Purpose: To identify more accurate predictors of upper urinary tract dilatation (UUTD) in neurogenic bladder (NB) children, we studied the relationship among urodynamic parameters at different bladder filling stages, detrusor leak point pressure (DLPP) and UUTD. Methods: A total of 158 children (3–16 years) with NB were included and then divided into 2 groups according to whether their NB diagnosis was complicated with UUTD: the UUTD group (39 patients) and those without UUTD group (control group, 119 patients). The bladder filling phase was divided into 3 equal parts: the early, middle, and end filling stages. The bladder compliance (BC) and detrusor pressure (△Pdet) at each phase and DLPP at the end filling stage were recorded. Results: A BC<8 mL/cm H2O both in the middle and end stages is more specific than a BC<9 mL/cm H2O in the end stage (72%, 73%, vs. 66%), and △Pdet >8 cm H2O in the early stage, 20 cm H2O in the middle stage and 25 cm H2O in the end stage are more sensitive than △Pdet >40 cm H2O in the end stage (82%, 85%, 85%, vs. 49%). A DLPP cutoff value of 20 cm H2O showed higher sensitivity for predicting UUTD than 40 cm H2O. Conclusions Low BC and a high △Pdet in the middle and end filling stages are more accurate factors than classic indicators for predicting UUTD. In addition, a DLPP value of >20 cm H2O in the end bladder filling stage shows high sensitivity.

Objective: To monitor the content of bisphenol S ( BPS ) in vegetables and fruits in Henan Province and evaluate the dietary exposure risk of the population, so as to provide the basis for formulating relevant food safety standards. Methods: From 2018 to 2019, 276 samples of vegetables and fruits produced and sold in Henan Province were collected. BPS was determined by isotope dilution ultra performance liquid chromatography triple quadrupole tandem mass spectrometry ( UPLC-MS/MS ) , and the dietary exposure was calculated according to the dietary structure and average body weight of local residents. The risk index of BPS was calculated according to the daily tolerable intake ( TDI ) of bisphenol A ( BPA ). Results: The BPS contents in vegetables and fruits were 0.006-12.600 µg/kg and 0.006-9.380 µg/kg, the medians were 0.053 µg/kg and 0.023 µg/kg, the detection rates were 78.43% and 62.60%, respectively.The detection rate and content of BPS in vegetables were higher than those in fruits ( P<0.05 ). The maximum exposure of BPS from vegetables and fruits was 5.37×10-2 µg/ ( kgbw·d ), and the exposure risk index was 1.07 × 10-3, which was acceptable. Conclusions BPS was detected from vegetables and fruits in Henan Province. The detection rate and content of BPS in vegetables were higher than those in fruits. The health risk of BPS exposed by vegetables and fruits is small.

Objective: To compare the efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) Siewert II and III AEG was confirmed by preoperative gastroscopy and biopsy, which could not be resected by endoscopy; patients undergoing radical proximal gastrectomy with double-tract reconstruction; (3) contrast-enhanced abdominal CT staging was cT1-2N0M0; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, American Association of Anesthesiologists (ASA) grade 1 to 2; (5) patients agreed to perform proximal gastrectomy and signed an informed consent. Those who had undergone neoadjuvant radiochemotherapy, suffered from serious mental diseases and had incomplete data were excluded. According to the above criteria, clinical data of 84 consecutive patients with Siewert II and III AEG undergoing surgery at General Surgery Department of The Affiliated Tumor Hospital of Zhengzhou University from October 2010 to December 2018 were collected and analyzed. Of 84 patients, 61 underwent open proximal gastrectomy with double-tract reconstruction (OPG group), while 23 underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG group). The perioperative complications and postoperative reflux esophagitis of two groups were compared. A P-value of <0.05 was considered to be statistically significant. Results: Among 84 cases, 74 were male and 10 were female. There were 43 cases of Siewert type II and 41 cases of Siewert type III. There were no significant differences in age, gender, body mass index, comorbidities, Siewert type, and tumor staging between the two groups (all P>0.05). As compared to the OPG group, the LPG group had longer operation duration [(223±21) minutes vs. (161±14) minutes, t=15.352, P<0.001], less intraoperative blood loss [195 (150, 215) ml vs. 208 (192, 230) ml, Z=2.143, P=0.032], and shorter time to flatus [(2.8±0.7) days vs. (3.3±0.9) days, t=2.477, P=0.015]. There were no significant differences in the number of harvested lymph nodes, time to the first meal and postoperative hospital stay between the two groups (all P>0.05). Postoperative complications developed in 2 cases (8.7%, 1 case each for anastomotic leakage and intestinal obstruction) in the LPG group and 5 cases (8.2%, 1 case each for anastomotic leakage, anastomotic bleeding, and anastomotic stenosis, 2 cases of incision infection) in the OPG group (χ(2)=5.603, P=0.231). The median follow-up was 41.2 (12.8-110.5) months. One patient (1.6%,1/61) had obvious reflux symptoms in the OPG group, compared with none in the LPG group (χ(2)=0.644, P=0.422). Esophagitis occurred in 1 case (4.8%, 1/21) in LPG group, compared with 4 patients (7.1%, 4/56) in the OPG group, without significant difference between the two groups (χ(2)=0.505, P=0.477). Conclusion: Laparoscopic proximal gastrectomy with double-tract reconstruction is safe and feasible without increasing the risk of postoperative complication and reflux esophagitis.
Adenocarcinoma/surgery* ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Esophagogastric Junction/surgery* ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome ; Young Adult

Objective: To analyze and summarize the diagnosis, treatment and prognosis of granulomatosis with polyangiitis (GPA) with nasal symptoms as the first clinical manifestation. Methods: The data of 18 patients of GPA with nasal mucosal symptoms as the first clinical manifestation from the Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University between 2005 and 2019 was collected, including 8 males and 10 females, aged from 5 to 68 years. Nasal endoscopy, imaging examination, laboratory examination, immunological and histopathological examination of nasal mucosa were completed. All patients were treated with glucocorticoid combined with cyclophosphamide and were followed up for 2 to 15 years. Descriptive statistical method was used for analysis. Results: All the 18 patients had the nasal mucosal symptoms as the first clinical manifestation, including nasal obstruction, running nose and epistaxis. Nasal endoscopy showed swelling, erosion, scab and bleeding of nasal mucosa, and 6 cases had nasal septal perforation. Nasal sinus CT scan showed high density shadow of sinus, as well as hyperostosis and osteosclerosis. CT imaging features of pulmonary showed nodular lesion or patchy infiltration in 12 patients and cavitation was found in 6 cases. Laboratory results showed that 13 cases were positive for anti-neutrophil cytoplasmic antibodies (ANCA), and 5 cases were negative. During follow-up period, thirteen patients were symptomatic controlled and survived; two patients died of disease progression; one patient gave up treatment and died; two patients were lost to follow-up. Conclusions: Nasal symptoms are the first clinical manifestation of GPA. Early diagnosis and early treatment with glucocorticoid combined with cyclophosphamide can effectively improve the survival rate.
Antibodies, Antineutrophil Cytoplasmic ; Cyclophosphamide ; Endoscopy ; Female ; Granulomatosis with Polyangiitis/diagnosis* ; Humans ; Male ; Paranasal Sinuses

Objective Fluid therapy strategy on cardiac surgical patients has always been disputing. The aim of the present study was to observe the effects of goal-directed hemodynamic management strategy on the prognosis of patients undergoing off-pump coronary artery bypass graft. Methods The study was a prospective quality improvement study. Patients who underwent elective off-pump coronary artery bypass grafting in our hospital from January to December 2016 were included in the study, and the implementation of improvement approach was started on June 20, 2016. A total number of 98 patients were included: 56 cases before the improvement (control group) and 42 cases after the improvement (experimental group). The approach of optimizing hemodynamic was standardized vasoactive usage based on the goal-directed fluid therapy taking SVV (Stroke Volume Variation) and CI (Cardiac Index) as the target. Intraoperative and postoperative data were collected through the medical record system. Comparison was done between two groups in the aspects of liquid intake and output, length of postoperative stay in hospital and complications, postoperative awaken time, volume of thoracic drainage in 24h, extubation rate in 6h, time of ICU stay, concentration of Troponin I on the first day after surgery, mortality rate within 30 days and 6 months. Results There was no statistically difference in total fluid intake after the improvement, while the volume of voluven(676.79± 380.90 mL vs 890.48 ±222.58mL,P < 0.05) and urine volume (516.07±224.87 mL vs 695.24± 311.53mL,P < 0.05) increased significantly, the volume of crystal decreased significantly (663.84 ±224.97mL vs 430.24 ±201.76mL,P < 0.001). The positive liquid balance of intake and output volume was significantly reduced (683.82 ±556.08ml vs 456.43 ±505.36ml, P < 0.05). There were no significant differences in proportion of autologous blood or erythrocyte transfusion and volume of blood loss between the two groups (P > 0.05). There were no significant differences between the two groups in postoperative awaken time, volume of thoracic drainage within 24h, extubation rate within 6, concentration of Troponin I on the first day after surgery and ICU stay(P > 0.05). After the improvement, the length of postoperative stay in hospital was reduced compared with the control group (11.81 vs 13.82, P < 0.05). Multiple linear regression analysis was performed after the logarithmic transformation, and the standardized coefficient B of the improvement was -0.296 (SE=0.061, P < 0.05), indicating that the goal-directed hemodynamic management would reduce the length of postoperative stay in hospital by 19.4 %( 95%CI 7.3%~31.5%) with other conditions being equal. Postoperative complications decreased from 41.07% to 16.67 %( P < 0.05). Conclusion The implementation of goal-directed hemodynamic management strategy can reduce postoperative complications, postoperative hospital stay and improve short-term prognosis of patients undergoing off-pump coronary artery bypass surgery.

To update and improve the Chinese concept of Zhishengquan,a comparative analysis was made of the U.S. military terms and PLA military terms.Zhishengquan is re-defined as "command and superiority in the bio-domain".

This study was performed to investigate a potential marker for the presence of spermatozoa in the ejaculate following varicocelectomy in Chinese men with nonobstructive azoospermia and varicoceles. The micro-RNA (miR)-192a levels in seminal plasma and testicular tissue were evaluated by quantitative real-time polymerase chain reaction from 60 men with nonobstructive azoospermia and varicoceles (Group A: 27 men with spermatozoa found in the ejaculate after surgery; Group B: 33 men without spermatozoa found in the ejaculate after surgery) and 30 controls. The seminal plasma and testicular tissue miR-192a levels were higher in Group B than in Group A and the controls (P < 0.001), and there was no significant difference between Group A and the controls (P > 0.05). Apoptosis and proliferation assays with miR mimics and inhibitors showed that miR-192a induced GC-2 cell apoptosis through the activation of Caspase-3 protein. Thus, seminal plasma miR-192a appears to be a potential marker for successfully indicating spermatozoa in the ejaculate following microsurgical varicocelectomy in men with nonobstructive azoospermia and varicoceles. Seminal plasma miR-192a may be a useful clinical marker for prescreening to determine which patients with nonobstructive azoospermia and varicoceles would benefit from varicocelectomy.
Adult ; Apoptosis ; Asian People ; Azoospermia/surgery* ; Biomarkers/analysis* ; Caspase 3/analysis* ; Cell Proliferation ; Humans ; Infertility, Male/etiology* ; Male ; MicroRNAs/biosynthesis* ; Microsurgery ; Predictive Value of Tests ; Semen/metabolism* ; Testis/metabolism* ; Treatment Outcome ; Varicocele/surgery*

Objective To study biomechanical properties such as range of motion (ROM), intervertebral disc stress, ligament tension of inferior cervical spinal segment after the treatment of Discover, Prodisc-C artificial intervertebral disc replacement, and anterior cervical discectomy and fusion (ACDF), as well as mechanical property changes of the prosthesis after implantation. Methods Three kinds of operation plan on C5-6 cervical disc degeneration were established: Discover model, Prodisc-C model and ACDF model, as well as C4-7 segment original model of cervical vertebra. Biomechanical property changes after operation in cervical spine C4-7 segment in sagittal, coronal and transverse section were analyzed. Results ROM changes of cervical segment C5-C6 were as following: in Discover model it increased by 12.7%-73.1%, Prodisc-C model increased by 74%-98%, ACDF decreased by 55.8%-71.8%. The stress of C4-5 intervertebral disc after Discover artificial disc replacement showed no obvious increase, while the stress of C6-7 intervertebral disc decreased by 33.2%-54.2% under flexion, extension and axial rotation conditions. The amplification of ligament tension in Discover model decreased by 30%-40% as compared to that in Prodisc-C model. The maximum stress of Discover model (36.72 MPa) appeared under flexion condition, which was smaller than that in Prodisc-C model. Conclusions Artificial disc replacement can help to keep movement performance for segment after surgery. As a newly developed artificial intervertebral disc prosthesis, Discover makes some progress in the aspect of decreasing ligament stress and maintaining spinal stability. The research findings will provide theoretical basis for the clinical study on ACDF and artificial cervical intervertebral disc replacement surgeries.

Objective To establish a 3D finite element model of cervicothoracic spinal segments C5-T2 based on CT images and test its validity and effectiveness. Methods By using the Mimics, Geomagic and Hypermesh software, the 3D model of cervicothoracic spinal segments C5-T2 was reconstructed, repaired and pre-processed. Moment of ±0.5, 1, 1.5, 2 N•m were applied on top of the model to simulate loads produced during the flexion and extension movement of human body. The range of motion (ROM) of the segments C5-T2 during flexion and extension was calculated by ANSYS, and the reliability of the model was verified by comparing the experimental results in the previous literature with the finite element analysis results obtained in this study. Results Under the moment of 1 N•m, the ROMs of C5-6, C6-7, C7-T1 and T1-2 during flexion were 4.30°,3.21°,1.66° and 1.41°, and those during extension were 3.47°, 2.86°, 0.96° and 0.92°, respectively. The maximum stress during flexion appeared on the front of the vertebral body, while that during extension appeared on the back of the vertebral body. The trends of ROM and stress distributions were consistent with results reported in the previous literature. Conclusions The 3D model established in this study is accurate and realistic, and conforms to biomechanical properties of the cervicothoracic spine. The simulation results can be further used to explore clinical pathology of the spine and provide theoretical references for evaluation on cervicothoracic spine surgery.

Objective To establish 3D finite element of human cervicothoracic spine C5-T2 based on CT images, and explore effects on stability of the cervicothoracic spine after total spondylectomy (TS) by using various combinations of internal fixation devices (pedicle screw, titanium mesh, steel plate), including the stress distributions on these internal fixation devices. Methods The intact finite element model of cervicothoracic spine C5-T2 was established and validated by comparing the model’s range of motion (ROM) with that of other in vitro experiments. Then four reconstruction models after TS of cervical spine segment C7 were established: TM+AP+DPS model (titanium mesh + anterior plate + posterior double-segmental pedicle screw), TM+AP+SPS model (titanium mesh + anterior plate + posterior single-segmental pedicle screw), TM+DPS model (titanium mesh + posterior double-segmental pedicle screw), AP+DPS model (anterior plate + posterior double-segmental pedicle screw). ROM of each reconstruction model under flexion, extension, lateral bending and rotation and stress distributions on these internal fixation devices were then analyzed. Results ROM of the reconstruction segments was greatly reduced by over 93% as compare to that of the intact model. Stress concentration phenomenon appeared on the titanium mesh in the TM+AP+SPS model. Conclusions The fixation effects of four reconstruction models are similar. Stresses on 3 DPS fixed-models are more evenly distributed, indicating that the overall stability of DPS fixed-model is superior to that of SPS fixed-model.