Objective:To investigate the clinical efficacy of programmed Retzius-sparing robot-assisted radical prostatectomy and " Sandwich" technique of total urethral reconstruction.Methods:The clinical data of 120 consecutive patients who underwent programmed Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by the same operator at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2023 to August 2024 were retrospectively analyzed to explore the efficacy and summarize the experience. Baseline characteristics included: mean age (67.2±7.5) years, BMI (25.3±3.1)kg/m 2, prostate volume (32.3±15.8) ml, and PSA (16.6±19.7) ng/ml (57 cases 4-10 ng/ml; 41 >10-20 ng/ml; 22 >20 ng/ml). 28 patients underwent radical prostatectomy without prostate biopsy, while 92 had biopsy-proven cancer (Gleason: 6/7/8/9/10: 18/35/17/17/5). Clinical stages were cT 1(8), cT 2(73), cT 3(39). The surgical method was programmed Retzius-sparing robot-assisted radical prostatectomy and " Sandwich" technique of total urethral reconstruction. The peritoneum was incised slightly above the Douglas pouch and denonvilliers' fascia was dissected closely along the dorsal aspect of prostate, extending to the prostatic apex. Both vas deferens were transected, and the seminal vesicles were isolated. A combination of blunt and sharp dissection was employed to expose the prostatic fascia. The bladder neck was precisely visualized and transected. The urethra was precisely dissected, exposed and divided. Complete urethral reconstruction was performed using the "Sandwich" technique of total urethral reconstruction. The operation time, intraoperative bleeding, catheter preservation time, pathological staging and positive margin rate, and recovery of urinary control immediately after postoperative catheter removal were recorded. Results:In this study, all 120 surgeries were successfully completed, with no cases converted to anterior approach radical surgery or open surgery, and no serious intraoperative complications such as post-shamus hemorrhage or ureteric/rectal injury. The median postoperative follow-up was 16.0(10.0, 20.0)months, and there were no cases of readmission for surgical complications. The average duration of surgery was (93.6±35.9) min, and the average bleeding volume was (85.3±32.1) ml. The mean duration of catheter after surgery was (7.3±1.2)d. Immediate urinary control was achieved in 98 cases when the catheter was removed, and the rate of immediate urinary control was 81.7%. Postoperative urinary control rate was 88.3% at 1 month after surgery, 94.2% at 3 month after surgery, 98.3% at 6 month after surgery. There were 70 cases with pT 2 and 50 cases with pT 3 after postoperative pathological stage. There were 18 cases (15.0%) with positive margins, including 6 cases (8.6%) with positive margins in T 2 and 12 cases (24.0%) with positive margins in T 3 stage. There were no serious complications after surgery, and urinary retention occurred in 3 cases after urinary catheter removal, and the urinary catheter was removed after 1 week. 93.3% (112/120), 90.8% (109/120), and 89.2% (107/120) of patients with PSA < 0.2 ng/ml at 1, 3, and 6 months after surgery, respectively. For postoperative erectile function, we selected patients younger than 60 years of age, who had surgery to preserve unilateral or bilateral vascular nerve bundles, and who were followed for more than 6 months. A total of 18 patients met the above conditions and were followed up for erectile function, among which 4 of the 11 patients (36.4%) who retained unilateral vascular nerve bundles regained erectile function. Among the 7 patients with bilateral vascular nerve bundle preservation, 3 patients (42.9%) regained erectile function. Conclusions:The programmed RS-RARP combined with the " Sandwich" urethral reconstruction technique is technically feasible for patients with localized prostate cancer. Recent follow-up data indicate satisfactory postoperative urinary continence and oncological control outcomes.

Objective:To investigate the clinical efficacy of programmed Retzius-sparing robot-assisted radical prostatectomy and " Sandwich" technique of total urethral reconstruction.Methods:The clinical data of 120 consecutive patients who underwent programmed Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by the same operator at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2023 to August 2024 were retrospectively analyzed to explore the efficacy and summarize the experience. Baseline characteristics included: mean age (67.2±7.5) years, BMI (25.3±3.1)kg/m 2, prostate volume (32.3±15.8) ml, and PSA (16.6±19.7) ng/ml (57 cases 4-10 ng/ml; 41 >10-20 ng/ml; 22 >20 ng/ml). 28 patients underwent radical prostatectomy without prostate biopsy, while 92 had biopsy-proven cancer (Gleason: 6/7/8/9/10: 18/35/17/17/5). Clinical stages were cT 1(8), cT 2(73), cT 3(39). The surgical method was programmed Retzius-sparing robot-assisted radical prostatectomy and " Sandwich" technique of total urethral reconstruction. The peritoneum was incised slightly above the Douglas pouch and denonvilliers' fascia was dissected closely along the dorsal aspect of prostate, extending to the prostatic apex. Both vas deferens were transected, and the seminal vesicles were isolated. A combination of blunt and sharp dissection was employed to expose the prostatic fascia. The bladder neck was precisely visualized and transected. The urethra was precisely dissected, exposed and divided. Complete urethral reconstruction was performed using the "Sandwich" technique of total urethral reconstruction. The operation time, intraoperative bleeding, catheter preservation time, pathological staging and positive margin rate, and recovery of urinary control immediately after postoperative catheter removal were recorded. Results:In this study, all 120 surgeries were successfully completed, with no cases converted to anterior approach radical surgery or open surgery, and no serious intraoperative complications such as post-shamus hemorrhage or ureteric/rectal injury. The median postoperative follow-up was 16.0(10.0, 20.0)months, and there were no cases of readmission for surgical complications. The average duration of surgery was (93.6±35.9) min, and the average bleeding volume was (85.3±32.1) ml. The mean duration of catheter after surgery was (7.3±1.2)d. Immediate urinary control was achieved in 98 cases when the catheter was removed, and the rate of immediate urinary control was 81.7%. Postoperative urinary control rate was 88.3% at 1 month after surgery, 94.2% at 3 month after surgery, 98.3% at 6 month after surgery. There were 70 cases with pT 2 and 50 cases with pT 3 after postoperative pathological stage. There were 18 cases (15.0%) with positive margins, including 6 cases (8.6%) with positive margins in T 2 and 12 cases (24.0%) with positive margins in T 3 stage. There were no serious complications after surgery, and urinary retention occurred in 3 cases after urinary catheter removal, and the urinary catheter was removed after 1 week. 93.3% (112/120), 90.8% (109/120), and 89.2% (107/120) of patients with PSA < 0.2 ng/ml at 1, 3, and 6 months after surgery, respectively. For postoperative erectile function, we selected patients younger than 60 years of age, who had surgery to preserve unilateral or bilateral vascular nerve bundles, and who were followed for more than 6 months. A total of 18 patients met the above conditions and were followed up for erectile function, among which 4 of the 11 patients (36.4%) who retained unilateral vascular nerve bundles regained erectile function. Among the 7 patients with bilateral vascular nerve bundle preservation, 3 patients (42.9%) regained erectile function. Conclusions:The programmed RS-RARP combined with the " Sandwich" urethral reconstruction technique is technically feasible for patients with localized prostate cancer. Recent follow-up data indicate satisfactory postoperative urinary continence and oncological control outcomes.

OBJECTIVE To establish the fingerprint of Huangqin decoction （HQD）， to separate the phase states and screen the active phase states of antidermatophytic activity so as to study the spectrum-effect relationship. METHODS HPLC method was adopted using baicalin as reference， the fingerprints of 10 batches of HQD were drawn and the similarity evaluation was carried out using the Similarity Evaluation System of Chromatographic Fingerprint of TCM （2012 edition） to determine the common peak； the phase states of HQD were separated and characterized by high-speed centrifugation and membrane dialysis. The minimum inhibitory concentrations （MIC） of HQD and its different phase states against Trichophyton mentagrophytes were determined simultaneously. Using the peak area of 37 common peaks as independent variable， MIC as dependent variable， Pearson correlation analysis was performed by using SPSS 21.0 software. RESULTS A total of 37 common peaks were obtained in HPLC fingerprints of 10 batches of HQD， with the similarity higher than 0.99. Ten components were identified， such as albiflorin， paeoniflorin， liquiritin apioside， baicalin， melaleuca glycoside A， wogonoside， baicalein， glycyrrhizic acid， wogonin and oroxylin A. HQD was split into 3 phase states， such as precipitation phase （HQD-P）， solution phase （HQD-S） and nano phase （HQD-N）. The morphology of HQD-P was irregular granular， and the average particle size was 4.670-91.522 μm. The morphology of HQD-S was uniform flakes， and no particle size was detected. HQD-N was spherical in shape and the particle size was （129.0±12.9） nm. MIC values of each phase state of HQD against T. mentagrophytes in different phase states were HQD-N （4.64 mg/mL） ＜HQD （5.85 mg/mL） ＜HQD-P （7.37 mg/mL） ＜HQD-S （12.89 mg/mL） at the same dosage. Pearson correlation analysis showed that the peak area of 25 of the 37 common peaks （including identified components） was significantly negatively correlated with MIC （absolute values of correlation coefficient＞0.95 and P＜0.05）. CONCLUSIONS The chemical composition of 10 batches of HQD is consistent； HQD-N is the active phase state of HQD. Ten components such as paeoniflorin， liquiritin apioside and baicalin may be the main active components of HQD. The antidermatophytic effect of HQD is closely related to its component content and physical phase state.

Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective:To investigate the clinical effect of free anterior tibial artery proximal periosteal perforator bone-skin flap for repairing phased thumb defect.Methods:Eight patients of phased defect of thumb were repaired from March, 2013 to January, 2019 utilizing proximal tibial artery periosteal perforator bone and skin flap. Of which, 2 cases suffered defects at interphalangeal joint of thumb, 3 in proximal phalanx, and 3 at thenar muscle and metacarpale. There were 4 cases with tendon defect, 6 cases with other finger injuries.The areas of soft tissue defect was 4.5 cm×2.5 cm to 7.2 cm×4.0 cm, and the length of metacarpale bone defect was 1.2 to 2.5 cm. The flap size ranged from 5.0 cm×3.0 cm to 7.5 cm×4.5 cm, and the bone flap size was 1.2 cm×1.0 cm×0.8 cm to 2.5 cm×1.0 cm×1.0 cm. Six cases received direct suture or local skin metastasis in anterior tibial region and 2 cases with skin grafting. All patients were followed-up by clinic visits, telephone or WeChat reviews, and home visits.Results:All the flaps survived after surgery. A 6 to 24 months followed-up showed that the flaps were normal in colour with good texture and moderate thickness. TPD of the flaps ranged from 7 to 10 mm. The donor site of the shank had good appearance and were in normal function, and the walking were not affected. Healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the Evaluation Criteria of Upper Limb Function of the Hand Surgery Society of Chinese Medical Association, the results were excellent in 7 thumbs and good in 1 thumb. According to Michigan Hand Function Evaluation Criteria, 8 thumbs scored 81.3 to 91.8 points, with an average of 83.6 points.Conclusion:The reconstruction of phased defect of thumb with proximal tibial artery periosteal perforator bone-skin flap can restore the appearance and function of thumb to the greatest extent, and the affect to donor site is minimum. It is an effective surgical method for repairing phased defect of thumb.

Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective: To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods: From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect. Results: Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.

Objective To evaluate the clinical effect of endovascular stent placement to the treatment of intracranial internal carotid artery dissection.Methods Two patients with intracranial internal carotid artery dissection received the treatment of stent placement,and 1 patient with a dissection of the supra clinoid internal carotid artery received conventional anticoagulation treatment.Results Two patients with intracranial internal carotid artery dissection were given treatment of Apollo stent placement,of which 1 patient had improvement of left limb paresis,the score of NIHSS from 3 before operation to 2 after operation; the other one with episodic left limb weakness was not seen any attack after stent placement.Another one patient without stent placement receiving conventional anticoagulation treatment had some improvement of right limb paralysis.Conclusion The treatment of endovascular stent placement to the intracranial internal carotid artery dissection has better clinical efficacy and especially used for those patients with no effect to the conventional anticoagulation treatment.

OBJECTIVE To evaluate the antibiotic susceptibility on coagulase negative staphylococci(CNS) in Xiangya Hospital and to investigate the role of slime in the resistance mechanism of biofilms.METHODS To isolate and identify CNS from clinical(specimens).The susceptibility of 15 antibiotics was tested by the disc diffusion method.The quantity of slime(produced) by CNS was measured by the colorimetric method.Slime was isolated from selected strains of CNS and analyzed by SDS-PAGE.The MICs to vancomycin,gentamicin and rifampin were determined with and(without) the addition of extracted slime by a standard microtiter method.RESULTS Of all these 15 antibiotics,the highest resistance to CNS was penicillin,followed by erythromycin and trimethoprim-sulfamethoxazole.CNS was more susceptible to ampicillin/sulbactam and rifampin.None was resistant to vancomycin.All of 158 CNS,except one strain,could produce slime.There was a statistical difference between the quantities of slime produced by CNS that produced high and low quantity slime.However,there was a non-statistical difference of resistance to these 15 antibiotics of above CNS. There was an increase in the MICs to vancomycin and gentamicin,but no in the MIC to rifampin,in the absence of 20mg/ml extracted slime.The extracted slime seemed to be similar to the glycosaminoglycans(GAG);it had mobility similar to that of chondroitin sulfate.CONCLUSIONS CNS can(produce slime) on some condition,universally,then to form biofilms.However,in vitro susceptibility testing(employed) cannot really reflect the susceptibility of bacteria in biofilms in vivo.Slime can increase the MICs to vancomycin and gentamicin because of interference with either the antimicrobial action of these drugs or the(perfusion) of these drugs through the medium to increase the resistance of biofilms.It does not affect the MIC to rifampin.