Objective To investigate the impact of tubeless technique on male sexual function after transurethral ureteroscopic lithotripsy.Methods 82 male patients from January 2023 to June 2023 with transethral ureteroscopic lithotripsy were selected as the study objects.Prior to surgery,39 male patients without double J tube indwelling after lithotripsy were randomly selected as the tubeless group and 43 male patients with double J tube indwelling were selected as the indwelling group by drawing lots.General clinical data and postoperative complications(lumbago,hematuria,irritation sign of bladder and fever)of the two groups were compared.The International Index of Erectile Function-5(IIEF-5)score,sexual life quality questionnaire(SLQQ)score and premature ejaculation diagnostic tool(PEDT)score of the two groups were statistically analyzed before surgery,1 month after surgery(before excutation in indwelling group),3 months and 6 months after surgery.Results Compared with the indwelling group,patients in the tubeless group had significantly fewer cases of lumbago,hematuria,and irritation sign of bladder 1 month after surgery,and the difference was statistically significant(P<0.05),but there was no significant difference in postoperative fever between the two groups(P>0.05).There were no statistically significant differences in the IIEF-5 score,SLQQ score and PEDT score between the two groups before the operation,3 months after the operation and 6 months after the operation(P>0.05).One month after the operation,the IIEF-5 score and SLQQ score of the tubeless group were significantly higher than those of the indwelling group,while the PEDT score was lower than that of the indwelling group,the differences were statistically significant(P<0.01).There were no statistically significant difference in the IIEF-5 score,SLQQ score and PEDT score at different time points in the tubeless group(P>0.05).The IIEF-5 score and SLQQ score of the indwelling group one month after the operation were significantly lower than those before the operation,while the PEDT score was significantly higher than that before the operation,the IIEF-5 score and SLQQ score of the indwelling group 3 and 6 months after the operation were significantly higher than those at 1 month after the operation,and the PEDT score was significantly lower than that at 1 month after the operation,the differences were statistically significant(P<0.01).There were statistically significant differences in the IIEF-5 score,SLQQ score and PEDT score at different time points in the indwelling group(P<0.05).Conclusion The tubeless technique after ureteroscopy has a relatively small impact on male sexual function and can significantly improve the quality of life of patients,alleviate lumbago,hematuria and irritation sign of bladder.It is worthy of clinical promotion and application.

Objective:To analyze the effects of Mulligan technique combined with isokinetic exercise training (IET) on isokinetic muscle strength and neuromuscular control ability in patients with knee osteoarthritis (KOA).Methods:A retrospective case-control study was conducted. A total of 49 patients with KOA who underwent IET at Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to January 2022 were included in the control group. An additional 49 patients with KOA who received Mulligan technique and IET at the same hospital from June 2022 to June 2023 were included in the observation group. Both groups were treated for 8 successive weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, proprioception metrics [including average track error (ATE) and test time execution (TTE)], isokinetic muscle strength [peak torque (PT) and average power (AP) for flexors and extensors at 60°/s, 90°/s, and 120°/s)]were compared between the two groups before and after 4 and 8 weeks of intervention. Additionally, Visual Analog Scale score was compared between the two groups at baseline and after 8 weeks of intervention.Results:There was no statistically significant difference in WOMAC score, Lysholm score, or PT and AP levels for flexor and extensor muscles at 60°/s, 120°/s, and 180°/s between the two groups before intervention (all P > 0.05). After 4 and 8 weeks of intervention, the levels of PT and AP for both flexors and extensors at 60°/s, 120°/s, and 180°/s, as well as the Lysholm scores, were significantly higher in the observation group compared with the control group [PT level: t = -0.10, -3.03, -3.85, -0.35, -3.62, -3.95, -0.27, -5.51, -6.52, -1.13, -2.74, -3.68, -0.09, -2.91, -5.79, -0.13, -4.66, -6.05; AP level: t = -0.23, -4.77, -6.15, 0.01, -3.10, -3.75, -0.13, -3.73, -3.44, 0.16, -2.09, -4.05, -0.17, -3.71, -3.51, -0.27, -3.26, -3.69; Lysholm score: t = -7.17, -6.44; all P < 0.05]. After 4 and 8 weeks of intervention, the WOMAC score, ATE, and TTE in the observation group were significantly lower than those in the control group [WOMAC score: t = 3.68, 0.64; ATE level: t = 3.88, 4.13; TTE level: t = 4.86, 4.60; all P < 0.05]. After 8 weeks of intervention, both groups had lower Visual Analog Scale scores compared with their scores before the intervention (U control group = -8.75, U observation group = -8.63), with the observation group showing significantly lower scores than the control group ( U = -5.95, P < 0.001). Conclusions:The Mulligan technique combined with IET can effectively alleviate knee joint pain in patients with KOA, promote the recovery of knee joint function, enhance proprioceptive recovery, and improve neuromuscular control abilities.

Objective To investigate the impact of tubeless technique on male sexual function after transurethral ureteroscopic lithotripsy.Methods 82 male patients from January 2023 to June 2023 with transethral ureteroscopic lithotripsy were selected as the study objects.Prior to surgery,39 male patients without double J tube indwelling after lithotripsy were randomly selected as the tubeless group and 43 male patients with double J tube indwelling were selected as the indwelling group by drawing lots.General clinical data and postoperative complications(lumbago,hematuria,irritation sign of bladder and fever)of the two groups were compared.The International Index of Erectile Function-5(IIEF-5)score,sexual life quality questionnaire(SLQQ)score and premature ejaculation diagnostic tool(PEDT)score of the two groups were statistically analyzed before surgery,1 month after surgery(before excutation in indwelling group),3 months and 6 months after surgery.Results Compared with the indwelling group,patients in the tubeless group had significantly fewer cases of lumbago,hematuria,and irritation sign of bladder 1 month after surgery,and the difference was statistically significant(P<0.05),but there was no significant difference in postoperative fever between the two groups(P>0.05).There were no statistically significant differences in the IIEF-5 score,SLQQ score and PEDT score between the two groups before the operation,3 months after the operation and 6 months after the operation(P>0.05).One month after the operation,the IIEF-5 score and SLQQ score of the tubeless group were significantly higher than those of the indwelling group,while the PEDT score was lower than that of the indwelling group,the differences were statistically significant(P<0.01).There were no statistically significant difference in the IIEF-5 score,SLQQ score and PEDT score at different time points in the tubeless group(P>0.05).The IIEF-5 score and SLQQ score of the indwelling group one month after the operation were significantly lower than those before the operation,while the PEDT score was significantly higher than that before the operation,the IIEF-5 score and SLQQ score of the indwelling group 3 and 6 months after the operation were significantly higher than those at 1 month after the operation,and the PEDT score was significantly lower than that at 1 month after the operation,the differences were statistically significant(P<0.01).There were statistically significant differences in the IIEF-5 score,SLQQ score and PEDT score at different time points in the indwelling group(P<0.05).Conclusion The tubeless technique after ureteroscopy has a relatively small impact on male sexual function and can significantly improve the quality of life of patients,alleviate lumbago,hematuria and irritation sign of bladder.It is worthy of clinical promotion and application.

Objective:To analyze the effects of Mulligan technique combined with isokinetic exercise training (IET) on isokinetic muscle strength and neuromuscular control ability in patients with knee osteoarthritis (KOA).Methods:A retrospective case-control study was conducted. A total of 49 patients with KOA who underwent IET at Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2021 to January 2022 were included in the control group. An additional 49 patients with KOA who received Mulligan technique and IET at the same hospital from June 2022 to June 2023 were included in the observation group. Both groups were treated for 8 successive weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Lysholm score, proprioception metrics [including average track error (ATE) and test time execution (TTE)], isokinetic muscle strength [peak torque (PT) and average power (AP) for flexors and extensors at 60°/s, 90°/s, and 120°/s)]were compared between the two groups before and after 4 and 8 weeks of intervention. Additionally, Visual Analog Scale score was compared between the two groups at baseline and after 8 weeks of intervention.Results:There was no statistically significant difference in WOMAC score, Lysholm score, or PT and AP levels for flexor and extensor muscles at 60°/s, 120°/s, and 180°/s between the two groups before intervention (all P > 0.05). After 4 and 8 weeks of intervention, the levels of PT and AP for both flexors and extensors at 60°/s, 120°/s, and 180°/s, as well as the Lysholm scores, were significantly higher in the observation group compared with the control group [PT level: t = -0.10, -3.03, -3.85, -0.35, -3.62, -3.95, -0.27, -5.51, -6.52, -1.13, -2.74, -3.68, -0.09, -2.91, -5.79, -0.13, -4.66, -6.05; AP level: t = -0.23, -4.77, -6.15, 0.01, -3.10, -3.75, -0.13, -3.73, -3.44, 0.16, -2.09, -4.05, -0.17, -3.71, -3.51, -0.27, -3.26, -3.69; Lysholm score: t = -7.17, -6.44; all P < 0.05]. After 4 and 8 weeks of intervention, the WOMAC score, ATE, and TTE in the observation group were significantly lower than those in the control group [WOMAC score: t = 3.68, 0.64; ATE level: t = 3.88, 4.13; TTE level: t = 4.86, 4.60; all P < 0.05]. After 8 weeks of intervention, both groups had lower Visual Analog Scale scores compared with their scores before the intervention (U control group = -8.75, U observation group = -8.63), with the observation group showing significantly lower scores than the control group ( U = -5.95, P < 0.001). Conclusions:The Mulligan technique combined with IET can effectively alleviate knee joint pain in patients with KOA, promote the recovery of knee joint function, enhance proprioceptive recovery, and improve neuromuscular control abilities.

Objective:To investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.Methods:The data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to December 2018 were retrospectively studied. There were 188 males (54.8%) and 155 females (45.2%) with an average age of 59.47±10.21 years old (range 23-91 years). The patients were divided into operation group (150 cases, 43.7%) and non operation group (193 cases, 56.3%). The demographics, types of primary tumor, non spinal metastasis, visceral metastasis, spinal metastasis and segments, pathological fractures of vertebra, Frankel classification, physical function status (Karnofsky performance scale, KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS) were recorded and analyzed. The impact of different treatments on the survival prognosis of patients with spinal metastasis was evaluated. The independent factors affecting survival in those patients were analyzed by Cox proportional hazards regression model.Results:The peak incidence of spinal metastases was found in the age group of 46-60 years (43.7%, 150/343). 38.5% (132/343) of the patients had pathological fractures of the involved vertebral body. 58.3% (200/343) of the patients had extraspinal bone metastasis. 36.2% (124/343) of the patients had visceral metastasis. Among the primary tumors, adenocarcinoma was the most common tpye (61.5%, 211/343), followed by large cell lung cancer (12.5%, 43/343), small cell lung cancer (6.4%, 22/343), squamous cell cancer (6.1%, 21/343) and mixed cell lung cancer (5.3%, 18/343). The type of lung cancer cells in about 8.2 (28/343) patients was unknown. Among the surgical patients, 21 patients underwent minimally invasive surgery (14.0%), 28 patients underwent simple decompression surgery (18.7%), 76 patients underwent separation surgery (50.7%), and 25 patients underwent radical surgery (16.6%). 59.3% (89/150) of the patients had a better neurological function than before surgery. The average survival time of all patients was 9.88 months with the median survival time of 8 (5,14) months. The survival rates were 62.1% (213/343), 30.0% (103/343), and 3.8% (13/343) at 6, 12, and 24 months, respectively. The average survival time of patients in the operation group was 10.24 months with the median survival time of 9 (5, 15) months, and the average survival time of patients in the non operation group was 9.41 months with the median survival time of 7 (5, 13) months with no significant difference between the groups (χ 2=0.300, P=0.584). Multivariate Cox proportional hazard regression model analysis showed that radiotherapy [ HR=1.913, 95% CI(1.471, 2.488), P<0.001], chemotherapy [ HR=1.313, 95% CI(1.040, 1.658), P=0.022], targeted drug therapy [ HR=1.683, 95% CI(1.221, 2.319), P=0.001], KPS [ HR=1.593, 95% CI(1.140, 2.225), P=0.006] and pathological type (non-small cell lung cancer) were independent factors affecting the 1-year survival rate of patients with spinal metastasis secondary to lung cancer [ HR=0.322, 95% CI(0.225, 0.460), P<0.001] with significant difference. Conclusion:Surgical treatment can improve both the neurological function and general status of patients with spinal metastasis. Treatments of radiotherapy, chemotherapy, and targeted drug therapy can significantly improve 1-year survival rate, while a KPS less than 50 points and a primary lung cancer other than adenocarcinoma were independent risk factors reducing 1-year survival rate.

Objective:To retrospectively analyze the patients with spinal metastases who received surgical intervention and summarize the evolution of their clinical and pathological characteristics and surgical methods.Methods:The data of 703 patients with spinal metastases from January 2007 to December 2018 were collected retrospectively. There were 395 males (56.19%, 395/703) and 308 females (43.81%, 308/703) with an average age of 58.14±11.46 years (range 13-84 years). According to the degree of invasion and thoroughness of tumor resection, the surgical methods could be divided into minimally invasive surgery, decompression surgery, separation surgery, piecemeal resection and total en-bloc spondylectomy surgery. The operative methods were minimally invasive surgery in 89 cases (12.66%), decompression surgery in 96 cases (13.66%), separation surgery in 303 cases (43.10%), piecemeal resection in 182 cases (25.89%) and total en-bloc spondylectomy in 33 cases (4.69%). To analyze the trend of the clinical, pathological types and surgical treatment of patients with spinal metastases over the years, and determine the relevant factors affecting the decision-making of surgical methods by multivariate logistic regression.Results:The ratio of male to female was 1.28:1. 39.54% (278/703) of patients with single-segment involvement in 703 patients, 24.04% (169/703) of patients with double-segment metastasis and 36.42% (256/703) of patients with multi-segment metastasis. The most common type of primary tumor was lung cancer (34.57%, 243/703), followed by breast cancer (8.25%, 58/703), myeloma (8.11%, 57/703), gastrointestinal tumor (6.82%, 48/703) and renal malignant tumor (6.40%, 45/703). From 2007 to 2018, there was no significant difference in the percentage change of different age, gender and primary tumor source composition (age: χ 2=14.01, P=0.233; gender: χ 2=35.73, P=0.341; primary tumor: χ 2=120.09, P=0.074). The percentage of patients with sacrococcygeal metastasis decreased from 20.00% in 2008 to 1.89% in 2017 and the difference was statistically significant (χ 2=8.09, P=0.005). The percentage of patients with multi-level metastasis increased from 26.67% in 2008 to 52.83% in 2017, and the difference was statistically significant (χ 2=7.23, P=0.007). The percentage of patients with minimally invasive surgery decreased from 25.00% in 2007 to 5.88% in 2018, and the percentage of patients with segmented resection decreased from 53.33% in 2008 to 10.29% in 2018. The proportion of the two surgical methods showed a significant downward trend, and the differences were statistically significant (minimally invasive surgery: χ 2=1.46, P=0.026; segmented resection surgery: χ 2=19.56, P<0.001). The percentage of patients undergoing separation surgery increased from 13.33% in 2008 to 64.71% in 2018, and the proportion of patients undergoing total en-bloc spondylectomy increased from 0 in 2007 to 10.29% in 2018. Both surgical methods showed a significant growth trend and the differences were statistically significant (separation surgery: χ 2=27.09, P<0.001; χ 2=4.16, P=0.042). Multivariate Logistic regression analysis showed that age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score were independent factors influencing surgical decision-making ( P<0.05). Conclusion:With different time and age, the invasiveness and thoroughness of surgery are increasing, which shows that the percentage of patients who underwent separation surgery and to-tal en-bloc spondylectomy is significantly increasing. Age, metastatic site, number of metastatic segments, pathological vertebral fractures, Frankel grade, SINS score and VAS score are independent factors affecting surgical decision-making.

Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.

Objective:To find out predictors of the testicular ischemia caused by incarcerated inguinal hernia and evaluate the ischemic injury of the testis more accurately, which can indicate testicle exploration in time or prevent unnecessary testicle exploration.Methods:Pediatric patients (median: 9 months) undergoing operation of unilateral incarcerated inguinal hernia and ipsilateral testicular exploration from 1 Jul. 2013 to 30 Jun. 2019 were retrospectively investigated. Age at surgery, incarcerate duration, degree of intestinal and testicular injury, times of manual reduction and preoperative ultrasound data were collected. Statistical analysis was performed by SAS 9.4 (Copyright ? 2016 SAS Institute Inc.Cary, NC, USA) .Results:460 patients (median: 9 months) , of which 57 (12.39%) (median: 1.4 months, interquartile range 0.8-10.7 months) had severe testicular injury, and their average incarceration time was (23.9±9.3) h. Univariate logistic regression revealed that increased times of manual reduction, ultrasound scores, incarcerate duration and degree of intestinal injury were positively correlated with the degree of testicular ischemia, while age at surgery was negatively correlated with the degree of testicular ischemia ( P<0.05) . A model for calculating the probability of severe testicular ischemia injury was established: P= through multivariate analysis with backward stepwise logistic regression and 10-fold cross-validation was used for preliminary verification of the model. Conclusion:This study provides a relative reliable model to predict the risk of irreversible testicular ischemia due to incarcerated inguinal hernia using readily available clinical characteristics in young pediatrics with testicular ischemia.

Objective: To investigate the effect of histone deacetylase inhibitor apicidin on the glioblastoma U87 cells and its regulation of OCT-4 gene expression. Methods: Glioblastoma U87 cells were treated with different concentrations of apicidin, and dimethyl sulfoxide instead of apicidin was negative control. Methyl thiazolyl tetrazolium (MTT) assay was used to detect the proliferative ability of U87 cells treated by apicidin. The cell apoptosis was observed under the fluorescence microscope, and the cell cycle was detected by using flow cytometry. Reverse transcription-polymerase chain reaction and Western blot was used to detect the expression of mRNA and protein of U87 cells, respectively relative to the expression of GAPDH. Results: MTT assay results showed that apicidin inhibited U87 cells proliferation in a dose-dependent and time-dependent manner, and half of the inhibitory concentration of cell proliferation at 48 h was (1.74±0.13) μmol/L. The cell proportion of U87 cells in S-phase of the negative control, 0.2, 0.5, and 1.0 μmol/L apicidin was (32.68±0.49)%, (33.73±0.76)%, (42.92±0.56)%, and (56.95±0.53)%, respectively after 48 h apicidin administration (P < 0.05), while the proportion of G₁ and G₂ phase cells was decreased. The karyopyknosis and other apoptotic changes were detected in U87 cells after 48 h treatment of 1.0 μmol/L apicidin under the confocal fluorescence microscope. Western blot and RT-PCR showed that the mRNA and protein relative levels of U87 cells OCT-4 were reduced after 1.0 μmol/L apicidin treatment for 48 h compared with the negative control group (mRNA: 72.44±0.00 vs. 56.66±0.23; protein: 86.59±0.19 vs. 56.04±0.15, both P < 0.01). Conclusions Apicidin can inhibit the growth of glioblastoma U87 cells, induce cell cycle arrest and apoptosis. Its mechanism may be related to the expression of OCT-4 inhibited by apicidin.

Objective To investigate the change of serum Nogo-A protein in patients with acute closed brain injury, and explore its relationship with the severity of neuronal damage and prognosis. Methods Thirty-one patients with acute closed brain injury were enrolled. Venous blood samples (2 mL) were obtained 1, 3 and 5 d after injury. Serum concentrations of Nogo-A protein were determined by ELISA. Patients were divided into mild (n =7), moderate (n = 10) and severe (n = 14) injury groups according to Glasgow coma score (GCS), and were divided into favorable prognosis (n = 23) and poor prognosis (n = 8) groups according to Glasgow outcome score (GOS). Another 20 healthy adults were served as controls. Results The mass concentrations of serum Nogo-A protein in mild, moderate and severe injury groups 1, 3, 5 d after injury were significantly higher than those in control group (P < 0.01), and the mass concentrations of serum Nogo-A protein in moderate and severe injury groups 1, 3, 5 d after injury were significantly higher than those in mild injury group (P <0.05, P <0.01). The mass concentrations of serum Nogo-A protein 1, 3, 5 d after injury were significantly higher in poor prognosis group than those in favourable prognosis group (P < 0.01). Conclusion Serum Nogo-A protein level significantly increases after brain injury, and is related to the degree of injury and prognosis.