Objective:To study the clinical effects of modified surgical method with H-uvulopalatopharyngoplasty(H-UPPP)and traditional surgical method in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS)in children.Methods:The clini-cal data of 364 pediatric patients with OSAHS were retrospectively analyzed.The patients were divided into 2 groups and treated by low-temperature plasma knife radio frequency ablation for bilateral tonsil removal combined with H-UPPP(group A,n=204)and low-temperature plasma knife radio frequency ablation only(group B,n=160)respectively.The operative time,intraoperative bleed-ing,postoperative secondary bleeding,VAS of pain following operation,postoperative traumatic white film shedding time,OAH1,LSaO2,ESS scores and complications of the 2 groups were compared.Results:In group A the operative time,intraoperative bleed-ing,VAS,OAHI and ESS scores were lower than those in group B(P＜0.05),wile postoperative traumatic white film detachment time and LSaO2 were higher(P＜0.05).No statistically significant difference in terms of the number of cases of postoperative seconda-ry bleeding and complications was observed between the 2 groups(P＞0.05).Conclusion:The combination of low-temperature plas-ma radio frequency ablation and H-UPPP for the treatment of OSAHS may provide clear intraoperative view,and may improve the treatment effects.

A 51-year-old female patient with ovarian cancer was treated with 5 cycles of immunotherapy, targeted therapy, and chemotherapy (pablizumab+bevacizumab+irinotecan+cisplatin), and her disease condition was stable. After that, pabolizumab was changed to toripalimab for 2 cycles because of personal reason. Two days after the last treatments, the patient developed erythema with pruritus, and eyelid edema; 10 days later, symptoms such as dysphagia, dysarthria, and decreased muscle strength appeared. Laboratory tests showed creatine kinase 2 633 U/L, interleukin-6 48.69 ng/L, positive anti-TIF1-γ antibody. Magnetic resonance imaging of limb muscles showed myositis. Electromyography showed myogenic injury of the left deltoid and tibialis anterior muscles. It was considered that the myositis was caused by toripalimab. After 16 days of treatments with methylprednisolone, intravenous human immunoglobulin for intravenous injection, and tocilizumab, the patient′s systemic erythema and eyelid edema basically subsided, the muscle zymogram continued to decline, but dysphagia and dysarthria still existed.

A 51-year-old female patient with ovarian cancer was treated with 5 cycles of immunotherapy, targeted therapy, and chemotherapy (pablizumab+bevacizumab+irinotecan+cisplatin), and her disease condition was stable. After that, pabolizumab was changed to toripalimab for 2 cycles because of personal reason. Two days after the last treatments, the patient developed erythema with pruritus, and eyelid edema; 10 days later, symptoms such as dysphagia, dysarthria, and decreased muscle strength appeared. Laboratory tests showed creatine kinase 2 633 U/L, interleukin-6 48.69 ng/L, positive anti-TIF1-γ antibody. Magnetic resonance imaging of limb muscles showed myositis. Electromyography showed myogenic injury of the left deltoid and tibialis anterior muscles. It was considered that the myositis was caused by toripalimab. After 16 days of treatments with methylprednisolone, intravenous human immunoglobulin for intravenous injection, and tocilizumab, the patient′s systemic erythema and eyelid edema basically subsided, the muscle zymogram continued to decline, but dysphagia and dysarthria still existed.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

【Objective】 To investigate the predictive value of high preoperative neutrophile-lymphocyte ratio (NLR) for the prognosis of nonurothelial carcinoma of the bladder (NUBC) after radical cystectomy (RC). 【Methods】 Clinical and follow-up data of NUBC patients undergoing RC during Jan.2005 and Dec.2020 were collected. The optimal cut-off value of NLR was determined with the receiver operating characteristic (ROC) curve. The survival curve was drawn with Kaplan-Meier method to compare the differences in cancer specific survival (CSS) and overall survival (OS) between the high-NLR and low-NLR groups. The independent risk factors of CSS and OS were screened with Cox proportional hazard regression model. 【Results】 Of the 62 eligible cases,34 (54.8%) were diagnosed with adenocarcinoma,17 (27.4%) with squamous cell carcinoma, 6 (9.7%) with small cell carcinoma and 5 (8.1%) with sarcoma. Kaplan-Meier analysis results showed high NLR was associated with poor CSS (P=0.001) and OS (P<0.001). Cox regression results indicated that high NLR (HR=2.42, 95%CI: 1.12-5.23, P=0.025) and advanced pathologic tumor stage (HR=3.21, 95%CI:1.53-6.74,P=0.002) were independent risk factors of unfavorable CSS. Similarly, high NLR (HR=2.75, 95%CI: 1.35-5.56, P=0.005) and advanced pathologic tumor stage (HR=2.81, 95%CI:1.43-5.57, P=0.003) were independent risk factors of unfavorable OS. 【Conclusion】 As an independent risk factor of unfavorable CSS and OS in NUBC patients undergoing RC, high preoperative NLR is of great value in the prediction of long-term prognosis and may help to optimize individualized treatment.

A recurrent misdiagnosed case of congenital left renal arteriovenous fistula (RAVF) with multiple left renal arteries and scoliosis was reported. The patient was admitted to hospital on 29 August 2020 due to repeated hematuria for one year. No abnormality was found in two flexible ureteroscope examinations, imaging and laboratory examinations after admission. It was found that the structure of blood vessels in the inferior pole of renal sinus was disordered, and the blood vessels were tortuous and clustered through careful reading of CT enhancement films. The dilated tortuous blood vessels were also seen around the renal pelvis, and hematuria was considered to be caused by renal vascular malformation. In order to confirm the etiology, digital subtraction angiography (DSA) of renal artery was performed. DSA showed a congenital left renal RAVF with three renal arteries, and the arteriovenous fistula of renal arteries was embolized. For patients presenting with severe gross hematuria, if tumor, stone, tuberculosis, or coagulation abnormalities were excluded by conventional imaging and/or laboratory examination the possibility of congenital renal vascular malformation should be suspected, and DSA examination should be performed. Endovascular embolization is an effective treatment for congenital RAVF.

Solitary kidney, renal duplication and malrotation are rare congenital renal malformations in urology department, and probably contributed to some complications such as obstruction, hydronephrosis, infection, stones. In this case report, we firstly presented a male patient with rarely multiple renal malformations, including solitary kidney, renal duplication, misaligned malrotation of upper and lower moieties, and accompanied by complete staghorn stones and hydronephrosis, who was treated with open pyelolithotomy under general anesthesia. After the operation, obstruction, hydronephrosis, and infection were relieved.

A 66-year-old male patient with anxiety and depression received lorazepam 1 mg twice daily and buspirone 10 mg twice daily. Two months later, the patient developed chills, fever, drowsiness, and stiffness of limbs, etc. Laboratory tests showed white blood cell count 13.5×10 9/L, neutrophils 0.89, C-reactive protein 68.7 mg/L, serum creatinine 211 mmol/L, direct bilirubin 10.3 mmol/L, alanine aminotransferase 96 U/L, aspartate aminotransferase 121 U/L, creatine kinase (CK) 4 557 U/L, CK-MB 83 U/L, lactate dehydrogenase 462 U/L, α-hydroxybutyrate dehydrogenase 339 U/L, and troponin 116 ng/L. Malignant syndrome caused by buspirone was considered. The drug was stopped, lorazepam was continued, and oxygen inhalation, ECG monitoring, physical cooling, anti-infection, and other treatments were given. The patient still had fever and developed deep coma, with brown urine and myoglobin >3 000 mg/L. Secondary rhabdomyolysis was considered. Anti-infection treatment was continued and treatments such as correcting electrolyte balance, alkalizing urine, and diuresis were given. On the 10th day of drug withdrawal, the patient had normal limb activity and urine color, his creatine kinase was 246 U/L, and myoglobin was 856 mg/L. One month later, the laboratory tests showed no obvious abnormalities and no malignant syndrome releted symptoms recurred. The rhabdomyolysis secondary to malignant syndrome in the patient was considered to be possibly related to buspiron and the combination with lorazepam might promote its occurrence.

A 79-year-old male patient with small cell lung cancer (extensive stage) received EC chemotherapy regimen (IV infusions of etoposide 0.1 g on day 1 to 3 and carboplatin 400 mg on day 1) combined with immunotherapy (IV infusion of duvalizumab 620 mg on day 1), and 21 days was a cycle. On the 16th day of the 3rd cycle (the 58th day after the first medication), the patient developed left limb tremor and epilepsy. Biochemical examination of cerebrospinal fluid showed total protein 642 mg/L, white blood cell count 10×10 6/L. Electroencephalogram showed a small amount of sharp waves in bilateral lower temporal lobe. Immune-related encephalitis due to durvalumab was considered. Durvalumab was discontinued, glucocorticoid was given to suppress immune responses, and levetiracetam was given for antiepileptic treatment. Thirty-five days later, no obvious tremor appeared in the left limb and no seizure recurred.

A 66-year-old male patient with anxiety and depression received lorazepam 1 mg twice daily and buspirone 10 mg twice daily. Two months later, the patient developed chills, fever, drowsiness, and stiffness of limbs, etc. Laboratory tests showed white blood cell count 13.5×10 9/L, neutrophils 0.89, C-reactive protein 68.7 mg/L, serum creatinine 211 mmol/L, direct bilirubin 10.3 mmol/L, alanine aminotransferase 96 U/L, aspartate aminotransferase 121 U/L, creatine kinase (CK) 4 557 U/L, CK-MB 83 U/L, lactate dehydrogenase 462 U/L, α-hydroxybutyrate dehydrogenase 339 U/L, and troponin 116 ng/L. Malignant syndrome caused by buspirone was considered. The drug was stopped, lorazepam was continued, and oxygen inhalation, ECG monitoring, physical cooling, anti-infection, and other treatments were given. The patient still had fever and developed deep coma, with brown urine and myoglobin >3 000 mg/L. Secondary rhabdomyolysis was considered. Anti-infection treatment was continued and treatments such as correcting electrolyte balance, alkalizing urine, and diuresis were given. On the 10th day of drug withdrawal, the patient had normal limb activity and urine color, his creatine kinase was 246 U/L, and myoglobin was 856 mg/L. One month later, the laboratory tests showed no obvious abnormalities and no malignant syndrome releted symptoms recurred. The rhabdomyolysis secondary to malignant syndrome in the patient was considered to be possibly related to buspiron and the combination with lorazepam might promote its occurrence.