23 patients in the cT 2 and 12 patients in the cT 3. The RARC group paid special attention to the protective function of the following surgical details: ①To detect the abdominal organs, reveal the pelvic cavity, observe the blood vessels and ureter, open the perinatal membrane next to the cross of the ureter, along the outer venous veins and closed-hole nerves around the standard or expand the pelvic lymph node cleaning. In this study, the patients who did not have obvious suspected lymph node metastasis were removed within the standard range of the pelvic lymph nodes on both sidesin order to protect the nerves at the pelvic floor as much as possible. ② With the robot 3rd arm lifting the bladder, the peritoneum was opened at the site of seminal vesicle and ampulla of vas deferent duct, which connected to the two sides with the open peritoneum. Along the vasectomy and the sac free, the denonvillier fasica was opened and exposing the back of the prostate. With the third arm pulling down, the umbilical ligament was observe. The peritoneal was opened to the retropubic space so that the prostate region was revealed. Continue to dissect the bladder front space until the pelvic fascia and the osteopathic prostate ligament are exposed. The Hem-o-1oks were used to ligate the bilateral bladder lateral ligaments. The bladder and prostate were removed in the fascia level. The NVB bundle on both sides was kept to the apex of prostate. The urethra was exposed and remove the catheter.With Hem-o-lok clamping, the urethra was dissected in the level of prostatic apex. The distal end of urethral tissue was sent to the rapid freeze pathology examination. In the procedure of prostate removing, parallel prostate fascia excision was considered and pubo-prostatic ligament could be preserved.③ Preserving the bilateral neurovascular bundle (NVB) and try to avoid the damage of NVB. Retaining the bladder lateral ligament neurovascular bundle. Retaining the1.2-1.5 cm urethra and surrounding continent control structure. The cold knife is advocated. Blood vessel clamp can be used to stop bleeding. We compared with operative time, bleeding amount, postoperative hospitalization, IIEF-5 scores and satisfaction of sexual between those groups. Results:All operations were successfully performed without conversion and serious surgical complications. The operative time in the RARC group and LRC group were [(313.5±31.9)min and (276.5±32.3)min, P>0.05] .The intraoperative amount of blood loss and postoperative hospitalization were [(190.1±44.1) ml and (212.3±39.2) ml, P>0.05], [(14.3±2.1) d and (15.2±3.0) d, P>0.05]. There was no significantly difference between the two groups. The median follow-up period of 84 patients was 18 months. The IIEF-5 score of the RARC group was higher than LRC group at 6 months(18.5±1.6 vs.10.6±1.3)and 12 months (18.6±2.4 vs.11.2±1.4) ( P<0.05). In addition, the satisfaction of sexual in the RARC group was relative better than LRC group (both P<0.05) at 6 months[44.4%(20/45)vs.25.6%(10/39)], and 12 months[51.1%(23/45) vs.28.2%(11/39)] post-operation. Conclusion:Robot-assisted radical cystectomy(RARC) and orthotopic neobladder reconstruction revealed relative better recovering in post-operative sexual function and improvements in patient quality of life.

Objective:To compare the injury of renal blood vessels using different puncture pathways and access sizes.Methods:Between April 2018 and June 2019, eighty fresh pig kidneys were selected to perform percutaneous puncture and dilation, which was used to compare the injury of renal blood vessels with different puncture pathways and access sizes. The puncture pathway included the centerline of the normal renal pyramid (A), centreline of one side pyramid of the fused renal pyramid (FRP) (B), midline of the entire FRP (C) and midline of the renal column (D). The access size included F8, F12, F16, F20, F24 and F30. Histopathological methods were used to analyze the injury of renal blood vessels.Results:The puncture through paths A and B mainly caused injury to the grade Ⅴ and Ⅵ arteries in renal cortex. The puncture often directly injures the grade Ⅳ artery in path C. The puncture often simultaneously injures the grade Ⅲ-Ⅵ arteries in path D. Grade Ⅲ artery injury began to occur when paths A, B, C, and D were dilated to F30, F24, F16, and F12, respectively. The degree of arterial injury among the four different puncture pathways was significantly different in F8, F12, F16, F20, F24 and F30 ( P<0.05). Statistical differences were found between paths A and D in F12, F16, F20, F24 and F30 ( P<0.05), and between paths A and C in F16, F20 and F24 ( P<0.05). No significant difference was found between paths A and B in all access sizes ( P>0.05). Compared with F8, the degree of arterial injury of the F30 in path A and the F24 and F30 in path B were increased significantly ( P<0.05). Conclusions:Vascular injury in path D was the most serious followed by that in path C. Relatively little vascular injury can be achieved in paths A and B. The vascular injury increased when the path B was dilated to F24, while the path A needed to be dilated to F30.

Objective: To clinically validate the feasibility and accuracy of cine images acquired through the multitasking method, with no electrocardiogram gating and free-breathing, in measuring left ventricular (LV) function indices by comparing them with those acquired through the balanced steady-state free precession (bSSFP) method, with multiple breath-holds and electrocardiogram gating. Materials and Methods: Forty-three healthy volunteers (female:male, 30:13; mean age, 23.1 ± 2.3 years) and 36 patients requiring an assessment of LV function for various clinical indications (female:male, 22:14; 57.8 ± 11.3 years) were enrolled in this prospective study. Each participant underwent cardiac magnetic resonance imaging (MRI) using the multiple breath-hold bSSFP method and free-breathing multitasking method. LV function parameters were measured for both MRI methods. Image quality was assessed through subjective image quality scores (1 to 5) and calculation of the contrast-to-noise ratio (CNR) between the myocardium and blood pool. Differences between the two MRI methods were analyzed using the Bland–Altman plot, paired t-test, or Wilcoxon signed-rank test, as appropriate. Results: LV ejection fraction (LVEF) was not significantly different between the two MRI methods (P = 0.222 in healthy volunteers and P = 0.343 in patients). LV end-diastolic mass was slightly overestimated with multitasking in both healthy volunteers (multitasking vs. bSSFP, 60.5 ± 10.7 g vs. 58.0 ± 10.4 g, respectively; P < 0.001) and patients (69.4 ± 18.1 g vs. 66.8 ± 18.0 g, respectively; P = 0.003). Acceptable and comparable image quality was achieved for both MRI methods (multitasking vs. bSSFP, 4.5 ± 0.7 vs. 4.6 ± 0.6, respectively; P = 0.203). The CNR between the myocardium and blood pool showed no significant differences between the two MRI methods (18.89 ± 6.65 vs. 18.19 ± 5.83, respectively; P = 0.480). Conclusion Multitasking-derived cine images obtained without electrocardiogram gating and breath-holding achieved similar image quality and accurate quantification of LVEF in healthy volunteers and patients.

IgG4-related disease (IgG4-RD) involving the ureter manifested as a ureteral tumor is rare. This paper reports a case of a female patient who was found with a mass at the left ureteropelvic junction for one week during physical examination. Urinary ultrasound and MRI showed a 3 cm mass at the left ureteropelvic junction with hydronephrosis, and the serum level of IgG4 was elevated. B-ultrasonic guided biopsy of the mass was performed. Histopathological findings showed lymphoplasmic infiltration and the ratio of IgG4/IgG positive cells>0.5. We finally diagnosed IgG4-RD and started using glucocorticoid for her treatment. One month later, CT-scan revealed that the tumor became smaller and the serum IgG4 decreased to the normal range.