A case of an adult patient who was admitted to the hospital with the primary complaint of dysuria was presented. CT imaging of the urinary tract revealed incomplete duplication of the bladder, accompanied by multiple diverticula in the left bladder. Urodynamic studies indicated low detrusor contraction of the bladder. Cystoscopy revealed that the left bladder was connected to the urethra, with both bladders linked by a narrow connection. Laparoscopic expansion of this junction alleviated dysuria; however, it did not significantly reduce bladder residual volume during the short-term follow-up.

A case of an adult patient who was admitted to the hospital with the primary complaint of dysuria was presented. CT imaging of the urinary tract revealed incomplete duplication of the bladder, accompanied by multiple diverticula in the left bladder. Urodynamic studies indicated low detrusor contraction of the bladder. Cystoscopy revealed that the left bladder was connected to the urethra, with both bladders linked by a narrow connection. Laparoscopic expansion of this junction alleviated dysuria; however, it did not significantly reduce bladder residual volume during the short-term follow-up.

Objective To explore the differences in efficacy and safety of drug selection based on pharmacogenomics and evidence-based medicine for treatment-resistant schizophrenia(TRS).Methods A total of 100 patients with TRS in our hospital from January 2023 to October 2023 were divided into observation group(gene-oriented antipsychotic drug selection group,22 males and 28 females)and control group(evidence-based medicine oriented antipsychotic drug selection group,23 males and 27 females).Oral mucosal epithelial cells of the observation group were noninvasive collected with a sampling brush and antipsychotic drug gene detection was performed.Antipsychotic drugs with normal metabolism,good response and little toxic side effects were selected according to the test results,and the drugs of the control group were selected by the designated physician on the basis of the Chinese Guidelines for the Prevention and Treatment of Schizophrenia,2015 revision.Antipsychotic efficacy was evaluated before treatment and 4 weeks,8 weeks after treatment with positive and negative syndrome scale(PANSS).Treatment emergent symptom scale(TESS)was used to assess adverse reactions at the 4th and 8th weekend after treatment.Results After 8 weeks of treatment,the incidence of adverse reactions in central nervous system,autonomic nervous system,endocrine system,circulatory system and digestive system in the control group was higher than that in the observation group.The difference was remarkable.The scores of positive symptoms,negative symptoms and general psychopathological symptoms between the observation group and the control group at baseline were basically the same(P>0.05).After 4 weeks of treatment,the scores of positive symptoms,negative symptoms and general psychopathological symptoms in the observation group were lower than those in the control group.The difference was remarkable.After 8 weeks of treatment,the scores of positive symptoms,negative symptoms and general psychopathological symptoms in the observation group were lower than those in the control group.The difference was remarkable.At the end of the 8th week after treatment,the effective rate of the observation group was higher than that of the control group,the difference was remarkable(44%vs.24%,P=0.035).Two-factor repeated measurement analysis of variance was used,indicating that PANSS scores of the two groups changed with time at baseline,4 weeks and 8 weeks after treatment,and the difference was remarkable(F-time=697.139,P<0.05);The difference of PANSS among groups was remarkable(F-groups=5.398,P<0.05);PANSS score was different with different treatment methods,and the difference was remarkable(F-interaction=3.008,P<0.05).Conclusion Gene-directed antipsychotic selection maybe is superior to evidence-based antipsychotic selection in improving effective rate and reducing adverse drug reactions.

Objective:To compare the perioperative analgesic efficacy of ultrasound-guided serratus plane block (SPB) with pectoral nerves Ⅱ (Pecs Ⅱ) block in patients undergoing modified radical mastectomy for breast cancer under general anesthesia.Methods:Sixty female patients, aged 20-60 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for modified radical mastectomy for breast cancer, were divided into 2 groups ( n=30 each) using a random number table method: SPB group (group S) and Pecs Ⅱ block group (group P). Both groups received ultrasound-guided nerve block with 0.5% ropivacaine 20 ml before induction of general anesthesia.The patients in both groups received patient-controlled intravenous analgesia.Tramadol 100 mg was intramuscularly injected as rescue analgesic.The block status of each segmental dermatome, comsumption of intraoperative remifentanil and analgesics (sufentanil in patient-controlled intravenous analgesia and rescue analgesics) within 24 h after operation, duration of nerve block, Horner syndrome, and complications such as respiratory depression, nausea and vomiting within 24 h after operation were also recorded. Results:Compared with group S, the block rate of T 5-T 7 dermatome and consumption of sufentanil after surgery were significantly decreased ( P<0.01), and no significant change was found in the consumption of remifentanil and duration of nerve block in group P ( P>0.05). No rescue analgesic was used and no nerve block-related complications and postoperative complications were found in either group. Conclusions:The ultrasound-guided Pecs Ⅱ block provides better efficacy than SPB in the patients undergoing modified radical mastectomy for breast cancer under general anesthesia.

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is a common respiratory disease in clinic, and with a pathological manifestation of pulmonary edema, decreased pulmonary compliance as well as pulmonary epithelial/endothelial cells injury. At present, it was suggested that systemic inflammatory response syndrome (SIRS) caused by various causes which play an important role in the occurrence and development of ALI/ARDS. Widely activated neutrophils can migrate to lung tissue and release plenty of proteases in the procedure of SIRS, including neutrophil serine proteases (NSPs), lysozyme, myeloperoxidase and collagenase, which can induce severe lung injury. Meanwhile, NSPs, such as neutrophil elastase (NE), cathepsin G (CG), proteinase 3 (PR3) and neutrophil serine proteinase 4 (NSP4), are important in the pathogenesis of ALI/ARDS. Therefore, Serpins may protect lung tissue by inhibiting NSPs. However, the specific mechanism of Serpins is not totally clear. In this article, we will discuss the mechanism of action of NSPs in the inflammatory response of ALI/ARDS, the structural overview of Serpins, the primary role of Serpins in ALI/ARDS,such as the inhibition of NSPs activity, other roles of Serpins in ALI/ARDS, such as the inhibition of inflammatory factor release, regulation of apoptosis and protection of vascular endothelial cells and pulmonary surfactant-associated glycoprotein D (SP-D), and the clinical application of exogenous Serpins in ALI/ARDS to explore the role of Serpins in the pathogenesis of ALI/ARDS. The aim is to provide new ideas and strategies for the clinical treatment of ALI/ARDS.

In the recent years, the damage of the spleen has been increased due to trauma or neoplastic diseases. Traditional view holds the point that the damaged spleen should be completely removed, but with the development of spleen surgery, the important physiological function of the spleen has been widely recognized, and partial splenectomy has been well recognized by the surgeons. This paper summarized the clinical experience in partial splenectomy and raised some technical points.

Objective:To explore the clinical value of peripheral blood lymphocyte subsets in the differential diagnosis of BK virus nephropathy (BKVN) in renal transplantation recipients.Methods:From 2014 to 2018, a total of 172 renal transplant recipients were recruited. Their peripheral blood lymphocyte subsets were detected. According to the pathological puncture results of transplanted kidney, they were divided into acute rejection group (AR, n=68), BKVN group ( n=73) and stable graft function group (STA, n=31). The proportion and absolute number of peripheral blood lymphocyte subsets in each group were measured by flow cytometry and the proportion and absolute count of peripheral blood lymphocyte subsets in each group compared. Results:The proportion and absolute number of CD19 + B cells were markedly lower in BKVN group than those in AR group ( P=0.005, 0.003; 8.5% vs 13.2%, 0.094×10 9/L vs 0.202×10 9/L) and STA group ( P=0.005, 0.003; 8.5% vs 14.8%, 0.094×10 9/L vs 0.198×10 9/L); the proportion of CD3 + CD8 + T cells was significantly higher in BKVN group than that in AR group ( P=0.013; 36.9% vs 31.2%). In addition, no obvious difference existed in the proportion and absolute number of lymphocytes, CD3 + T, CD3 + CD4 + T and CD16 + CD56 + natural killer (NK) among three groups ( P>0.05). No obvious difference existed in the proportion of CD3 + CD4 + / CD3 + CD8 + T cells among three groups ( P>0.05). Conclusions:No difference exists in T cell-related lymphocyte subsets between BKVN and acute rejection recipients. However, the number and proportion of CD19 + B cells decrease markedly in BKVN.

Objective To assess the protective effect of the normobaric oxygen (NBO)and hyperbaric oxygen (HBO)on the acute ischemic stroke of rat using MR diffusion weighted imaging (DWI).Methods 30 adult male SD rats were subjected to right middle cerebral artery occlusion (MCAO)model using the suture method and transferred into a MRI scanner at 30 minutes after the onset of MCAO,then 30 rats were randomly divided into 3 groups (n=10 in each group),control,NBO and HBO group.NBO group rats were exposed to 100% oxygen for 2 hours,HBO group rats were administrated with hyperbaric oxygen for 2 hours respectively at 45 minutes after the onset of MCAO.Brain MRI scanner was performed at 12 h after the onset of MCAO,then pathological change of brain tissue was observed with hematoxylin-eosin (HE)staining and compared with DWI-infarct lesion.The relative cerebral infarction area and relative apparent diffusion coefficient (rADC)values of every group were measured on ADC maps.Results High signal intensity on MRI was found in the right cerebral ischemic region on DWI in three groups.The increased rates of the infraction lesion area in both NBO and HBO group were lower than that in control group (P<0.01),however,there was no significant difference between NBO and HBO group (P>0.05).The reduction rates of rADC in NBO and HBO group were significantly less than that in the control group (P<0.01),however,there was no significant difference between NBO and HBO group (P>0.05).HE staining confirmed that the cerebral infraction occured in three groups.There were significant positive correlations of the relative infarction lesion area between HE staining and DWI at 12 h after MCAO in three groups (P<0.01).Conclusion MRI shows that NBO and HBO could reduce the growth rates of cerebral infarction lesion area and the reduction rates of rADC,which proves that NBO and HBO have the neuroprotective effect on acute ischemic stroke of rats.

Objective To evaluate the efficacy and safety of mesenchymal stem cells(MSCs)in preventing early acute rejection after renal transplantation.Methods Eighty-eight primary cadaveric renal allograft recipients in our department were randomized into two groups treated with bone marrow MSCs (BMSCs group,n =43) or not (control group,n =45).Main immunosuppressive therapy regimen consisted of steroids,tacrolimus or cyclosporine and mycophenolate mofetil in all recipients.Estimated glomerular filtration rate (eGFR) of transplant kidney,incidence of acute reaction (AR),graft survival and incidence of adverse events were recorded within 24 months.Results In BMSCs group,the incidence of AR was 4.7 ％ and 9.3 ％ at 3rd month and 6th month respectively,significantly lower than 20.0 ％ and 26.7 ％ (P＜0.05) in the control group.The eGFR at day 7,14and 30 post-transplantation was significantly higher in the BMSCs group than in the control group (P＜0.01,P＜0.01,P＜0.05 respectively).The incidence of adverse events in the BMSCs group and the control group was 44.2 ％ (19/43) and 66.7 ％ (30/45,P ＜ 0.05) respectively and the rate of infection was 37.2 ％ (16/43) and 33.3 ％ ( 15/46,P ＞ 0.05) respectively within 24 months.Conclusion Induction therapy with autogenous BMSCs appeared to be more effective in the prevention of AR following cadaveric kidney transplantation and was associated with better clinical outcomes as far as early renal graft function without compromising patient safety.

Objective To evaluate the life quality in front and at the back of the cure of the floating population tuberculosis patients.Methods The SF-36 scale was applied to the new smear-positive pulmonary tuberculosis patient in floating population using face to face interview in Shenzhen 6 districts.The contrast was tuberculosis patient in the population of the household register,the people stayed temporarily in the same term.Results The score of general health(43.36 ± 15.67),vitality(57.96 ± 16.54) and mental health(61.46 ± 14.26) in the floating population was lower than the appraisal result with the population of the household register(49.28 ± 17.85,66.38 ± 17.03 and 66.70 ± 15.12),the people stayed temporarily(45.00 ± 17.22,60.99 ± 16.59 and 63.13 ±13.71 ) (P ＜ 0.05 ).It was still lower than the other two groups after 2 (3) months and 6 (7) months (P ＜ 0.05 ).But the score of social functioning in floating population ( 88.92 ± 14.88 ) was higher than the other two groups (82.62 ± 14.44,68.02 ± 27.30).The change rate of general health ( (76.05 ± 132.82) ％,(69.32 ± 111.98 ) ％and (48.36 ± 101.31 ) ％ ) and social functioning scores( (46.49 ± 85.18 ) ％,( 26.33 ± 50.25 ) ％ and ( 51.09±73.44)％ ) were significant difference in the three groups(x2 =12.088,P=0.002;x2 =11.611,P=0.003).The change rate of the general health score in floating population was higher than the household register population and people stayed temporarily.Conclusion It is necessary to implement the management in whole course to the floating population tuberculosis patients.