Objective:To evaluate the mid-term complication rates of the Hui-Jing one-stage procedure (lingual mucosa combined with longitudinal preputial island flap onlay urethroplasty + tubularized incised plate glansplasty)versus the classic Bracka staged surgery for children with severe hypospadias.Methods:A retrospective analysis was conducted on clinical data of 75 children with proximal hypospadias who were treated at the Seventh Medical Center of PLA General Hospital from March 2017 to June 2022. Of these patients, 31 cases (15 cases penoscrotal type and 16 cases perineal type) were underwent the Bracka two-stage surgery with a median age of 38 months (24.0, 44.5) and 44 cases underwent the Hui-Jing one-stage procedure (23 cases penoscrotal type and 21 perineal type) with a median age of 40.5 months (20.75, 90.5). The length of urethral plate defect after correction of penile curvature was (4.30±0.84)cm in the Bracka group and (4.56±0.79)cm in the Hui-Jing group, which also showed no significant difference.There was no statistically significant difference of the median age and the position of preoperative urethral opening between the two groups( P=0.47, P=0.74). The first stage of Bracka repair consists of orthoplasty and urethral bed substitution with free preputial graft. After 6 months, the urethral plate created from free graft was tabularized to form neourethra; Hui-Jing procedure group used the free lingual mucosal as urethral plate substitution, then we conducted longitudinal preputial island flap Onlay and Snodgrass phalloplasty. The incidence of postoperative urethral fistula, urethral stricture and urethral diverticulum was compared between the two groups of cases and the difference in efficacy between the two procedures was assessed. Results:Among the 75 patients included in the study, there was no statistically significant difference in age or location of urethral meatus between the Bracka and Hui-Jing groups. In Bracka group, 9 cases of urethral stricture (29.0%), 6 case of urethral fistula (19.4%), and 2 cases of urethral diverticulum (6.5%) occurred after surgery, while 12 cases of urethral fistula (27.3%) and 3 case of urethral fistula (6.8%) occurred in the Hui-Jing group. No urethral stricture occurred in Hui-Jing group. There was no statistically significant difference in overall incidence of complications between the two groups [17/31(54.8%) vs.15/44(34.1%), P=0.12]. The incidence of urethral fistula and urethral diverticulum show no significant differences between two groups(19.4% vs 27.3, P=0.61, 6.5% vs. 6.8%, P=0.13). The number of operation in Bracka group was (2.68±1.03) and the hospitalization cost was (12 984.63±3 808.15) Yuan, while the number of operation in Hui-Jing group was (1.36±0.53) and the hospitalization cost was (8 490.54±3 136.84) Yuan. Conclusions:The Hui-Jing one-stage procedure can be used for the surgical treatment of children with severe hypospadias. There is no urethral stricture happened in Hui-Jing group, while the general complication incidence and incidence of urethral fistula and diverticulum show no differences.

Objective:This study aimed to explore the feasibility and clinical value of monitoring the progression of early kidney injury in type 2 diabetic patients by assessment of the urinary C-terminal agrin fragment (uCAF) with enzymatic chemiluminescence immunoassay.Methods:A total of 251 patients with type 2 diabetes, who attended the Second Affiliated Hospital of Wenzhou Medical University from October 2018 to March 2020, were included in this retrospective analysis. One hundred and fifty-six participants undergoing health check-up at the Second Affiliated Hospital of Zhejiang University School of Medicine in February 2021 served as controls. Basic clinical information, glycosylated hemoglobin type A 1c and serum creatinine values were recorded, and urine specimens were collected for urinary creatinine, urinary α 1 microglobulin(uα 1M), urinary immunoglobulin G (uIgG), urinary albumin, urinary N-Acetyl-B-D-glycosaminidase (uNAG) and uCAF measurements. Based on the estimated glomerular filtration rate (eGFR), 251 patients were classified into G1~G5 stage groups with 116, 22, 28, 55 and 30 patients in each group. One hundred and sixty-six patients with early diabetic kidney disease (stage G1-G3) were divided into subgroups A1 (79), A2 (48) and A3 (39) according to the urinary albumin/creatinine ratio (UACR), the uα1M levels were divided into uα1M subgroup 1 (83 cases), uα1M subgroup 2 (42 cases), and uα1M subgroup 3 (41 cases), and uIgG subgroup 1 (83 cases), uIgG subgroup 2 (42 cases), and uIgG subgroup 3 (41 cases) according to uIgG levels. The Spearman method was used to analyze the correlation between uCAF levels and eGFR, UACR, uα1M and uIgG levels. Results:(1) The linear range of the uCAF detected by enzymatic chemiluminescence immunoassay was 3.97-2 000.00 ng/ml, with a detection limit of 2.28 ng/ml, intra-batch coefficients of variation of 1.15% and 1.57%, inter-batch coefficients of variation of 1.63% and 5.78%, and a biological reference interval of <95.35 μg/g Cr. (2) The uCAF level and positive rate (UACR≥30 mg/g) increased with the decrease of eGFR from G1-G3, uCAF level was negatively correlated with eGFR value ( r=-0.543, P<0.000 1), and the positive rate increased from 24.14% (28/116) to 85.71% (24/28) from G1-G3. The uCAF level and positivity rate decreased with the decrease of eGFR from G4 to G5. uCAF level was positively correlated with eGFR value ( r=0.495, P<0.001), and the positivity rate decreased from 30.91% (17/55) to 23.33% (7/30) from G4 to G5. (3) In patients with early diabetic kidney disease, uCAF levels and positivity rates increased gradually with the increase of UACR. uCAF levels were positively correlated with UACR values ( r=0.602, P<0.001), and the uCAF positivity rate reached 21.52% (17/79) in the A1 subgroup. (4) uCAF level was positively correlated with uα1M and uIgG levels in patients with early diabetic kidney disease ( r=0.757, 0.596, both P<0.001). Conclusion:Analytical performance of enzyme chemiluminescence immunoassay for the detection of CAF is satisfactory and could be used a biomarker for monitoring damage and progression of early diabetic kidney disease in patients with type 2 diabetes.

Objective:In order to analyze the current research status of handover shift in nursing management, summarize, analyze and judge the existing literature, in order to provide reference for clinical nursing practice.Methods:Through literature review, it is planned to review the current situation, shortcomings and future development of nursing handover classes.Results:The handover process was generally divided into four stages, of which SBAR was the best practice tool for handing over key information. For the performance of handover shifts, NASR, PVNC-BR, HES and Handoff CEX were often used to evaluate the performance of shifts, and for the results of shifts, evaluations were mostly conducted at the levels of patient safety, process elements, and organizational management. At present, the use of electronic information systems, benign organizational culture and patient and family-centered clinical practice could effectively improve the efficiency and effectiveness of handover.Conclusions:The process and elements of the current shift mode are relatively complete, and the communication strategy is reasonable, but there are still many shortcomings and defects. This suggests that nursing managers should adopt scientific intervention methods and evaluation tools when paying attention to and reforming nursing handover in the future to continuously improve the quality of handover.

Objective:To evaluate the effects of different doses of dexmedetomidine infused at nighttime on early postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of malignant gastrointestinal tumors.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of either sex, aged 65-75 yr, with body mass index of 18-24 kg/m 2, scheduled for elective radical resection of malignant gastrointestinal tumors, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C) and different doses of dexmedetomidine groups (D 1-3 groups). Dexmedetomidine 0.1, 0.2 and 0.3 μg·kg -1·h -1 (infusion rate 4 ml/h) were intravenously infused from 21: 00 on the day of surgery and the first day after surgery until 6: 00 in the next morning.Normal saline was given instead of dexmedetomidine in group C. The period of sleep and the number of awakening at night were recorded before surgery and at 2 and 7 days after surgery.Cognitive function was assessed at 1 day before surgery and 7 days after surgery.The concentrations of plasma cortisol were measured at 16: 00 before surgery and 2 and 7 days after surgery and at 8: 00 in the corresponding morning of the next day.The difference in the plasma cortisol concentration measured at 8: 00 every day and at 16: 00 of the previous day were calculated. Results:The incidence of POCD was significantly lower in D 2, 3 groups than in group C ( P<0.05). The number of awakening at night was significantly decreased at 2 days after surgery in group D 3 as compared with the other three groups ( P<0.05). The difference in the plasma cortisol concentration was significantly decreased at 2 and 7 days after surgery in D 2, 3 groups when compared with group C and group D 1 ( P<0.05). Compared with group D 2, no significant change was found in the difference in the plasma cortisol concentration at each time point in group D 3 ( P>0.05). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and tachycardia among the four groups ( P>0.05). Conclusion:Infusing dexmedetomidine 0.2 or 0.3 μg·kg -1·h -1 at the nighttime can reduce the development of POCD in the elderly patients undergoing radical resection of malignant gastrointestinal tumors.

Objective To explore the imaging characteristics of the ovarian thecoma-fibroma.Methods The clinical imaging characteristics of 25 patients with thecoma-fibroma were retrospectively analyzed. Results A total of 27 lesions were seen in 25 patients, and the maximum diameter of the tumors was 1.2 - 15.0 cm, with an average diameter of 6.9 cm. The tumors whose maximum diameter larger than 6 cm were mainly as cysticsolid. Twenty-six lesions were well-defined margin, and 14 lesions were round and oval masses, 9 lesions were lobulated masses, 3 lesions were irregular masses, and 1 lesion presented with unclear boundary. A total of 10 lesions in 9 cases were performed with CT scan, and the density was similar to uterine muscle density. In MRI scan of a total of 17 lesions of 16 cases, all lesions showed hypointensity on T1WI. On T2WI, 8 lesions showed slightly hyperintensity, 7 lesions appeared slight hypointensity, and 2 lesions appeared significantly hypointense. Eight lesions showed slit hyperintensity. Enhancement scanning was performed in seven cases. Five cases showed mild to moderate enhancement, 1 case was enhanced obviously, and 1 case was not strengthened. Conclusions The imaging findings of the ovarian thecoma-fibroma have somewhat features and can indirectly reflect pathology of tumor. Combined with the clinical data, imaging characteristics are is helpful to the diagnosis and differential diagnosis of the disease.

Objective To explore the value of apparent diffusion coefficient (ADC)in differentiating brain tuberculomas from me-tastases.Methods Conventional and enhanced MRI as well as diffusion weighted imaging (DWI)were performed in 24 cases of brain tuberculomas(immature in 18 cases and mature in 6 case)and 36 cases of metastases.The mean ADC values and relative ADC (rADC)values were calculated from the enhanced and non-enhanced regions of mass and the peripheral edema regions of brain le-sions.Results The mean ADC values and rADC values in the enhanced,non-enhanced and the peripheral edema regions were 796.90×10 -6 mm2/s and 1.1 6,864.85×10 -6 mm2/s and 1.27,1 531.60×10 -6 mm2/s and 2.24 for the immature brain tuberculo-mas;791.95×10 -6 mm2/s and 1.1 6,61 1.80×10 -6 mm2/s and 0.87,and 1 488.45×10 -6 mm2/s and 2.10 for the mature tubercu-lomas;421.95×10 -6 mm2/s and 0.61,961.00×10 -6 mm2/s and 1.36,1 545.00×10 -6 mm2/s and 2.18 for the brain metastases, respectively.There were significant differences in the mean ADC values (H =42.293,P ≤0.05)and rADC values (H =42.575, P ≤0.05)for the enhance regions in the three groups .There were also significant differences in the mean ADC values (H =33.100, P ≤0.05)and rADC values (H =1 7.867,P ≤0.05)for the non-enhance regions.No significant difference in the mean ADC values (H =1.550,P ≥0.05)and rADC values (H =5.511,P ≥0.05)were found for the peripheral edema regions.Conclusion The ADC values of DWI can help to differentiate brain tuberculomas from metastases,when combining with the conventional and enhanced MRI.

Objective:To investigate levels of autophagy in T cells and B cell of patients with systemic lupus erythematosus ( SLE) and its clinical significance.Methods: 68 SLE patients without treatment within 4 weeks were enrolled in this study.We accessed the levels of autophagy in T cells and B cells of 23 healthy controls and 68 patients before and after treatment by flow cytometry,and analyzed their correlations with serum levels of C3 and anti-dsDNA antibodies,SLEDAI score,et al.Results: Before treatment,a significantly increased levels of LC3-Ⅱ was observed in SLE patients than healthy controls, the active group ( SLEDAI score≥10) was significantly higher than the stable group(SLEDAI score<10),and the newly diagnosed group was significantly higher than the recurrent group(all P<0.05).While the levels of LC3-Ⅱ was decreased in B lymphocytes in SLE patients,the active group was significantly lower than stable group,and the active group was significantly lower than the newly diagnosed group(all P<0.05). Correlation analysis found that,a positively correlation was observed for the levels of LC3-Ⅱwith SLEDAI score in T lymphocyte( rs=0.289,P<0.05),and the levels of C3 were positively correlated the levels of LC3-Ⅱ in B lymphocyte(rs=0.371,P<0.01).After treatment for five days, levels of autophagy in T lymphocytes of SLE patients with good prognosis ( SLEDAI score decreased ≥4 ) significantly decreased(P<0.05).Also,three days after treatment,levels of autophagy in B lymphocytes of SLE patients with good prognosis were increased significantly ( P<0.05 ) .However, SLE patients with poor prognosis had no such difference ( P>0.05 ) . Conclusion:Levels of autophagy in T and B lymphocytes of SLE patients are abnormal compared to healthy controls,and these changes are associated with disease activity.Also,these changes are expected to be the indicators of disease activity and potential therapeutic targets in SLE.

BACKGROUNDBalanced steady-state free precession MR angiography (b-SSFP MRA) has shown great promise in diagnosing renal artery stenosis (RAS) as a non-contrast MR angiography (NC-MRA) method. However, results from related studies are inconsistent. The purpose of this meta-analysis was to assess the accuracy of b-SSFP MRA compared to contrast-enhanced MR angiography (CE-MRA) in diagnosing RAS.

METHODSEnglish and Chinese studies that were published prior to September 4, 2013 and that assessed b-SSFP MRA diagnostic performance in RAS patients were reviewed. Quality of the literature was assessed independently by two observers. The statistical analysis was adopted by the software of Meta-Disc version 1.4. Using the heterogeneity test, a statistical effect model was chosen to calculate different pooled weighted values. The receiver operator characteristic (ROC) space and Spearman correlation coefficient were to explore threshold effect. Sensitivity analysis and the publication bias were performed to demonstrate if the pooled estimates were stable and reliable. We produced forest plots to calculate the pooled values and corresponding 95% confidence interval (CI) of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and constructed a summary receiver operating characteristic curve (SROC) to calculate the area under the curve (AUC).

RESULTSA total of 10 high quality articles were used in this meta-analysis. The studies showed a high degree of heterogeneity. The "shoulder-arm" shape in the ROC plot and the Spearman correlation coefficient between the log(SEN) and log(1-SPE) suggested that there was a threshold effect. Sensitivity analysis demonstrated that the actual combined effect size was equal to the theoretical combined effect size. The publication bias was low after quality evaluation of the literature and the construction of a funnel plot. The pooled sensitivity was 0.88 (95% CI, 0.83-0.91) and pooled specificity was 0.94 (95% CI, 0.93-0.95); pooled PLR was 14.57 (95% CI, 9.78-21.71]) and pooled NLR was 0.15 (95% CI, 0.11-0.20). The AUC was 0.964 3.

CONCLUSIONIn contrast to CE-MRA, the b-SSFP MRA is more accurate in diagnosing RAS, and may be able to replace other diagnostic methods in patients with renal insufficiency.

Objective To explore the feasibility of combining anterior and posterior fontanelle acoustic windows for fetal median sagittal plane cranial scanning in prenatal ultrasound.Methods From July 5 to August 25 in 2012,200 pregnant women in Huai'an First Hospital at 22 to 24 gestational weeks accepted transabdominal uhrasonography,with anterior fontanelle,longitudinal suture and posterior fontanelle as acoustic windows to obtain the median sagittal plane.In the mean time,ten aborted or induced fetuses (with malformations or maternal complications) underwent cranial ultrasound with the same acoustic windows.The successful rates of obtaining median sagittal plane were calculated.Data were analyzed by Chi-square test.Results (1) Among the ten aborted or induced fetuses,all median sagittal planes were successfully obtained through anterior,posterior fontanelle,or longitudinal suture alone.(2) Among the 200 cases of prenatal uhrasonography,the successful rate of obtaining median sagittal plane through posterior fontanelle alone was 76.0％(152/200),which was higher than that through anterior fontanelle alone [59.5％ (119/200),x2=12.5,P＜0.01].The successful rate was 95.5％ (191/200) when combining the anterior and posterior fontanelle,which was higher than that through anterior fontanelle or posterior fontanelle alone (x2 =74.3 and 31.1,both P＜0.01).The successful rate of obtaining median sagittal plane through posterior fontanelle was 67.3％ (65/102) in cephalic presentation,which was also higher than that through anterior fontanelle [37.3％ (38/102),x2 =14.3,P＜0.01].The successful rate was 88.8％ (87/98) through posterior fontanelle in non-cephalic presentation,which was similar to that through anterior fontanelle [82.7％(81/98),x2 =1.5,P＞0.05].When both anterior and posterior fontanelle applied,the successful rate in cephalic presentation was 9.8％ (10/102),lower than that in non-cephalic presentation fetuses [71.4％ (70/98),x2 =79.1,P＜0.01].Conclusions The successful rate in obtaining median sagittal plane through posterior fontanelle is higher than that through anterior fontanelle,and might be increased when both anterior and posterior fontanelle were used.

BACKGROUND:To decrease operation amount of finite element analysis and increase its clinical practice,previous studies explored the material properties and 10 kinds of material attributes were assigned,which met the requirements of finite element analysis.Moreover,it can be used to calculate bone density.OBJECTIVE:To explore a method for measurement of bone density based on three-dimensional reconstruction and finite element analysis.METHODS:A total of 11 specimens of femoral superior segment were selected.The mass of control group was firstly measured.The experimental groups were treated with thin-slice high resolution CT scan and three-dimensional reconstruction in Mimics 10.0,volume meshing in Ansys,assigned with 10,100 and 400 kinds of material attributes Mimics,exported to Ansys to calculat the volumes of the block elements of every types of material attributes.The mass and the density of the specimens was harvested according to the empirical formula concerning the gray value and the bone density.All results were treated with one-way ANOVA.RESULTS AND CONCLUSION:One-way ANOVA showed that there were no significant differences between control group and experimental groups assigned with 10,100 and 400 kinds of material attributes (P＞0.28),and there were no significantly among the experimental groups (P＞0.8).Results show that the method was able to measure the mass and the density of bone quantitatively,as well as the proportion between compact bone and cancellous bone;to assign 10 kinds of material attributes to three-dimensional model of femur could match the needs for measurements.The results can be used as an initial preparation for the unification of bone density and finite element analysis for osteoporosis.