Objective:To investigate the safety and efficacy of four-hook needle combined with holographic image in robot-assisted partial nephrectomy for completely intrarenal tumors.Methods:The clinical data of 8 patients with completely intrarenal tumors treated by robot-assisted partial nephrectomy with four-hook needle combined with holographic image admitted to General Hospital of Central Theater Command from October 2023 to December 2023 were retrospectively analyzed. There were 6 males and 2 females, with average age of (44.5±12.0) years old. Tumors of 6 cases were in the left side and 2 cases in the right side. The maximum diameter of the tumor was (23.2±8.1) mm. The R. E.N.A.L. score was (9.0±1.4). The preoperative serum creatinine (Scr) was (73.1±14.7) μmol/L. CT-guided four-hook needle was used to locate the edge of completely intrarenal tumor before surgery. During the operation, the tumor was precisely resected under the guidance of hologram and four-hook needle. Perioperative data of patients were collected and analyzed.Results:All the tumor were successfully resected under the guidance of four-hook needle and hologram without conversion to radical nephrectomy or open surgery. The mean operative time was (117.0±14.5) min, the mean hot ischemia time was (20.2±5.1) min, the mean intraoperative blood loss was (75.0±17.3) ml, and the average hospitalization time was (9.5±1.3) days.The one week postoperative Scr was (73.2±14.8) μmol/L, which had no significant difference with that of before operation ( P=0.952). None of them received blood transfusion. The pathology results of 8 patients were clear cell renal cell carcinoma, and the surgical margins were negative. Conclusions:For completely intrarenal tumors, the four-hook needle combined with the hologram can guide the surgeon to quickly locate the tumor, accurately resect the tumor, reduce perioperative complications, and is safe and effective.

Abstract: Objective　To investigate the molecular characteristics and drug resistance of Staphylococcus aureus (SA) isolated from wounds of paatients with orthopedic trauma, and analyze the molecular subtyping, virulence genes and drug resistance of SA in wounds of patients, so as to provide reference for the prevention and treatment of wound SA infection in patients. Methods　From January 2020 to June 2022, a total of 128 SA isolates were collected from wound specimens of orthopedic trauma patients at Wuxi 9th People's Hospital Affiliated to Soochow University. Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) were differentiated using PCR. Multilocus Sequence Typing (MLST), staphylococcal protein A (spa), staphylococcal chromatoidal cassette mec (SCCmec), and accessory gene regulator (agr) typing were performed to determine the molecular typing and presence of virulence genes and drug resistance profiles. Results　Among the 128 SA isolates, 76 (59.38%) were MRSA and 52 (40.62%) were MSSA. MRSA typing showed that, MLST was dominated by ST59 (46 strains, 60.53%), spa was dominated by t437 (52.63%), SCCmec was dominated by Ⅰ (42.11%) and Ⅳ (39.47%). MSSA typing showed that, MLST was dominated by ST188 (30.77%), spa was dominated by t189 (61.54%), agr was dominated by Ⅰ (53.85%). In MLST typing, ST59 of MRSA was higher than that of MSSA, and ST188 and ST6 of MRSA were lower than those of MSSA (χ2=36.207, 20.227, 9.984, P<0.05). In spa typing, the t437 of MRSA was higher than that of MSSA, and the t189 of MRSA was lower than that of MSSA (χ2=18.276, 32.781, P<0.05). The virulence genes showed that, the detection rates of hlb and seb in MRSA were higher than those in MSSA (χ2=47.838, 10.261, P<0.05), and the detection rates of cna and ebpS in MRSA were lower than those in MSSA (χ2=26.176, 8.305, P<0.05). Drug susceptibility test showed that, and the drug resistance rates of MRSA and MSSA to vancomycin (VAN) and linezolid (LNZ) were 0. The drug resistance rates of MRSA to oxacillin (OXA), ERY and CLI were 86.84%, 68.42% and 76.32%, which were higher than corresponding 7.69%, 42.31% and 46.15% of MSSA (χ2=78.055, 8.623, 12.200, P<0.05). The analysis of multi-drug resistant strains (MDR) showed that 76 MRSA strains were MDR strains, and 12 of 52 MSSA strains (23.08%) were MDR strains. Conclusions　The molecular characteristics of SA isolated from orthopedic trauma patients' wounds were predominantly associated with MRSA strains of ST59-t437-SCCmec Ⅰ/Ⅳ-MRSA and ST188/ST6-t189-agr Ⅰ. These strains showed higher resistance to oxacillin, erythromycin, clindamycin, and higher susceptibility to vancomycin and linezolid. Such characteristics were closely related to the carriage of virulence genes. Clinicians should pay attention to the presence of MDR MSSA and develop appropriate antimicrobial strategies based on SA's molecular characteristics and antimicrobial resistance.

Objective:To examine the ultrasound images, clinical features, intraoperative conditions, and pathological features of ovarian clear cell carcinoma(OCCC)during perimenopause, in order to improve the early diagnosis of OCCC via ultrasound examination.Methods:A retrospective analysis of 29 patients, aged 42-72(56.8±7.4)years, who were surgically treated and pathologically diagnosed with OCCC at our hospital between 1 September 2015 and 31 December 2022, including 10 in the non-menopausal phase, 3(10.3%)in early menopausal transition, 7(24.1%)in late menopausal transition, and 19(65.5%)in the post-menopausal phase.The number of pregnancies(1.86±1.04)and the number of births(0.97±0.56)were also recorded.Results:In 29 cases, the masses contained solid components, and the ultrasound manifestations were as follows: (1)single-compartment cystic masses(solid components accounted for <50% of the total volume)were found in 11 cases, with clear borders, regular morphology, ground-glass echoes inside the cystic cavity, multiple solid protrusions inside the cystic cavity, and blood flow signals inside the solid components on color Doppler flow imaging(CDFI); (2)multi-compartment cystic masses(solid components accounted for <50% of the total volume)occurred in 8 cases, with largely clear borders, ground-glass echoes inside the cystic cavity, multiple solid protrusions inside the cavity, thick walls where the protrusions were attached, varying thickness of walls separating the cystic cavities, and blood flow signals inside the solid components, walls where there were solid attachments and thicker parts of the separating walls on CDFI; (3)there were 7 cases with predominantly solid cystic masses(the solid components accounted for >50% of the total volume), unclear borders, poor translucency, irregular morphology of the solid components, uneven internal echoes, and blood flow signals in the solid component on CDFI; (4)solid masses(the solid components accounted for >95%of the total volume)were seen in 3 cases with unclear borders, irregular morphology, uneven internal echoes, and a small number of cystic cavities(cystic portion <5%), with poor translucency in the cystic cavities and blood flow signals in the solid components on CDFI.Intraoperative exploration of ascites was performed in 17 cases, and adhesion between the mass and surrounding organs was found in 27 cases.Postoperative pathological results revealed 26 cases with high grade tumors and 3 cases with intermediate grade tumors.There were 3 cases with bilateral OCCC, 13 with left side OCCC and 13 with right side OCCC.According to the FIGO pathological staging system, 12 cases were in stage Ⅰ, 10 in stage Ⅱ, 5 in stage Ⅲ and 2 in stage Ⅳ.Comparison of different pathological stages(early stages Ⅰ and Ⅱ versus late stages Ⅲ and Ⅳ)showed statistically significant differences in the ratio of pathological stages between patients with different ultrasonographic manifestations( χ2=11.163, P<0.05), and the results of two-by-two comparisons showed that OCCC patients with ultrasonographic manifestations of solid masses(solid component accounting for >95%of the total volume)were more often in the late stage at the time of onset, while OCCC patients with a high number of cystic components within the lesions were more likely to be in the early stage at the time of onset.OCCC patients with more cystic components in the lesions tended to have an earlier onset and a better prognosis. Conclusions:When ultrasound imaging shows primarily a single chamber cystic solid mass in a patient in the perimenopausal phase with an endometriosis history, together with signs of specialized examination and pelvic adhesion during transvaginal sonography, a diagnosis of OCCC should be suspected.It is of great significance to pay attention to transvaginal sonography examination, ultrasound image features and clinical symptoms in perimenopausal women for the early diagnosis of OCCC.

Objective:To analyze the characteristic ultrasonographic findings and clinical symptoms of primary fallopian tube cancer(PFTC)in peri-and post-menopausal women, and to provide a basis for the early diagnosis of PFTC via ultrasonography.Methods:A total of 34 patients with PFTC confirmed by surgery and pathology in Beijing Hospital from May 2012 to January 2022 were retrospectively analyzed.Patients aged between 46-85 years, including 1(2.9%)in early menopausal transition(46 years old), 3(8.8%)in late menopausal transition(48 years old, 49 years old, and 50 years old), and 30(88.2%)in post-menopause.The median age was 60 years(60.9±9.7 years). The ultrasound and clinical features were analyzed and compared with pathological results.Results:Irregular vaginal bleeding was the most common clinical symptom in the 34 patients.According to the characteristics of adnexal masses and the involvement of other organs in the pelvis and abdominal cavity, the 34 cases of PFTC were divided into 4 groups.In Group A, 6 cases showed sausage-like cystic masses in the adnexal area, with unsmooth inner walls, medium echo papillary projections on the inner wall, incomplete strip partitions, and rich or relatively rich blood flow signals on the papillary projections and partitions.On ultrasound, 1 case was diagnosed with hydrosalpinx, 2 cases with cysts in the adnexal area, and 3 cases with PFTC.In Group B, 13 cases presented with cystic or solid masses of irregular shapes and sausage-like changes in some areas.The cystic part had poor sound transmission and the solid part exhibited rich or relatively rich blood flow signals.On ultrasound, 2 cases were diagnosed with PFTC and 11 cases with ovarian cancer with 2 showing intrauterine effusion and 3 showing abdominal and pelvic effusion.There were 11 cases in Group C, presenting with hypoechoic irregular solid masses in the adnexal area, with some accompanied by thickening of the peritoneum of the anterior and posterior fornix and the omentum.There were abundant or relatively abundant blood flow signals inside the masses.On ultrasound, 10 cases were diagnosed with ovarian cancer and 1 with pelvic metastatic cancer.There were 4 cases in Group D, who showed no adnexal mass, but 3 cases had ascites and were suspected of having a malignant tumor of unknown origin.Postoperative pathological results of the 34 PFTC cases revealed that 30 had high-grade serous carcinoma, 1 had low-grade serous carcinoma, 2 had serous tubal intraepithelial carcinoma(STIC), and 1 had serous tubal in-situ carcinoma.There were 3 cases with bilateral PFTC, 10 cases with PFTC on the left and 21 cases on the right.There were 4 cases with PFTC plus ovarian cancer.According to FIGO pathological staging, 8 cases were in stage Ⅰ, 9 in stage Ⅱ, 11 in stage Ⅲ and 6 in stage Ⅳ.The accuracy of preoperative diagnosis of PFTC by ultrasound was 50.0% in Group A and 15.4% in Group B. Preoperative ultrasound did not correctly diagnose PFTC in Group C and Group D, and instead suggested pelvic malignant tumor.Conclusions:Clear display of bilateral ovaries, sausage-like masses in the adnexal area, abundant or relatively abundant low resistive index blood flow signals in papillary projections and low-speed neovascularization are helpful ultrasound signs for the early diagnosis of PFTC, but not very useful for predicting the pathological stages of PFTC.Postmenopausal woman with vaginal bleeding, vaginal secretions or lower abdominal pain should be alert to PFTC.

Forty two resident general practitioners (GPs) attending obstetrics and gynecology course in Beijing Hospital were divided into trial group and control group with 21 in each group. The 2-hour study content uterine fibroids was taught by the same teacher. For control group the traditional classroom teaching mode was used, while for the trial group the WeChat-based flipped classroom model was used. The teaching effectiveness was evaluated by means of paper examination, critical examination and questionnaire survey. The average scores and the clinical reasoning scores of trial were significantly higher than those of control group [(90.5±3.4) vs. (82.5±4.2) points and (94.5±1.5) vs. (84.5±2.0) points; t=4.28, P<0.05 and t=5.01, P<0.05, respectively]. Compared with the control group, the trial group presented more learning interest, higher learning efficiency and self-learning ability; and also the ability of expression and communication was improved, the ability of teamwork and the ability of analyzing and solving problems was enhanced more markedly in trial group (all P<0.05). The result indicates that WeChat-based flipped classroom teaching model can improve the learning efficiency in general practice residency training.

Objective:To examine the ultrasonographic and clinical features of post-menopausal struma ovarii(PMOS).Methods:Clinical presentations and transvaginal sonography(TVS)data of 7 PMOS patients diagnosed during surgery were retrospectively analyzed and compared with histopathological results.Results:The ages of 7 patients ranged from 52 to 77 years(60.1±8.0 years, median age: 59 years, natural menopause age: 49.9±1.8 years). Ultrasound imaging data showed all adnexal masses were unilateral(1 on the left side, 6 on the right side). The focal lesions were irregular, round or elliptic in shape, measuring 2.8-9.5 cm, with either clear or unclear margins.Two PMSO cases were diagnose as teratoma on ultrasound, showing mixed echogenic patterns, with echoless interior regions and poor sound transmission.Color doppler flow imaging found no blood flow signal inside and around the mixed echogenic areas.Five cases were misdiagnosed on ultrasound, with 2 as postmenopausal ovarian endometrial cyst and 3 as ovarian cystadenocarcinoma.All patients recovered well after surgery.By the end of the follow-up, no recurrence of struma ovarii was found in the 7 cases.Conclusions:PMSO is a rare monodermal teratoma, can be easily misdiagnosed and needs to be differentiated from postmenopausal ovarian endometrial cyst, mature teratoma, ovarian cystadenocarcinoma and other types of lesions.A mass >5 cm may exhibit characteristic ultrasonographic manifestations, including protruding thyroid nodules, cyst wall calcification, etc.A solid portion of the cystic mass with blood flow may suggest a diagnosis of struma ovarii.

Objective:To investigate the correlations between the labor process and the elastography parameters, and to explore the correlations among the elastography parameters.Methods:A total of 48 pregnant women in the late periods of pregnancy in Beijing Hospital from November 10, 2018 to January 30, 2019 were recruited prospectively. Elastography was performed to measure several elastographic parameters including the cervical length (CL), elasticity contrast index (ECI), hardness ratio (HR), internal orifice uterus(IOS) and external orifice uterus(EOS). They were followed up to delivery, and were divided into normal group and prolonged group according to the time duration of the first stage of labor. The correlation between the parameters and the time duration of the first stage of labor, as well as the relationships among the parameters were evaluated.Results:Among the 48 pregnant women, 35 cases were delivered by the vagina, 13 by cesarean section, 4 of whom were due to the prolongation of the first stage of labor and the other 9 cases for other reasons. The values of the CL and HR in normal group were significantly lower than that in prolonged group ( P=0.004, 0.02). The ECI in the normal group was significantly higher than that in the prolonged group ( P=0.046). Both the IOS and EOS in the normal group were higher than those in prolonged group without no significant difference( P>0.05). For the 35 women who underwent cervical elasticity assessment before labor and finally delivered vaginally, the duration of the first stage of labor was negatively correlated with cervical ECI ( r=-0.415, P<0.05). The ECI were negatively correlated with CL and HR ( r=-0.528, -0.374; P<0.05), and HR were negatively correlated with IOS and EOS ( r=-0.669, -0.558; P<0.01), whereas HR had no significant correlation with CL( P>0.05). Conclusions:The ECI of cervical tissue measured by cervical elastography can be used to semi-quantitatively evaluate the maturity of the cervix, it has potential value in predicting the labor duration and guiding clinical decision-making.

Objective:To investigate the ultrasonographic and clinical features of postmenopausal ovarian endometriosis(OEM).Methods:Clinical, transvaginal sonography(TVS)and pathological data of 26 postmenopausal OEM patients confirmed by surgery and histology in our hospital from June 2014 to June 2019 were included in this retrospective analysis.The ages of patients ranged from 47 to 65 years(median age: 57 years old), and the age at natural menopause was(48.8±3.3)years.The duration after menopause was 1-25 years(median duration: 8 years). Transvaginal sonography(TVS)results were compared with pathological data.Results:A total of 36 adnexal lesions were found by TVS.Postoperative pathological examination confirmed 39 lesions, of which 76.9%(30 cases)were OEM lesions and 23.1%(9 cases)were non-OEM lesions in the ovary.92.3% of the adnexal lesions(36 cases)were effectively screened by TVS, and 3 lesions less than 1 cm were missed in the ovary.Among 26 subjects, unilateral OEM lesions accounted for 84.6%(22 cases). Simple cysts were the most common concurrent condition(6 cases), followed by uterine leiomyoma(4 cases), ovarian cancer(2 cases)and serous cystadenoma(1 case). The sizes of 30 postmenopausal OEM lesions ranged from 0.8 cm to 6.6 cm, and 53.3%(16 cases)were anechoic, typical of OEM on TVS.TVS found that 40.0%(12 cases)showed no specific sonographic features, 16.7%(5 cases)showed a heterogeneous echo pattern, 13.3%(4 cases)showed a homogeneous hypoecho pattern, and 10.0%(3 cases)showed a hypoechoic mass with strong internal echo, following a shadow behind it.The rate of missed diagnoses of 30 postmenopausal OEM lesions by TVS was 30.0%(9 cases), of which 23.3%(7 cases)were misdiagnosed as solid masses in the adnexal area on TVS, and 6.7%(2 cases)were missed on TVS(OEM lesions less than 1.0 cm).Conclusions:Ultrasonographic heterogeneity exists in postmenopausal OEM patients.Unilateral and anechoic ultrasound is the most common type of ultrasound imaging.It is of great significance to pay attention to TVS examination and corresponding ultrasound imaging analysis in postmenopausal women for the early diagnosis of postmenopausal OEM.

Objective: To investigate the epidemiological and clinical characteristics of 91 cases of dengue fever outbreak in Jiangxi Province in 2019, and to strengthen the management and prevention of dengue fever. Methods: The clinical data, laboratory results and etiology tests of 91 patients with dengue fever from the Ninth Hospital of Nanchang, Zhangshu People′s Hospital, Fengcheng People′s Hospital and Nanchang County People′s Hospital from July 31, 2019 to September 27, 2019 were retrospectively collected. The t test was used for continuous variables and chi-square test was used for categorical variables. Results: A total of 91 dengue fever patients were reviewed. The patients age ranged from 4 to 87 years old, and the majority were adult patients. Most patients were farmers and they all had mosquito-biting history. Local cases were the major source of this outbreak. The incubation time was (5.19±2.96) days. All patients had fever over 38 ℃. Thirty-eight (41.8%) patients developed rashes, mainly distributed on the limbs and trunk, and 15 patients (16.5%) developed myalgia and fatigue. The incidence of rashes in patients admitted in September was 15.9% (7/44), which was significantly lower than 68.1% (32/47) in July and August (χ²=25.262, P<0.01). The incidence of headache in patients admitted in September was 27.3%(12/44), which was significantly lower than 78.7% (37/47) in July and August (χ² =24.206, P<0.01). Among the 91 patients, 64 (70.3%) patients had white blood cell counts less than 4×10⁹/L, 14(15.4%) patients had platelet counts less than 50×10⁹/L. The positive rate of dengue non-structural protein 1 (NS1) antigen was 100.0%(37/37), the positive rates of dengue antibody IgM and IgG were 50.0%(11/22) and 13.6%(3/22), respectively. Among the 113 serum samples tested for dengue virus RNA, 106 were identified with dengue virus type-1 and two were dengue virus type-2. In 22 patients who received tests within 7 days, the positive rate of NS1 antigen was 100.0% (22/22), the IgM and IgG positive rates were 50.0%(11/22) and 13.6% (3/22), respectively, and 19 patients were infected with dengue type-1. Among the IgM antibody positive cases, the onset days before sampling was (5.09±1.64) days, longer than that of IgM antibody negative cases ((2.82±1.83) days), with statistical significance (t=3.063, P=0.007). The onset time before sampling in dengue virus RNA-positive group was (3.53±1.87) days, which was shorter than that of RNA-negative group ((6.67±0.58) days), and the difference was statistically significant (t=2.839, P=0.013). Conclusions The dengue fever outbreak cases in Jiangxi Province in 2019 have typical clinical manifestations of dengue fever. Using the NS1 antigen test, IgM and IgG antibody tests and real-time fluorescent quantitative polymerase chain reaction for dengue virus genotyping during early onset of the disease can assistant clinicians in clinical management, controlling infectious source and stopping disease transmission.

Objective To observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection.Methods A retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi'an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination.Results The visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15％) were obstructed by simple ophthalmic artery; 5 eyes (25％) were obstructed by ophthalmic artery combined with cerebral artery; 7 eyes (35％) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes); 1 eye (5％) was CRAO with ciliary artery branch obstruction; 1 eye (5％) was branch artery occlusion with ischemic optic neuropathy; 2 eyes (10％) were CRAO with nasal dorsal artery occlusion; 1 eye (5％) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20％) had eye movement disorder and eyelid skin bun; 2 patients (10％) had facial pain and nasal skin ischemic necrosis. MRA revealed 6 patients (30％) of new intracranial ischemic lesions. Among them, 5 patients of hyaluronic acid injection showed asymptomatic small blood vessel embolization; 1 patient of autologous fat injection showed ophthalmary artery occlusion, cerebral artery occlusion, ipsilateral eye blindness, eye movement disorder and contralateral limb hemiplegia.Conclusion Facial cosmetic injection can cause severe iatrogenic complications such as RAO, ciliary artery occlusion, ischemic optic neuropathy, ophthalmic artery occlusion, and cerebral artery occlusion.