Objective To evaluate the efficacy and safety of modified pelvic floor reconstruction in non-nerve-sparing robot-assisted radical prostatectomy (NNS RARP) for improving postoperative urinary control. Methods A retrospective analysis was conducted on the clinical data of 79 prostate cancer patients who underwent NNS RARP at Tangdu Hospital during Jan.2020 and Dec.2023, including 29 in the reconstruction group, and 50 in the non-reconstruction group. The baseline characteristics including age, body mass index, prostate-specific antigen (PSA) level, clinical stage, prostate volume, and biopsy Gleason score, and perioperative indexes including operation time, intraoperative blood loss, catheter indwelling time, complication rate, and positive rate of surgical margins were compared between the two groups. Additionally, urinary continence function was assessed before operation and 1,3,6, and 12 months after operation using the international consultation on incontinence questionnaire-short form (ICIQ-SF) and the incontinence quality of life questionnaire score (I-QoL). Results No statistically significant differences were observed in the baseline characteristics between the two groups (P>0.05). The operation time was significantly longer in the reconstruction group than in the non-reconstruction group [ (110.24±15.08) min vs. (101.80±9.89) min, P=0.010]. There were no significant differences in intraoperative blood loss, catheter indwelling time, complication rate, and positive rate of surgical margins between the two groups (P>0.05). The reconstruction group demonstrated significantly lower ICIQ-SF scores at 1 month [ (10.17±2.16) vs. (11.56±1.66), P=0.002],3 months [ (7.62±1.29) vs. (9.52±1.80), P<0.001], and 6 months postoperatively [ (4.93±1.22) vs. (6.18± 1.67), P=0.001]compared to the non-reconstruction group (adjusted P<0.0125). Conversely, the I-QoL scores were significantly higher in the reconstruction group at 1 month [ (73.32±10.30) vs. (63.88±9.55), P<0.001]and 3 months postoperatively [ (78.91±4.82) vs. (75.66±5.17), P=0.007] (adjusted P<0.0125). However, no significant differences were found in ICIQ-SF or I-QoL scores between the two groups preoperatively and 12 months postoperatively (adjusted P>0.0125). Conclusion The application of modified pelvic floor reconstruction technique in NNS RARP is safe and feasible. Although it slightly prolongs the operation time, it does not increase surgical risks; instead, it effectively promotes early recovery of postoperative urinary continence, thereby significantly enhancing patients'quality of life.

The pursuit of cosmetic effects in post-surgical wounds has led to the development of ultra-minimally invasive techniques in surgery. Minimal invasive surgery has replaced open surgery and has become the new gold-standard for treating diseases. One such technique is the single incision triangulated umbilicus surgery (SITUS), which offers several advantages over traditional laparoscopic and other scarless surgeries, including reduced trauma, faster recovery, and better cosmetic outcomes. SITUS also has a short learning curve, aligns with conventional instrumentation operating habits, and can be used for whole abdominal surgeries. Chinese scholars have made further improvements to the SITUS technology, including expanding its applicability in intra-abdominal surgery and refining its incision closure methods to achieve superior cosmetic results. Currently, SITUS technology is experiencing rapid development in urology applications and has demonstrated satisfactory results in both domestic and international reports. This review aims to discuss the effectiveness and development of the SITUS technique in urology.

Objective:To investigate the effect and mechanism of esophageal squamous cell carcinoma exosomal miR-181b-5p to the polarization of M2 macrophages.Methods:Extracted and identified exosomes from esophageal squamous cell carcinoma,and detected the expression of miR-181b-5p in esophageal squamous cell carcinoma cells and their exosomes by qRT-PCR.M0 type macro-phages were divided into PBS group,HEEC exo group,Eca-109 exo group,miR-NC exo group,miR-181b-5p exo group,miR-NC group,miR-181b-5p mimic group,si-NC group,si-PTEN group,miR-181b-5p exo+PTEN group.qRT-PCR was used to detect the expressions of CD163,CD206,iNOS and TNF-α in each group.The targeting relationship between miR-181b-5p and PTEN were veri-fied by double luciferase reporter gene experiment.Results:miR-181b-5p was significantly overexpressed in esophageal squamous cell carcinoma cells TE-13,TE-12,TE-10,Eca-109,KYSE30 and their exosomes(P<0.001).Compared with miR-NC group,the expression of CD163 and CD206 in cells were significantly upregulated in the miR-181b-5p mimic group,as well as the expressions of iNOS and TNF-α were significantly downregulated(P<0.001).The results of double luciferase reporter genes showed that PTEN was the target gene of miR-181b-5p.Compared with si-NC group,the expressions of CD163 and CD206 in cells were significantly upregu-lated in the si-PTEN group,as well as the expressions of iNOS and TNF-α were significantly downregulated(P<0.001).Compared with PBS group,the expressions of CD163 and CD206 in cells were significantly upregulated in the Eca-109 exo group,as well as the expressions of iNOS and TNF-α were significantly downregulated(P<0.001).Compared with miR-NC exo group,the expressions of CD163 and CD206 in cells were significantly upregulated in the miR-181b-5p exo group,as well as the expressions of iNOS and TNF-α were significantly downregulated(P<0.001).Compared with miR-181b-5p exo group,the expressions of CD163 and CD206 in cells were significantly downregulated in the miR-181b-5p exo+PTEN group,as well as the expressions of iNOS and TNF-α were significantly upregulated(P<0.001).Conclusion:Exosomal miR-181b-5p inhibits PTEN expressions to promote M2 macrophage polarization.

Objective The main purpose of this study is to compare the embryo development and clinical outcomes of women in different age groups undergoing in vitro fertilization(IVF)processes using gonadotrophin-releasing hormone(GnRH)antagonist protocol,GnRH agonist long protocol,and early follicular phase protocol.We aim to provide reliable reference for future clinical treatments.Methods We conducted a detailed analysis of patients who underwent treatment between January 2021 and February 2023.1)In the overall patient population,we comprehensively compared the basic characteristics,the embryo development,and the clinical outcomes of patients treated with three different ovarian stimulation protocols,including the GnRH antagonist protocol group(n=4 173),the agonist long protocol group(n=2 410),and the early follicular phase long protocol group(n=341).2)We divided the overall population into three age groups,one group for patients under 30 years old(n=2 576),one for patients aged 30-35(n=3 249),and one for patients older than 35 years old(n=1 099).Then,we compared the three stimulation protocols based on the group division.We separately compared the embryo development and clinical outcomes of patients using the three stimulation protocols in the under 30 years old,the 30-35 years old,and the over 35 years old age groups.With this analysis,we aimed to explore the response of different age groups to different stimulation protocols and their impact on the success rate of IVF.Results 1)In the overall population,we found that the average number of oocytes retrieved in the GnRH agonist long protocol group was significantly higher than that in the GnRH antagonist protocol group([13.85±7.162]vs.[13.36±7.862],P=0.022 4),as well as the early follicular phase long protocol group([13.85±7.162]vs.[11.86±6.802],P<0.000 1).Patients in the GnRH antagonist protocol group not only had a significantly lower starting dose of gonadotrophin(Gn)compared to the other two groups(P<0.05)but also had a significantly lower number of days of Gn use(P<0.05).The blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups,significantly higher compared to the GnRH agonist long protocol group(64.91% vs.62.35%,P<0.000 1)and the early follicular phase long protocol group(64.91% vs.61.18%,P=0.000 1).However,there were no significant differences in the clinical pregnancy rates or the live birth rates among the three groups treated with different ovarian stimulation protocols(P>0.05).2)In the<30 age group,the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups,significantly higher compared to the GnRH agonist long protocol group(66.12% vs.63.33%,P<0.000 1)and the early follicular phase long protocol group(66.12% vs.62.13%,P=0.009 4).In the 30-35 age group,the blastocyst formation rate in the GnRH antagonist protocol group was the highest among the three groups,significantly higher compared to the GnRH agonist long protocol group(64.88% vs.62.93%,P=0.000 9)and the early follicular phase long protocol group(64.88% vs.60.39%,P=0.001 1).In the>35 age group,the blastocyst formation rate in the GnRH antagonist protocol group was significantly higher than that in the GnRH agonist long protocol group(59.83% vs.56.51%,P=0.009 3),while there was no significant difference compared to that of the early follicular phase long protocol group(P>0.05).In the three age groups,we found that there were no significant differences in clinical pregnancy rate,live birth rate,and neonatal outcome indicators(fetal weight and Apgar score)among the three stimulation protocols(antagonist protocol,GnRH agonist long protocol,and early follicular phase long protocol)(P>0.05).The findings showed no significant differences between clinical and neonatal outcomes in patients of all ages,regardless of the ovarian stimulation protocol,suggesting that the three ovarian stimulation protocols have similar therapeutic effects in patients of different ages.The results of this study have important implications for the selection of an appropriate ovarian stimulation protocol and the prediction of treatment outcomes.Conclusion In the younger than 30 and 30-35 age groups,the GnRH antagonist protocol showed a more significant advantage over the GnRH agonist long protocol and the early follicular phase long protocol.This suggests that for younger and middle-aged patients,the antagonist protocol may lead to better outcomes during ovarian stimulation.In the older than 35 age group,while the antagonist protocol still outperformed the GnRH agonist long protocol,there was no significant difference compared to the early follicular phase long protocol.This may imply that with increasing age,the early follicular phase long protocol may have effects similar to the antagonist protocol to some extent.The advantages of the antagonist protocol lie in its ability to reduce stimulation duration and the dosage of GnRH,while enhancing patient compliance with treatment.This means that patients may find it easier to accept and adhere to this treatment protocol,thereby improving treatment success rates.Particularly for older patients,the use of the antagonist protocol may significantly increase the blastocyst formation rate,which is crucial for improving the success rates.Although there were no significant differences in the clinical outcomes of patients treated with the three protocols in each age group,further research is still needed to validate these findings.Future multicenter studies and increased sample sizes may help comprehensively assess the efficacy of different stimulation protocols.Additionally,prospective studies are needed to further validate these findings and determine the optimal treatment strategies.

Objective To evaluate the application and effect of signature verification technology in children's vaccination clinics (CVC) of Jiangsu Province in 2020. Methods The signature verification data were derived from the Jiangsu Provincial Vaccination Integrated Service Management Information System, and the inquiry and registration, informed consent, vaccine traceability code scanning and observation information of children's vaccination clinics in different regions were analyzed. 210 doses of vaccination information were randomly selected from CVCs in each county, and the length of vaccination services in different regions was compared. Results During 2020, all of CVCs in Jiangsu were equipped with signature verification technology, and the signature verification rate of each vaccination sector was more than 99.90%. The length of outpatient vaccination service and overall length of stay in southern Jiangsu were slightly shorter than those in other regions. Conclusion The introduction of electronic signature verification technology in CVCs can effectively standardize the vaccination. It is necessary to expand the functions of electronic signature verification equipment, strengthen data analysis and utilization, and guide vaccination scientifically.

Objective:To investigate patients' compliance of endoscopic surveillance after endoscopic submucosal dissection (ESD) and the influencing factors.Methods:This study was a cross-sectional survey. The data of patients who underwent ESD in Xijing Digestive Hospital of Air Force Military Medical University from January 2014 to December 2015 were collected through questionnaire and telephone call. The questionnaire survey was conducted from May 1, 2019 to July 31, 2020. Patients' compliance for endoscopic surveillance and influencing factors were evaluated. Logistic regression model was used for multivariate analysis to determine independent risk factors affecting compliance of endoscopic surveillance.Results:A total of 413 questionnaires were collected, of which 331 (80.1%) patients were well complied with endoscopic surveillance, and 82 (19.9%) were not. Univariate analysis showed that gender ( χ2=4.68, P=0.034), lesion type ( χ2=10.10, P=0.002), educational background ( χ2=4.00, P=0.049), disposable income ( χ2=7.00, P=0.009), employment ( χ2=11.29, P=0.004) and medical insurance ( χ2=13.59, P=0.001) affected patients' endoscopic surveillance compliance. Logistic regression analysis indicated that patients with submucosal lesions were less likely to be compliant than patients with mucosal lesions with the same type of medical insurance ( P<0.001, OR=0.383, 95% CI: 0.227-0.644); and with the same lesion type, patients with urban medical insurance were more likely to be compliant than those with rural cooperative medical insurance ( P<0.001, OR=2.938, 95% CI: 1.696-5.090). Conclusion:The endoscopic surveillance compliance for post-ESD patients is related to the lesion type, the type of medical insurance, and the awareness of the disease. More attention should be paid to those with submucosal lesions and rural cooperative medical insurance due to their poor compliance. And it is necessary to improve health education on the disease for better surveillance compliance.

The etiology and pathogenesis of keloid are still not clear. It is believed that the formation of keloid is due to the joint action of many factors, during which process the external factor of fibroblast play an important role. Reprogramming of glucose metabolism in keloid fibroblasts is a new research direction. TGF-β 1 and its related TGF-β 1/Smad signalling pathway are considered to be the most closely related to the formation of keloid. This article reviews the research progress on extracellular factors, glucose metabolism and signaling pathways of keloids.

Objective:To explore the safety and efficacy of serial expansion without delay for the treatment of giant congenital melanocytic nevi (GCMN) on the back.Methods:The clinical date of children with GCMN on the back admitted to the Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from February 2017 to March 2019 were retrospectively analyzed. In stage Ⅰ, an expander was placed on each side of the back to laterally expand the skin on the back, as a whole. In stage Ⅱ, after the expanders were removed and part of the nevus was removed, the expanded flaps were advanced integrally across the back with additional incisions on both sides of the trunk. The new expanders were then placed under the expanded flaps simultaneously for serial expansion. In stage Ⅲ, the expanded flaps were used to reconstruct the wound after resection of GCMN. The color, texture of the flaps and the postoperative scar on the back were observed.Results:Ten patients were enrolled, including 4 males and 6 females, with an average age of 3.4 years (ranged between 2-6 years). All patients completed three stages of treatment. In the second stage, new expanders were placed under the expanded flap for serial expansion simultaneously. The three-stage operation took a total of 6.80 to 11.77 months, and all the nevus on the back were removed. The mean follow-up time was 16.6 months (ranged between 12-24 months). In one case, the skin flap necrosis (1.5 cm × 1.2 cm) was caused by abrasion at the end of stage Ⅱ when the inflation of the expander was nearly completed, without exposure of the dilator. After the expanders were removed in stage Ⅲ, the flap survived well. In the other children, no wound dehiscence, infection, dilator exposure and other complications occurred. The back was maintained as a whole aesthetic unit without conspicuous scars and the postoperative scars were located on the sides of the trunk. The color and texture of the flap were similar to its surrounding tissue.Conclusions:Serial expansion without delay is safe and efficient in the treatment of GCMN on the back. It not only eliminates the need to wait 4 to 15 months for the expander implantation, but also saves one operation and anesthesia. During the treatment, additional incisions are only made on both sides of the trunk, which could maintain the back as a whole aesthetic unit and obtain a better postoperative appearance.

The etiology and pathogenesis of keloid are still not clear. It is believed that the formation of keloid is due to the joint action of many factors, during which process the external factor of fibroblast play an important role. Reprogramming of glucose metabolism in keloid fibroblasts is a new research direction. TGF-β 1 and its related TGF-β 1/Smad signalling pathway are considered to be the most closely related to the formation of keloid. This article reviews the research progress on extracellular factors, glucose metabolism and signaling pathways of keloids.

Objective:To explore the safety and efficacy of serial expansion without delay for the treatment of giant congenital melanocytic nevi (GCMN) on the back.Methods:The clinical date of children with GCMN on the back admitted to the Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from February 2017 to March 2019 were retrospectively analyzed. In stage Ⅰ, an expander was placed on each side of the back to laterally expand the skin on the back, as a whole. In stage Ⅱ, after the expanders were removed and part of the nevus was removed, the expanded flaps were advanced integrally across the back with additional incisions on both sides of the trunk. The new expanders were then placed under the expanded flaps simultaneously for serial expansion. In stage Ⅲ, the expanded flaps were used to reconstruct the wound after resection of GCMN. The color, texture of the flaps and the postoperative scar on the back were observed.Results:Ten patients were enrolled, including 4 males and 6 females, with an average age of 3.4 years (ranged between 2-6 years). All patients completed three stages of treatment. In the second stage, new expanders were placed under the expanded flap for serial expansion simultaneously. The three-stage operation took a total of 6.80 to 11.77 months, and all the nevus on the back were removed. The mean follow-up time was 16.6 months (ranged between 12-24 months). In one case, the skin flap necrosis (1.5 cm × 1.2 cm) was caused by abrasion at the end of stage Ⅱ when the inflation of the expander was nearly completed, without exposure of the dilator. After the expanders were removed in stage Ⅲ, the flap survived well. In the other children, no wound dehiscence, infection, dilator exposure and other complications occurred. The back was maintained as a whole aesthetic unit without conspicuous scars and the postoperative scars were located on the sides of the trunk. The color and texture of the flap were similar to its surrounding tissue.Conclusions:Serial expansion without delay is safe and efficient in the treatment of GCMN on the back. It not only eliminates the need to wait 4 to 15 months for the expander implantation, but also saves one operation and anesthesia. During the treatment, additional incisions are only made on both sides of the trunk, which could maintain the back as a whole aesthetic unit and obtain a better postoperative appearance.