Objective:To investigate the effect of gracilis flap in repair of radiation-induced vesicovaginal fistula.Methods:The data of 18 patients with radiation-induced vesicovaginal fistula treated in the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2021 to August 2022 were retrospectively reviewed. Their age was (57.3±10.4) years. All patients underwent radical surgery for cervical cancer, and received (24.6±2.8)(range from 20 to 30)times of radiotherapy after surger. The median time between the end of radiotherapy and the onset of vesicovaginal fistula was 14.0(7.8, 18.2)months. The median duration of fistula urine was 12.0(9.8, 18.0)months. All patients were required to use median 19.5(15.8, 27.5) pads per day before surgery. The life quality score(QOL)of 18 cases was median 5.0(5.0, 6.0) points. Three cases had performed laparoscopic vesicovaginal fistula repair, two cases had underwent transvaginal vesicovaginal fistula repair, one case had underwent transvaginal and laparoscopic vesicovaginal fistula repair successively, and the remaining 12 cases were new vesicovaginal fistulas. Two cases were combined with rectovaginal fistulas. All patients underwent the repair of vesicovaginal fistula with gracilis flap interposition in prone and folded knife position, by transvaginal route, the vesicovaginal fistula was mobilized and the two layers were closed, and the vascular pedicle gracilis flap of left inner leg was romoved under the skin tunnel to repair the vesicovaginal fistula. Meanwhile, two cases combined rectovaginal fistulas were repaired and closed the rectovaginal fistulas. The urinary catheters were removed at 3 weeks after the operation and urination was recorded.Results:All patients underwent smooth surgery in (96.6±13.2) minutes. The median follow-up was 13.0(9.8, 20.2)(range from 6 to 24)months. The median number of urine pads used per day in 18 patients was 2.0(1.0, 11.8), and significantly reduced ( P<0.01).QOL score was median 1.0(0, 4.2) point and significantly reduced ( P<0.01).Successful outcome was achieved in 12 patients with no leakage of urine in the vagina. Two cases developed urinary incontinence and required conservative treatment, but the curative effect was poor. Two cases still had vaginal urine leakage performed vesicovaginal fistula repair again. One case was successfully repaired without significant urine leakage.The other case still had significant urine leakage and the QOL score was 3 points. She refused further treatment for self-satisfied. Two cases still had vesicovaginal fistula and rectovaginal fistula after the surgery, and refused further surgery. Conclusions:Repair with gracilis flap interposition is a surgical method with few complications and reliable surgical effect for patients with radiation-induced vesicovaginal fistula.

OBJECTIVE To investigate the pharmacokinetic characteristics of crossbow microemulsion in rabbit skin.METH-ODS The concentrations of chlorogenic acid,benzoyl new aconitine,periplocin and new aconitine were determined by UPLC.The effects of temperature,perfusion speed and mass concentration on the recovery rate of the probe were investigated by incremental and decrement methods,the changes of multi-component content in the dialysate at different time points after transdermal administration of crossbow microemulsion were determined by UPLC,and DAS 2.0 software was used to process the data.RESULTS The recovery rate of the probe increased with increasing temperature,and the higher the flow rate,the lower the recovery rate.The pharmacokinetic parameters of chlorogenic acid,benzoyl new aconitine,periplocin and new aconitine in microemulsion Cmax were(3.24±0.39)(1.04±0.29)(4.78±2.15)(2.86±0.55)μg·mL-1,respectively,and in AUC0-∞ were(52.42±30.84)(7.70±3.73)(42.23±13.93)(22.68±12.51)h·mg·mL-1,respectively.CONCLUSION A real-time in vivo microdialysis sampling technique was first used and a UPLC detection technique was established to study the skin pharmacokinetics of multi-components of crossbow microe-mulsion after transdermal administration,which provides a reference for the follow-up investigation and application of crossbow microe-mulsion.

Objective:To further elucidate the pathogenesis of hemifacial spasm by analyzing blinking reflex characteristics.Methods:A total of 63 patients with hemifacial spasm (hemifacial spasm group) who underwent neuroelectrophysiological evaluation in Department of Neurological Electrophysiology, Guizhou Provincial People's Hospital from January 2021 to December 2022 were included as study subjects. Additionally, 58 patients with primary trigeminal neuralgia (trigeminal neuralgia group), 8 patients with post-facial paralysis associated exercise (post-facial paralysis associated exercise group), and 20 healthy volunteers (normal group) were selected as controls. Differences in facial nerve motor conduction velocity, complex muscle action potential latency, and blinking reflex characteristics including R1 latency, R1 amplitude, R2 initiation latency, R2 amplitude, R2 terminal latency, R2' initiation latency recorded on the affected side, R2' amplitude recorded on the affected side, and R2' terminal latency recorded on the affected side were collected and compared. Severity of hemifacial spasm was graded from grade 1 to grade 4 according to Samsung Medical Center scoring system; based on microvascular decompression findings regarding responsible blood vessels contacted with the facial nerve, patients were divided into one responsible blood vessel group and two or more responsible blood vessels group; trends or differences in incidences of increased/prolonged blink reflex indexes among all groups were analyzed.Results:No significant difference in facial nerve motor conduction velocity or complex muscle action potential latency was noted among the 4 groups ( P>0.05); the hemifacial spasm group had significantly higher R1 amplitude than the trigeminal neuralgia group and post-facial paralysis associated exercise group; additionally, the hemifacial spasm group had significantly higher R2 amplitude, R2' amplitude recorded on the affected side, R2 terminal latency, and R2' terminal latency recorded on the affected side compared with the other 3 groups ( P<0.05). Among patients with varying degrees of hemifacial spasm, increased incidences of increased R1 amplitude and prolonged R2 terminal latency were noted with increased spasm degrees, enjoying significant differences ( P<0.05). No significant differences in incidences of increased R1 amplitude, increased R2 amplitude, prolonged R2 terminal latency, increased R2' amplitude recorded on the affected side or prolonged R2' terminal latency recorded on the affected side were noted between one responsible blood vessel group and two or more responsible blood vessels group ( P>0.05). Conclusion:Increased R1 amplitude and prolonged R2 latency in patients with hemifacial spasm further substantiate the pathogenesis of hyperexcitability within facial nerve nucleus.

【Objective】 To evaluate the safety and efficacy of transobturator bulbourethral suspension with modified four-armed pelvic sling for post-prostatectomy incontinence (PPI). 【Methods】 The clinical data of 78 male PPI patients treated during Jan.2012 and Dec.2017 in our hospital were collected. The incontinence quality of life (I-QOL) score, daily use of urine pad, 1-hour urine pad test, residual urine volume (RUV), and maximum flow rate (Qmax) were assessed before and after surgery. 【Results】 The total success rate was 79.5%, of which the cure rate was 56.4% and the improvement rate was 23.1%. The preoperative I-QOL score was (54.6±3.9), daily use of urinary pad was (3.6±0.7), and increase in weight of the 1-hour urine pad test was (33.6±5.0) g. Three years after surgery, the I-QOL score was (80.4±5.7), daily use of a urinary pad was (1.9±0.4), and increase in weight of the 1-hour urine pad test was (7.4±1.3) g. Compared to preoperative status, the I-QOL score, daily use of urine pad, and increase in weight of the 1-hour urine pad test 3 years after surgery improved significantly (P<0.05). During the mean follow-up of (61.4±20.5) months, no significant changes in the I-QOL score, daily use of a urinary pad, 1-hour urinary pad test, RUV or Qmax were observed, and no complications occurred. 【Conclusion】 Transobturator bulbourethral suspension with modified four-armed pelvic sling is an effective and safe procedure to treat post-prostatectomy incontinence. The long-term efficacy is satisfactory.

Objective:To investigate the effect of modified York-Mason technique on urethrorectal fistula after radical prostatectomy.Methods:A retrospective analysis of clinical data from 20 patients with urethrorectal fistula after radical prostatectomy admitted to Shanghai Sixth People's Hospital from May 2016 to October 2022 was conducted. Patients’ average age was (76.6±4.2) years. The etiology was rectal injury during radical prostatectomy. Patients present urine leakage from the anus during micturition. 2 cases also had bladder neck stenosis, and 1 case had urinary incontinence.3 cases had radiotherapy history because of prostate cancer. The average duration of urethrorectal fistula was (1.8±2.3)years. Preoperative imaging confirmed the presence of contrast agent flowing from the bladder neck into the rectum. Three suspicious patients also underwent CT three-dimensional reconstruction. Urethroscopy revealed a depression at the bladder neck in five cases. Anorectal examination in five cases showed the formation of gas bubbles in the lower anterior wall of the rectum, along with a concave anterior wall. The distance from the fistula to the anal margin was (6.0±2.1) cm, with fistula diameters ≥1 cm in twelve cases, <1 cm in eight cases. Twelve patients had previously undergone cystotomy, and seventeen patients had undergone colostomy. The modified York-Mason procedure was adopted for all 20 cases. The patients were under general anesthesia and placed in the prone jackknife position, with the buttocks spread and fixed to the sides to expose the anus. An 8 cm-long incision was made from two points near the sacrococcygeal joint to the anal edge, representing the modified York-Mason approach. After dividing the anal sphincter muscle, both sides were marked using 3-0 chromium thread for subsequent anal reconstruction. The urethrorectal fistula was exposed, and the urethral side of the fistula was sutured with 4-0 absorbable thread, while the anterior rectal wall side was sutured with 3-0 absorbable thread. In cases of bladder neck stenosis, urethral internal incision was performed, and a urethral catheter was retained for 3 weeks postoperatively. Perianal incision drainage tubes were removed after three days. Patients had colostomy repair could eat the day after surgery, while those who didn’t were fast for five days and received intravenous nutrition.Results:All 20 cases in this group were successfully completed without complications during surgery. Follow-up ranged from 10 to 48 months after surgery. Seventeen (17/20)cases had unobstructed urination, with a maximum urine flow rate >15 ml, and no urine leakage from the anus. Postoperative urethrography and cystourethroscopy showed there were no urethrorectal fistulas in 15 cases. None of the patients experienced fecal incontinence after the surgery, except for three patients with a history of radiotherapy who continued to experience anal leakage. One patient underwent a second modified York-Mason procedure and achieved complete recovery three months after the second surgery. Another patient had anal discharge, and the fistula healed after two weeks of urethral catheter retention. One patient refused further treatment due to advanced age and frailty but still had anal leakage. Another patient experienced regular urethral dilation for urination difficulties, while one patient continued to have urinary incontinence.Conclusions:The modified York-Mason technique could be an effective method for urethrorectal fistula after radical prostatectomy with high success rate and few side effects.

The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.

Objective:To analyze the risk factors for postoperative pulmonary venous obstruction after correction of total anomalous pulmonary venous connection(TAPVC).Methods:We retrospectively reviewed all patients undergoing operative repair of TAPVC in our institution from December 2013 to January 2018. Patients with functionally univentricular circulations or atrial isomerism were excluded. Patients were divided into two groups according to whether there was pulmonary vein obstruction. The clinical variables of the two groups were compared. Variables for the multivariable analysis were chosen if there was statistical significance on univariable analysis.Results:145 patients were included, 91(63%) males, aged 4(2, 8)months and weight 5.5(4.5, 7.5)kg. Mean follow-up interval was(51±23) months. Postoperative obstruction developed in 27 patients(18.6%). The differences of anatomic type[supracardiac 18(67%) vs.59(50%), cardiac 4(15%) vs. 50(42%), infracardiac 3(11%) vs. 1(1%), mixed 2(7%) vs. 8(7%), P=0.003], preoperative obstruction[yes 19(70%) vs. 37(31%), no 8(30%) vs. 81(69%), P<0.001], associated cardiac lesions[yes 13(48%) vs. 27(23%), no 14(52%) vs. 91(77%), P=0.008] and bypass time[109(89, 129)min vs. 88(70, 110)min, P=0.002] between two groups were statistical significant. A multivariable model showed preoperative obstruction( P<0.001) and bypass time( P=0.009) were associated with postoperative obstruction. Conclusion:The incidence of pulmonary vein obstruction after correction of TAPVC was still high. If there was preoperative obstruction, or the bypass time was too long during operation, the surveillance of pulmonary vein obstruction should be strengthened after operation.

Objective To assess the feasibility and efficacy of multi-modality three dimensional imaging reconstructive technology in diagnosing the urethral stricture.Methods Totally,121 male patients,suffered with urethral strictures,were enrolled in this study between January 2012 and June 2017.Their age ranged from 17 to 63 years old.The etiology included pelvic fracture in 71 cases,straddle injury in 16 cases,iatrogenic injury in 25 cases,infection in 9 cases.All patients accepted the routine antegrade and retrograde urethrography.The slim CT scan and 3D image reconstruction were performed in patients with posterior urethral stricture.The 3D ultrasound detection and image reconstruction were used in patients with anterior urethral strictures.The fly-through mode was used in each 3D image in order to simulate the process of endoscopic examination.The length of stricture was compared between that in traditional urethrography and in 3D dimensional image,based on the results from anastomotic procedure and substitution.Result Among patients,71 cases were diagnosed as posterior urethral stricture and 50 cases were diagnosed as anterior urethral stricture.In those patients with posterior urethral stricture,no statistical significant difference of stricture length was noticed between traditional urethrography and 3 D dimensional image [(2.30 ± 1.60)cm vs.(2.18 ± 1.55)cm,P =0.91)].In patients who complained about the urine leakage from anus,higher detective rate of fistula could be seen in the CT 3D image than that in traditional endoscopic examination (87.9％ vs.77.6％).To patients with anterior urethral strictures,no statistical significant difference of stricture length was noticed between traditional urethrography and 3D dimensional image [Penile:(2.13 ±0.34) cm vs.(2.24 ± 0.31) cm,P =0.13;Bulbar:(1.98 ± 0.47) cm vs.(2.13 ± 0.32) cm,P =0.23)].However,the advantage of 3D image could be shown in detecting the lesion of navicular fossa and periurethral pathologic fibrosis.In the fly-through mode,the effect of 3D CT image seems to be superior to that in the 3D ultrasound image,which could show more smooth urethral wall and longer urethral segment.The limitation of those 3D image reconstructive technology was that long time consuming was needed during the 3D image reconstruction.Conclusion Our study showed that the multi-modality three dimensional imaging reconstructive technology can improve the sensitivity and specify in diagnosing the urethral stricture.After some modification,it will become the alternative method in diagnosing the urethral stricture.

Objective To evaluate the accuracy of enhanced CT scan in clinical staging of colorectal cance by detecting the general sit-uation and T and N staging through plain scan combined with enhanced CT scan.Methods Totally 49 cases of colorectal cancer patients were enrolled in this study from May 2015 to October 2015,and it showed no distant metastasis of colorectal cancer in clinical examination. Evaluated the general situation (location,size,and pathologic type)and T and N staging of colorectal cancer through plain scan and enhanced CT scan and multiplanar restructuring.Compared the imaging staging with pathological staging,and respectively calculated the sensitivity,spe-cific degree and accuracy of T and N staging.Evaluated the accuracy of T and N staging with the consistency test,and the differences were statistically significant with P <0.05.Results The location and pathological type of tumor detected by CT scan were compared with the re-sults of operation,and the coincidence rate was 100%.The maximum diameter of the tumor was (2.26 ±1.40)cm from CT image and (2.37 ±1.38)cm from operation measure,and the data were highly correlated (r =0.906,P =0.000).The coincidence rate of T staging was 65.3%,and the consistency was good (k =0.467,P =0.000).The coincidence rate of N staging was 63.3%,and the consistency was good (k =0.440,P =0.000).Conclusion Enhanced CT scan can provide sufficient information for the preoperative evaluation of colorectal cancer,and it has important clinical application value.

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