OBJECTIVE: To investigate the incidence and potential risk factors associated with postoperative spinal epidural hematoma (SEH) following anterior cervical spine surgery (ACSS). METHODS: A retrospective analysis was conducted on the clinical data of patients who underwent ACSS for cervical spondylosis at Peking University Third Hospital between March 2013 and February 2022. Patients who developed postoperative SEH were categorized as the SEH group, while those in the cohort without SEH were randomly selected as the non-SEH group by individually matching with the same operator, same gender, same surgery year, and similar age (±5 years) at a ratio of 4 ∶ 1. The general condition, preoperative comorbidities, anticoagulant or antiplatelet therapy, preoperative coagulation and platelet counts, American society of Anesthesiologists physical status classification, cervical spondylosis classification, preoperative modified Japanese Orthopaedic Society score and cervical disability index score, surgical modality, surgical segment levels, ossification of the posterior longitudinal ligament among the surgical level, surgery duration, estimated blood loss, postoperative drainage volume, preoperative mean arterial pressure, mean arterial pressure during postoperative awakening periods, hospital stay and hospitalization cost were compared between the two groups. A bivariate Logistic regression model was applied to screen out the independent risk factors and calculate the odds ratios of indicators associated with SEH. Receiver operating characteristic curve and area under the curve (AUC) were used to describe the discrimination ability of the indicators. RESULTS: A total of 85 patients were enrolled in the study, including 17 patients in the SEH group and 68 patients in the non-SEH group. Seventeen patients with SEH underwent hematoma evacuation, and all of them were successfully treated and discharged from the hospital. Corpectomy (OR=7.247; 95%CI: 1.962-26.766; P=0.003) and the highest mean arterial pressure during awakening (OR=1.056; 95%CI: 1.002-1.113; P=0.043) were independent risk factors for SEH. The AUC values were 0.713 (95%CI: 0.578-0.848) and 0.665 (95%CI: 0.51-0.82) respectively. The patients with SEH had longer hospital stays (P < 0.001) and greater hospitalization costs (P=0.035). CONCLUSION Corpectomy and elevated maximum mean arterial pressure during awakening are independent risk factors for the development of postoperative SEH following ACSS. High-risk patients should be closely monitored during the perioperative period.
Humans ; Risk Factors ; Cervical Vertebrae/surgery* ; Retrospective Studies ; Hematoma, Epidural, Spinal/epidemiology* ; Incidence ; Male ; Female ; Postoperative Complications/etiology* ; Spondylosis/surgery* ; Logistic Models ; Length of Stay ; Middle Aged

Background The human body is usually exposed to a variety of heavy metals at the same time, and different types and concentrations of heavy metals may have complex interactions during their absorption and metabolism in the human body. Seminal fructose is an important energy source for sperm movement. A large number of studies have shown that metal exposure may impair semen quality, and seminal fructose is an important factor affecting male reproduction, so it is necessary to investigate the relationship between mixed heavy metal exposure and seminal fructose to explore the mechanism of semen quality damage caused by metal exposure. Objective To understand the status of common heavy metal exposure in men of childbearing age in Puyang City, Henan Province, and to study the relationship between mixed exposure to heavy metals and seminal fructose, as well as potential interactions among heavy metals. Methods Volunteers were recruited from the Puyang Maternal and Child Health Hospital Reproductive Center for a cross-sectional survey on general demographic characteristics, smoking, alcohol consumption, and other information. Semen samples were collected to detect 12 metals such as vanadium (V), manganese (Mn), cobalt (Co), nickel (Ni), zinc (Zn), selenium (Se), silver (Ag), cadmium (Cd), barium (Ba), thallium (Tl), iron (Fe), and lead (Pb) in seminal plasma and seminal fructose. After correcting for selected confounding factors, a Bayesian kernel machine regression (BKMR) model was used to evaluate the impact of seminal plasma heavy metal mixed exposure and its interactions on seminal fructose. Results A total of 825 adult males were enrolled. The concentrations in M (P₂₅, P₇₅) of V, Mn, Co, Ni, Zn, Se, Ag, Cd, Ba, Tl, Fe, and Pb in seminal plasma were 0.39 (0.28, 0.54), 12.31 (8.92, 17.52), 0.26 (0.18, 0.38), 5.15 (3.32, 8.64), 182159.80 (121847.80, 199144.50), 13.61 (10.55, 17.68), 0.03 (0.02, 0.04), 0.34 (0.27, 0.46), 8.64 (5.94, 13.43), 0.06 (0.05, 0.08), 168.74 (114.17, 259.45), and 1.69 (1.15, 2.36) μg·L⁻¹ respectively. The Spearman correlation results indicated that there was a negative correlation between V, Mn, Co, Zn, Se, Ba, Tl, or Fe in seminal plasma and seminal fructose (P<0.05), and the values of r (95%CI) were −0.044 (−0.087, −0.001), −0.129 (−0.171, −0.087), −0.055 (−0.099, −0.012), −0.099 (−0.143, −0.056), −0.053 (−0.097, −0.010), −0.068 (−0.111, −0.025), −0.095 (−0.138, −0.052), and −0.082 (−0.125, −0.039), respectively. The results of multiple linear regression indicated that there was a negative correlation between the exposure level of Cd, Mn, Zn, Ag, Ba, Tl, or Fe in seminal plasma and seminal fructose (P<0.05), the values of associated β (95%CI) were −0.551 (−0.956, −0.147), −0.315 (−0.419, −0.212), −0.187 (−0.272, −0.103), −0.161 (−0.301, −0.021), −0.188 (−0.314, −0.062), −1.159 (−2.170, −0.147), and −0.153 (−0.230, −0.076), respectively. The BKMR model analysis showed that seminal fructose level decreased with the increase of plasma metal mixed exposure concentration. Compared with all metal exposure at P₅₀, the seminal fructose level decreased by 0.2374 units when all metal exposure was at P₇₅. Seminal plasma Zn [posterior inclusion probabilities (PIPs)=1.0000] had the strongest effect on seminal fructose, followed by Mn (PIPs=0.5872), Se (PIPs=0.5656), and Ba (PIPs=0.5398). The univariate exposure-response curve showed a negative approximate linear correlations between Ba or Mn and seminal fructose, a positive linear correlation between Se and seminal fructose, and an approximate inverted U-shaped association between Zn and seminal fructose. No significant interaction between studied metals was found. Conclusion Mixed metal exposure may lead to decrease of seminal fructose, in which Zn, Mn, Se, and Ba may play an important role. Mn and Zn exposure may reduce the level of seminal fructose, Se may increase the level of seminal fructose, and there may be a threshold effect between Zn exposure and seminal fructose level. No interaction between different metals on seminal fructose is found.

Objective To discuss the effect and value of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy as urinary diversion after radical cystectomy.Methods The clinical data of 12 cases(7 males and 5 females)with bladder cancer during January 2016 and September 2017 were retrospectively analyzed.The median age was 77 years (range 75-83),and the course of the disease was 5 days to 2 years.11 cases had gross hematuria,5 cases had frequent and urgent urination,1 case had lower abdominal pain,and 1 case had no obvious clinical symptoms.9 cases had a history of transurethral prostatic resection.8 cases had a complication of hypertension,5 cases had a complication of diabetes,7 cases had a complication of cardiovascular and cerebrovascular diseases,and 6 cases had a complication of anemia.The ASA level was 3 in 9 cases and was level 4 in 3 cases.All the patiants were diagnosed of bladder urothelial carcinoma by biopsy.There were 8 cases with T3 tumor and 4 cases with T4.All the patients underwent laparoscopic radical cystectomy under general anesthesia,and wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy was used for urinary diversion.Take a segment of 3-5 cm wide pedicle omentum,which is covered from the distal end of the ureter to the end,and use a 4-0 absorbable line to fix the omentum and ureteral outer membrane,and then perform ureterocutaneostomy.The incidence of postoperative anastomotic stenosis,hydronephrosis and wound infection were observed.Results All the operations were performed successfully without obvious operative complications.The mean operating duration was125 (95-217) mins,estimated volume of blood loss 120 (50-600)ml.5 days after surgery,1 patient developed incision infection,which was cured by strengthening anti-infection drug therapy and wound dressing.No complications such as urinary fistula,intestinal fistula and peripheral hernia occurred.No death was reported during perioperative period.Single J tube was removed 1-3 months after surgery.Within a follow-up of 12 (3-23) months,1 case died of cerebral infarction 3 months after surgery,1 case occurred papilla light constriction without special treatment,no ureteral stenosis and necrosis cases and there were no cases of hydronephrosis.All the patients were satisfied with the quality of life after surgery.Conclusions Wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy is simple,safe and effective as urinary diversion after radical cystectomy.

Objective To investigate the experience in management of the high risk benign prostatic hyperplasia (BPH) patients in order to improve the safety of the operation.Methods The high-risk factors of 115 patients with BPH who had been treated with transurethral resection of prostate (TURP) were analyzed.The blood pressure of hypertensive patients should be controlled below 140/90 mm Hg.The patients with myocardial infarction should be in stable condition for more than 6 months.Smoking cessation,oxygen inhalation,and pulmonary function training should be carried out during the perioperative period in patients with chronic obstructive pulmonary disease,correct expectoration methods and rational use of antibiotics were also needed to improve the maximum amount of pulmonary ventilation to more than 70％.The blood-glucose of diabetic patients should be controlled below 8 mmol/L by insulin.Catheter was indwelled in patients with chronic obstructive renal insufficiency for more than 2 weeks so that the blood Cr could be below 130 μmol/L.Anticoagulant therapy should stop at least 5 days before surgery.Patients were encouraged to have physical training early after surgery and to have ankle stretch movement when they recovered form anesthesia,and pressure cycle drive therapeutic apparatus were also used to prevent deep venous thrombosis.Results All the patients tolerated TURP safely.Operation time was 30 to 60 min,the weight of the resection prostate tissue was 12 to 37 g,blood loss was 80 to 150 ml,and catheterization time was 3 to 7 days.The overall incidence of complications was 1.7％.There were 2 cases with deep venous thrombosis,who recovered after anticoagulant therapy.There were no pulmonary infection,bleeding,TUR syndrome,and other complications.Conclusion Correct analysis and effective management of the perioperative risk factors in high-risk BPH patients treated with TURP can improve the safety of the operation and reduce the complications.

Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.

Objective To report the safety and efficacy of partial nephrectomy (PN) in 56 patients with renal tumors. Methods A retrospective analysis was performed for 56 patients who were treated with PN.Patients were divided into two groups according to the occlusion time.The occlusion time for Group 1 was≤30 min in 28 cases,and Group 2＞30 min in 28 cases.All patients underwent pre-and post-operation 99Tcm-diethylenetriamine pentoacetic acid renal scintigraphy, to determine the renal glomerular filtration rate (GFR).The GFR values, amount of blood loss during operation,operative time,postoperative hospital stay and the complications rate were compared between the two groups prior to surgery and one week and six months post-surgery.All patients were followed-up.Results The average follow-up time was 36 (30-48) months.The overall survival rate and tumor recurrence-free survival rate were 100% and 98%.There was no significant difference between vessel clamp time≤30 min and＞30 min in the amount of intraoperative blood loss,operative time,postoperative hospital stay and complications rate,P values were 0.266,0.487,0.879 and 1.000.The preoperative and 1 week postoperative GFR values of the two groups were (42.9±4.9) and (34.2±4.9),(42.8±5.6) and (30.4±5.2) ml/min.The difference was significant(P=0.007).The GFR values were (41.2±4.3)ml/min at 6 months after surgery for Group 1,compared with that before surgery,but the difference was not significant (P＞0.05).While the GFR values were (38.1±5.0) ml/min for Group 2,and the GFR for Group 2 did not recover to the preoperative level (P=0.001). Conelusions PN for renal tumors could be a safe and effective treatment option.The damage on renal function could be minimal when the renal artery clamping time is controlled to within 30 min.

0bjective To observe the cell membrane penetration of protein transduction domain (PTD)-HBeAg fusion protein in vitro.Methods The sequence of trans-activator of transcription (Tat)-PTD was synthesized and the whole HBcAg gene was amplified by polymerase chain reaction (PCR).Overlap extension PCR was employed to fuse Tat-PTD and whole HBcAg gene.Then the fusion gene was cloned into prokaryotic expression vector pMAL-c2X.The correct vector was transformed into E.coli Rosetta-gamiTM 2(DE3),and the protein was induced by isopropyl β-D-1-thiogalactopyranoside(IPTG).Western blot was used tO identify the protein. Furthermore,the fusion protein PTD-HBcAg was purified by affinity chromatography.HBcAg protein expressed using the same methods was employed as eontr0l.The purified protein was added tO HuH-7 cell culture,then the transduction of PTD-HBcAg and HBcAg in cells were detected by indirect immunofluorescence assay (IFA).Results The fusion protein was effectively expressed in E. Coli and purified by affinity chromatography.Both purified PTD-HBcAg and HBcAg could be recognized by HBeAg monoclonal antibody in Western blot analysis.IFA visualization showed that PTD-HBeAg could be introduced into HUH-7 ceils while HBcAg only could not be detected in cells.Conclusions PTD-HBcAg fusion protein can be expressed effectively and purified in prokaryotic expression system.PTD could mediate HBcAg penetrating eell membrane into the cells.

There are numerous studies on transepithelial transports in duct cells including Cl and/or HCO3. However, studies on transepithelial K transport of normal duct cells in exocrine glands are scarce. In the present study, we examined the characteristics of K currents in single duct cells isolated from guinea pig pancreas, using a whole-cell patch clamp technique. Both Cl and K conductance were found with KCl rich pipette solutions. When the bath solution was changed to low Cl, reversal potentials shifted to the negative side, 75 4 mV, suggesting that this current is dominantly selective to K. We then characterized this outward rectifying K current and examined its Ca2 dependency. The K currents were activated by intracellular Ca2. 100 nM or 500 nM Ca2 in pipette significantly (P< 0.05) increased outward currents (currents were normalized, 76.8 7.9 pA, n=4 or 107.9 35.5 pA, n=6) at 100 mV membrane potential, compared to those with 0 nM Ca2 in pipette (27.8 3.7 pA, n=6). We next examined whether this K current, recorded with 100 nM Ca2 in pipette, was inhibited by various inhibitors, including Ba2, TEA and iberiotoxin. The currents were inhibited by 40.4 % (n=3), 87.0 % (n=5) and 82.5 % (n=9) by 1 mM Ba2, 5 mM TEA and 100 nM iberiotoxin, respectively. Particularly, an almost complete inhibition of the current by 100 nM iberiotoxin further confirmed that this current was activated by intracellular Ca2. The K current may play a role in secretory process, since recycling of K is critical for the initiation and sustaining of Cl or HCO3 secretion in these cells.
Animals ; Baths ; Exocrine Glands ; Guinea Pigs ; Membrane Potentials ; Pancreas ; Pancreatic Ducts* ; Recycling ; Secretory Pathway ; Tea