Objective: To explore the efficacy and surgical techniques of ultrasound-assisted transurethral flexible ureteroscopic holmium laser incision and internal drainage in the treatment of special renal cystic diseases，so as to provide reference for the diagnosis and treatment of such diseases. Methods: The clinical data of 48 patients with special renal cystic diseases treated during Jan.2019 and May 2023 were retrospectively analyzed.The diagnosis was made by computed tomography urography (CTU) and three dimensional urinary tract reconstruction before operation.All patients received the abovementioned surgery in semisupine lithotomy position.The general information，clinical data，and incidence of complications were analyzed. Results: There were 27 males and 21 females，with an average age of (48.0±7.5) years，including 22 cases of parapelvic cysts，6 cases of endogenic simple renal cysts with an average diameter of (5.0±1.0) cm，and 20 cases of renal calyceal diverticulum with stones，with an average diameter of (2.5±1.3) cm for the diverticulum and an average diameter of (1.5±1.0) cm for the stones，which were located in the upper or middle calyces.In 7 cases，ureteroscopic localization was difficult，and the surgery was completed with percutaneous renal puncture needle assisted localization.Ureteral stenosis was detected in 2 cases during surgery，and surgery was performed 4 weeks after double J tubes were placed.The remaining operations were successfully completed.The average operation time was (42.0±14.5) minutes，and average hospital stay was (2.0±0.5) days.During the follow-up of (12.0±8.5) months，lumbar pain improved in 27 cases (100%)，renal cysts disappeared in 23 cases (82.1%,23/28)，cysts significantly reduced by ≥50% in 4 cases (14.3%,4/28)，slightly reduced by <50% in 1 case (3.6%,1/28)，and the renal calyx diverticulum disappeared in 20 cases (100%).Gross hematuria and lower back pain occurred in 2 cases，and no other complications developed. Conclusion: Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage is a safe and effective treatment for special benign renal cystic diseases.When ultrasound-guided flexible ureteroscope localization is difficult to perform，percutaneous renal puncture needle may be applied.

Objective To investigate the value of a nomogram model constructed from intratumoral and peritumoral magnetic resonance imaging radiomics combined with clinical characteristics in predicting the status of lymphovascular space invasion(LVSI)in cervical cancer.Methods A retrospective analysis was conducted on 178 cervical cancer patients confirmed by postoperative pathology,with 70 cases of LVSI(+)and 108 cases of LVSI(-).The patients were divided into a training set[142 cases,including 54 cases of LVSI(+)and 88 cases of LVSI(-)]and a test set[36 cases,including 16 cases of LVSI(+)and 20 cases of LVSI(-)]at a ratio of 8:2.All underwent magnetic resonance imaging before surgery,and regions of interest were manually delineated layer by layer on the T2WI sequence,with the peritumoral region being uniformly expanded outward.Univariate logistic analysis was performed on clinical factors to select independent factors for cervical cancer LVSI(+).Radiomic features were extracted separately from the intratumoral region,the peritumoral region,and the intratumoral-peritumoral region to construct radiomics models,and the differences between the peritumoral and the intratumoral-peritumoral models were compared.A combined model was established based on the radiomics scores of the optimal intratumoral-peritumoral model and clinical independent predictive factors,and a nomogram was plotted.Receiver operating characteristic curves were used to evaluate the diagnostic performance of each model,and decision curve analysis was used to assess the clinical value of the models.Results The combined model demonstrated the best performance among the various models,with AUC of 0.970 in the training set and 0.803 in the test set.Conclusion Intratumoral and peritumoral magnetic resonance imaging radiomics combined with clinical characteristics can effectively predict LVSI in cervical cancer.

Objective:To explore the effect of match between childhood stress and adulthood stress on mental health status.Methods:Adult healthy volunteers( n=239) and adult mental disorder patients were examined by questionnaires or telephone interviews.Childhood trauma questionnaire (CTQ) and lifetime stress event list were used for measure of CS and AS, DSM5-level-1-cross-cutting-symptom-measure (DSM5-L1CCSM) and self-rating depression scale (SDS) for mental health outcomes.Subjects were grouped according to positive (+ ) / negative (-) stress events into five groups: CS+ AS+ Matched ( n=108), CS+ AS+ mismatched( n=240), CS-AS+ ( n=100), CS+ AS-( n=79), and CS-AS-( n=99). The data of stress and mental health status were compared and analyzed among stress groups. Results:The distributions of positive stress events among 626 volunteers were 68.2% with CS+ , 71.6% with AS+ , 17.3% with C+ A+ M+ .There were differences among groups in all parameters (all P<0.05) except for gender.Age, years of education, CS and emotional abuse were influencing factors of onset of AS( P<0.01). MANCOVA analysis showed that factors about the interaction of AS and CS had attribution on DSM5-L1CCSM and SDS ( P<0.01). Conclusion:CS has a facilitatory effect on AS.The match of CS-AS is an important risk factor of adulthood mental health outcomes.Re-experiencing the same type of CS in adulthood would worsen adulthood mental health status.

BACKGROUND: Studies have confirmed that the occurrence and development of diabetic nephropathy are related to tubular epithelial cell transdifferentiation and renal interstitial fibrosis. OBJECTIVE: To investigate the protective effect of erythropoietin preconditioned adipose-derived mesenchymal stem cells on diabetic nephropathy rat's kidney and to evaluate its potential mechanisms. METHODS: Human adipose-derived mesenchymal stem cells were harvested and identified for cell multilineage differentiation. TranswelI migration system was used to observe the effects of erythropoietin of different concentrations (0, 5, 20, 50 IU/mL) on the migration of adipose-derived mesenchymal stem cells to high glucose-induced rat renal tubular epithelial cell lines. Forty-eight Sprague-Dawley rats (provided by the Animal Experimental Center of Xuzhou Medical University in China) were randomly divided into normal control, diabetic model group, cell transplantation group and erythropoietin preconditioning group (n=12 per group). Adipose-derived mesenchymal stem cells (3.5×105, 150 μL) alone or erythropoietin (20 IU/mL) preconditioned adipose-derived mesenchymal stem cells were injected into the tail vein of rats in the latter two groups, respectively. The protein levels of transforming growth β1, α-smooth muscle actin, E-cadherin, matrix metalloproteinase-9 and matrix metalloproteinase inhibitor-1 in the renal tissues were detected by western blot assay at 14 weeks after cell transplantation. RESULTS AND CONCLUSION: Erythropoietin preconditioning markedly increased the number of migrated adipose-derived mesenchymal stem cells in a concentration-dependent manner (P < 0.05) , and the ability peaked at a concentration of 20 IU/ml. The expression of stromal cell-derived factor-1 protein in NRK-52 E cells was consistent with the migration trend of adipose-derived mesenchymal stem cells. Compared with the diabetic model group, the levels of transforming growth β1, α-smooth muscle actin, and matrix metalloproteinase inhibitor-1 were increased dramatically, while the levels of E-cadherin and matrix metalloproteinase-9 decreased remarkably in the other groups (P < 0.05) , especially in erythropoietin preconditioning group (P < 0.05). In conclusion, erythropoietin could promote the directional chemotaxis of adipose-derived mesenchymal stem cells, and moreover, adipose-derived mesenchymal stem cells could inhibit the transdifferentiation of renal tubular epithelial cells, reduce the deposition of extracellular matrix and delay the progression of diabetic renal fibrosis under the action of erythropoietin.

Objective To explore the effect of childhood trauma on escitalopram treatment of adult depression. Methods There were 68 adult patients with major depression disorder recruited. All patients were assessed with Childhood Trauma Questionnaire ( CTQ ) and given 8 weeks of standardized treatment with escitalopram. Beck Depression Inventory ( BDI) and HAMD-17 were assessed at the end of the 2nd,4th and 8th week respectively. The changes of BDI score and HAMD-17 score in patients with different CTQ fac-tors were observed. Results ( 1) The overall effect of intervention was 25. 0％ at the end of 4th week and 45. 6％ at the end of 8th week. The total effective rate was 94. 1％. At the end of 4th week,there was no sig-nificant difference in the clinical recovery rate between the positive group(19. 5％) and the negative group (33. 3％)(χ2=1. 66,P>0. 05). There was no significant difference in clinical recovery between the two groups at the end of 8th week(positive group :39. 0％,negative group :55. 6％,χ2=1. 79,P>0. 05). (2) The total score reduction rate of HAMD-17((46. 26±24. 79)％,(58. 39±23. 25)％) and BDI((51. 63± 16. 03)％,(66. 28±18. 05)％) at the end of 4th week and the total score reduction rate of BDI at the end of 8th week ((59. 13±15. 42)％,(68. 50±20. 91)％)in the positive group were lower than those in the nega-tive group (P<0. 05) . ( 3) Except for sexual abuse,there was a significant negative correlation between CTQ scores and the reduction rate of BDI scores at end of 4th and 8th week( r=-0. 46--0. 06,P<0. 05) . Conclu-sion Childhood trauma has adverse effects on the efficacy of escitalopram in the treatment of adult depres-sion.

Objective To explore the short?term functional outcomes of the reconstruction of the proximal humerus by re?verse shoulder arthroplasty after tumor rescetion. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old (25-61). 2 chon?drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stageⅠB and stageⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer typeⅠresection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow?up was scheduled, and the patient received X?ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant?Murley score and musculoskel?etal tumor society(MSTS) score was recorded. Results The mean duration of the operation was 2.7 h (2-3.5 h). The bleeding in the operation was 510 ml (300-850 ml). The mean length of humerus resection was 8 cm (6-10 cm). The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow?up was 13 months (3-26 months). No infec?tion, dislocation, or loosening of prosthesis was found by the last follow?up. The X?ray showed the case who received reimplanta?tion after tumor bone deactivation had achieved bone union 1 year postoperation,7 cases received allograft had still nonunion at the host?graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recur?rence of the tumor was found. At last follow?up, active abduction was 155° (100°-175° ) and active forward elevation was 150° (115°-170°) and Constant?Murley score was 76%(68%-87%). The MSTS score was 92%(87%-97%). Conclusion The func?tional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor rescetion was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long?term results need further study.

Objective To evaluate the bonding condition of hydroxyapatite (HA)/zirconia ( ZrO2 ) composite and bone interface and the ability of HA/ZrO2 in repair of bone defects.Methods Bone defect models were established in the lumbar vertebral body of 24 Beagle dogs and were implanted with HA/ZrO2 gradient composite (Group A ),HA/ZrO2 unilayer composite (Group B ),pure ZrO2 (Group C) and pure HA (Group D) successively.Dogs were sacrificed and lumbar vertebral specimens were harvested 6,12,16 weeks postoperatively and before the sacrifice at postoperative 6 and 12 weeks,the dogs were intramuscularly administered of quadracycline for fluorescence labeling.The interface bonding and repair of bone defects were observed through X-ray films,histomorphology and biomechanical test.Results The X-ray films displayed that the Group A achieved more formation of osteotylus and better repair of bone defects with the extension of the implantation period,followed by the Groups B and D and that the Group C had relatively worse results.Histomorphology study showed that the fluorescence labeling was enhanced gradually from 6 to 12 weeks in the Group A,with its growth from the edge of the implanted material to the inner part and its tight adhesion to the material,indicating active osteogenesis and massive bone formation.While the fluorescence labeling of the Groups B,C and D centered in the edge of implanted materials without presence in the material inner part.The mineralization rate of the four materials at 6 and 12 weeks had significant differences ( P ＜ 0.05).Synostosis rates at 6,12 and 16 weeks were the highest in the Group A,with the rate of up to (90.26 ±3.82) ％ at 16 weeks (P ＜0.05 ).Biomechanical test showed the maximum shear strengths at 6,12,16 weeks in the Group A were (2.64±0.16) MPa,(2.95 ±0.19) MPa and (3.45 ±0.23) MPa respectively (P＜0.05).Conclusion HA/ZrO2gradient biocomposite bonds well with the bone and possesses good repair ability for bone defects and hence is an ideal novel material for bone defect reconstruction.

Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement.

Objective To investigate technique and indications of proximal femoral autograft for pelvic reconstruction after tumor resection.Methods Between October 2006 and May 2011,5 patients with primary malignant pelvic tumor underwent tumor resection,pelvic reconstruction by proximal femoral autograft,and hip reconstruction by tumor prosthesis.There were 3 males and 2 females,aged from 19 to 55years (average,30.6 years).There were 3 cases of chondrosarcoma and 2 cases of primitive neuroectodermal tumor (PNET).The tumor involved zone Ⅰ and zone Ⅱ in 3 cases,and zone Ⅱ and zone Ⅲ in other 2cases.All 5 patients were followed up,and complications,MSTS (Musculoskeletal Tumour Society) score and prognosis were recorded.Results At final follow-up,one patient died of pulmonary metastasis,one patient survived with local recurrence,and other 3 patients survived without recurrence.The complications consisted of local recurrence,prosthesis loosening,nonunion,infection,and sciatic nerve palsy.One patient underwent revision surgery for prosthesis loosening 26 months after the initial operation.One patient underwent amputation for local recurrence 6 months after the initial operation.The average MSTS score was 19.2.Conclusion Proximal femoral autograft is an effective method for pelvic reconstruction after tumor resection,which can be used for defect in zone Ⅱ and zone Ⅲ,as well as in zone Ⅰ and zone Ⅱ.However,the method has a high rate of complications.The short-term result is similar to that of pelvic prosthesis,while the long-term result needs further observation.

Objective To screen possible factors affecting prognosis of chondrosarcoma.Methods A total of 37 patients with chondrosarcoma,who had undergone surgical treatment from December 2005 to March 2008 in our hospital and had complete follow-up data and definitive pathological diagnosis,were enrolled in this retrospective study.There were 16 males and 21 females,ageing from eleven to eighty-four years (average,42.8 years).The univariate analysis of survival rate was performed with Kaplan-Meier method and tested with the Log-rank test.Chi-squared test or Fisher's exact test were used to analyze numeration data,and then the significant indexes after univariate analysis were performed multivariate analysis with COX regression model to screen the independent factors affecting prognosis.On the basis of literatures,8factors including gender,age,duration of disease,tumor site,Enneking stage,surgical approach,distant metastasis and local recurrence were analyzed.Results Statistical significance was found in Enneking stage,surgical approach and distant metastasis,which indicated that they were related to survival rate 3years after surgery.However,gender,age,duration of disease,tumor site,and local recurrence had no significant correlation with prognosis.After multivariate analysis of Enneking stage,surgical approach,distant metastasis,the results showed that Enneking stage and surgical procedure were the independent prognostic factors,while distant metastasis was not an independent prognostic factor.Conclusion Enneking stage and surgical approach are the independent prognostic factors for chondrosarcoma,which can be used to evaluate prognosis of chondrosarcoma.