Objective:To investigate the effectiveness, safety and feasibility of transumbilical laparoendoscopic single-site surgery (TU-LESS) for abdominal wall endometriosis (AWE) lesion resection.Methods:A total of 11 patients who underwent AWE lesion resection via TU-LESS at The First Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were enrolled. The size, invasion depth of the lesion, horizontal distance from the lesion center to the original surgical scar, vertical distance from the lesion to the skin, body mass index (BMI), the thickness of abdominal wall fat, operative time, intraoperative blood loss, perioperative complications, postoperative pathology, postoperative incision healing and recurrence were recorded and analyzed.Results:All 11 patients in this study had a history of cesarean section, 10 of whom had transverse incision and 1 had longitudinal incision. The age was (35.0±6.2) years old. BMI was (25.0±4.0) kg/m 2, with the highest being 33.9 kg/m 2. The lesion size was (24.7±12.1) mm, with an average horizontal distance from the lesion center to the original surgical scar of (11.6±6.0) mm. The abdominal wall fat thickness was (21.4±5.8) mm, and the vertical distance from the lesion to the skin was (14.5±7.9) mm. There were a total of 12 lesions in the 11 patients. Among them, 1 lesion extended to the peritoneum inferiorly, 5 lesions extended to the rectus abdominis inferiorly, 5 lesions reached the anterior sheath of the rectus abdominis inferiorly, and 1 lesion was completely located within the abdominal wall fat. The operative time was (84.2±35.4) minutes, and the intraoperative blood loss was (9.0±4.2) ml. The postoperative incision healing of all patients was grade A. The anatomical structure of their umbilical region remained normal, free from any scarring, which contributed to the high satisfaction levels expressed by the patients. Postoperative pathological examination confirmed endometriosis with negative surgical margins, and no recurrence had been observed during follow-up. Conclusion:TU-LESS for AWE lesion resection is safe and feasible, particularly suitable for patients with lesions located far from the original surgical scar, deep lesion location, thick abdominal wall fat, and multiple focal leisons.

Objective:To investigate the effectiveness, safety and feasibility of transumbilical laparoendoscopic single-site surgery (TU-LESS) for abdominal wall endometriosis (AWE) lesion resection.Methods:A total of 11 patients who underwent AWE lesion resection via TU-LESS at The First Affiliated Hospital of Nanjing Medical University from January 2022 to May 2024 were enrolled. The size, invasion depth of the lesion, horizontal distance from the lesion center to the original surgical scar, vertical distance from the lesion to the skin, body mass index (BMI), the thickness of abdominal wall fat, operative time, intraoperative blood loss, perioperative complications, postoperative pathology, postoperative incision healing and recurrence were recorded and analyzed.Results:All 11 patients in this study had a history of cesarean section, 10 of whom had transverse incision and 1 had longitudinal incision. The age was (35.0±6.2) years old. BMI was (25.0±4.0) kg/m 2, with the highest being 33.9 kg/m 2. The lesion size was (24.7±12.1) mm, with an average horizontal distance from the lesion center to the original surgical scar of (11.6±6.0) mm. The abdominal wall fat thickness was (21.4±5.8) mm, and the vertical distance from the lesion to the skin was (14.5±7.9) mm. There were a total of 12 lesions in the 11 patients. Among them, 1 lesion extended to the peritoneum inferiorly, 5 lesions extended to the rectus abdominis inferiorly, 5 lesions reached the anterior sheath of the rectus abdominis inferiorly, and 1 lesion was completely located within the abdominal wall fat. The operative time was (84.2±35.4) minutes, and the intraoperative blood loss was (9.0±4.2) ml. The postoperative incision healing of all patients was grade A. The anatomical structure of their umbilical region remained normal, free from any scarring, which contributed to the high satisfaction levels expressed by the patients. Postoperative pathological examination confirmed endometriosis with negative surgical margins, and no recurrence had been observed during follow-up. Conclusion:TU-LESS for AWE lesion resection is safe and feasible, particularly suitable for patients with lesions located far from the original surgical scar, deep lesion location, thick abdominal wall fat, and multiple focal leisons.

Objective To analyze the deep venous thrombosis(DVT)after plasma infusion in a patient with congenital dysfibrinogene-mia(CD),and explore the relationship between the CD and DVT.Methods The clinical data were collected and the pedigree was investigated(3 subjects of 2 generations in total).The relevant indexes of coagulation factors of the patient and her family members were detected.The genomic DNA of peripheral blood was extracted for PCR amplification.All the exons,flanking sequences,5'and 3'untranslated regions of FGA,FGB and FGG genes of fibrinogen(Fg)of the patient were analyzed by direct sequencing.The corre-sponding mutation site was subjected to sequence in the other members of this family.The PyMol software was used to construct the pro-tein model before and after gene mutation.Results The patient was admitted to hospital for hysteromyomectomy.DVT appeared in 3 days after surgery.The prothrombin time(PT),thrombin time(TT),Fg activity(Fg∶C)and Fg antigen(Fg∶Ag)of the patient was 14.9 s,33.3 s,0.94 g/L and 2.10 g/L,respectively.The above four indicators in her mother were 14.7 s,32.8 s,0.97 g/L and 2.35 g/L,respectively.Gene sequencing revealed that both the patient and her mother had a heterozygous missense mutation c.2185G＞A(p.Glu729Lys)in exon 6 of the FGA gene.The protein model analysis demonstrated that p.Glu729Lys mutation changed the amino acid side chain and reduced the number of hydrogen bonds originally formed with Arg854.Conclusion A heterozygous missense mutation c.2185G＞A(NM_000508)in exon 6 of the FGA gene should be responsible for the low fibrinogen level in this pedigree,which might be the main reason for DVT after plasma infusion in this patient.

Objective:To investigate the correlation between serum proprotein convertase subtilisin/Kexin type 9 (PCSK9) level and white matter hyperintensities (WMHs) in healthy population.Methods:Consecutive healthy individuals underwent routine physical examinations at the Department of Neurology, Jinling Hospital Affiliated to Medical School of Nanjing University (April 2023 to December 2023) and Hexi Branch of Nanjing First Hospital (March 2024 to April 2024) were included prospectively. Enzyme-linked immunosorbent assay was used to detect serum PCSK9 level. The Fazekas scale was used to assess the severity of WMHs (total score 0-6) and they were divided into no or mild WMHs group (0-2) and moderate to severe WMHs group (3-6). Multivariate logistic regression analysis was used to determine the independent correlation between the serum PCSK9 level and the severity of WMHs. Results:A total of 177 subjects were enrolled, including 110 males (62.1%), aged 66.7±10.1 years. The median serum PCSK9 level was 203.9 ng/L. According to the Fazekas score, there were 102 patients (51.6%) in the no or mild WMHs group, and 75 (42.4%) in the moderate to severe WMHs group. One way analysis of variance showed that serum PCSK9 level significantly increased with the increase of WMHs total score ( P=0.001). The serum PCSK9 level in the moderate to severe WMHs group was significantly higher than that in the no or mild WMHs group (437.2±260.4 ng/L vs. 217.9±141.7 ng/L; P=0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, and other confounding factors, there was a significant independent correlation between higher serum PCSK9 level and moderate to severe WMHs (odds ratio 3.201, 95% confidence interval 2.107-5.082; P=0.001). Conclusion:Higher serum PCSK9 level is an independent risk factor for moderate to severe WMHs in healthy individuals.

Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.

Objective To investigate the effect of replacing a smaller-size catheter after tubularized incised plate (TIP) urethroplasty on postoperative urethral complications.Methods The data of 116 hypospadias patients underwent TIP urethroplasty performed by the same urologist in our hospital from January 2014 to December 2017 were retrospectively analyzed.The age of patients ranged from 0.5-15.4 years,with the median age of 1.5 years.Meatal location was distal in 47 (39.5％),midshaft in 62 (52.1％) and proximal in 10(8.4％) patients.Unhealthy urethral plate occurred in 49 (42.2％) patients.F8 catheter was used for urethroplasty in 92 (79.3 ％) patients,F10 in 17 (14.7％),and F12 in 7 (6.0％).According to the pattern of urinary diversion,patients were divided into two groups.Conventional catheter group in 56 patients (group A):the catheter was chosen in as large size as possible for urethroplasty without tension.Replace a smaller-size catheter group in 60 patients (group B):replace a smaller-size catheter after urethroplasty on the basis of group A.There were no statistically significant differences in age,meatal location and catheter size between the two groups (P ＞ 0.05).Results The mean follow up was 23 months (range 6-66 months).There were 73(62.9％) cases of orifice overflow during indwelling catheterization.There were 5 (4.3％) patients needed further reoperation result from postoperative urethral complications,including 4 cases of fistula and 1 case of meatal stenosis.The process of replacing a smaller-size catheter after urethroplasty in group B was simple and without adverse reactions.There were 15 (26.8％) cases of orifice overflow in group A and 58 (96.7％) in group B.There were statistically significant differences in orifice overflow between the two groups (P ＜ 0.05).There were 5 (8.9％) cases of postoperative urethral complications in group A and 0 case in group B.There were statistically significant differences in postoperative urethral complications (P ＜ 0.05).Conclusions The process of replacing a smaller-size catheter after TIP urethroplasty in was simple and subsequently contributed to less postoperative urethral complications.The results of replacing a smaller-size catheter after TIP urethroplasty were superior to that of no replacing conventionally.

Objective Cerebral microbleeds (CMBs) are important indicators of cerebral small vessel disease .However, it is still unclear whether endothelial dysfunction is involved in CMBs .The aim of this study is to investigate the correlation between CMBs and soluble E-selectin (sE-selectin) in patients with acute ischemic stroke . Methods Based on the results of MRI (3.0 T) susceptibility weighted imaging , we divided patients with first acute ischemic stroke into a CMBs group ( n=63 ) and a non-CMBs group (n=63), and recruited another 45 volunteers with normal MRI findings as controls .We collected and conducted comparative a-nalysis on the demographic data , biochemical variables ( including the sE-selectin level ) , vascular risk factors , and the number of CMBs of the patients . Results Ordinal logistic regression analysis showed a significantly positive correlation between sE -selectin and the number of CMBs (OR=1.062, 95%CI:1.023-1.103, P=0.002), higher systolic blood pressure associated with more CMBs (OR=1.014, 95%CI:1.002-1.025, P=0.021). Conclusion Serum sE-selectin is significantly positively correlated with and can be used as a biological marker for the severity of CMBs .