Objective:To explore the predictive value of preoperative pelvic floor electromyography(EMG)parameters for the risk of urinary incontinence after prostate cancer surgery.Methods:This study retrospectively analyzed the medical records of 271 patients who underwent radical prostatectomy in the urology department of Peking University First Hospital from January 2020 to October 2022.The data included patient age,body mass index(BMI),international prostate symptom score(IPSS),prostate-specific antigen(PSA)levels,Gleason score,type of surgery,urethral reconstruction,lymph node dis-section,nerve preservation,catheterization duration,D'Amico risk classification,American Society of Anesthesiologists(ASA)score,Charlson comorbidity index,postoperative duration,prostate volume,and pelvic floor EMG parameters(pre-resting mean,fast muscle mean,and slow muscle mean scores).Independent risk factors affecting early postoperative urinary incontinence were identified through multiva-riate Logistic regression analysis.The predictive efficacy of pelvic floor EMG results was evaluated by cal-culating the area under the receiver operating characteristic(ROC)curve,and the optimal threshold for early postoperative urinary incontinence was determined based on the Youden index and clinical signifi-cance.Results:The study included 271 prostate cancer patients,with an 81.9％rate of voluntary urinary control post-surgery.The median score for fast pelvic floor muscles was 23.5(18.2,31.6),and for slow muscles,it was 12.5(9.6,17.3).Among the patients,179(66.1％)did not preserve nerves,and 110(40.6％)underwent urethral reconstruction.Advanced age and low fast muscle scores were identified as independent risk factors for urinary incontinence.Patients aged ≤60 had 5.482 times the voluntary urinary control rate compared with those aged ≥70(95％CI:1.532-19.617,P＜0.05).There was a significant correlation between fast muscle scores and urinary incontinence recovery(OR=1.209,95％CI:1.132-1.291,P＜0.05).When the optimal threshold for preoperative fast muscle score was set at 18.5,the ROC sensitivity and specificity were 80.6％and 61.2％,respectively.Con-clusion:Preoperative pelvic floor EMG parameters show good predictive accuracy and clinical applicabili-ty for the risk of urinary incontinence after prostate cancer surgery.These parameters can be used for ear-ly identification of urinary incontinence risk,with age and fast muscle scores being important predictors.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

OBJECTIVES: To analyze the prevalence and influencing factors for drinking behavior and heavy drinking among government employees in Changsha and provide a basis for carrying out interventions for drinking behaviors and formulating public health promotion plans for government employees. METHODS: Government employees were recruited consecutively from the Health Management Center of a general hospital in Changsha between December 2017 and December 2018. Information on sociodemograpic characteristics, drinking behaviors, life events, and psychosocial characteristics was collected using a standard set of questionnaire. Drinking behavior was defined as drinking once or more per week for the past 12 months. The differences in drinking rates and excessive drinking rates among groups with different characteristics were compared. Multivariate analysis was performed to analyze the associated factors of drinking behaviors and heavy drinking for government employees. RESULTS: A total of 6 190 people completed this investigation. The overall drinking rate of government employees in Changsha was 21.9%, and the rate of drinking was higher in males than that in females (44.7% vs 4.0%, CONCLUSIONS The drinking and heavy drinking rates of government employees are high in Changsha. Marital status, physical exercise, and frequency of social intercourse are the common influencing factors of male drinking behavior and female drinking behavior. The life events stimulation is the influencing factor of heavy drinking.
Adult ; Alcohol Drinking/epidemiology* ; Female ; Government Employees ; Health Behavior ; Humans ; Male ; Middle Aged ; Risk Factors ; Smoking

Objectives:To summarize the experience of treatment of 23 cases of urachal carcinoma in order to improve the diagnosis and treatment of urachal carcinoma.Methods:Clinical data of a total of 23 patients with urachal carcinoma from January 2014 to August 2019, including 19 males and 4 females, with a median age of 53 years (34 to 84 years) were retrospectively analyzed. The most common symptom was painless gross hematuria (20/23, 87.0%). All patients underwent CT examination before operation. Three of them had calcification (13.0%), and the median maximum diameter was 3.5 cm (2.0-7.0 cm). Preoperative cystoscopy revealed 23 cases of anterior or parietal mass of the bladder. Partial cystectomy and urachectomy were performed in 17 cases, partial cystectomy plus urachectomy (including umbilectomy) were performed in 5 cases, and total cystectomy were performed in 1 case. Eleven patients (47.8%) underwent pelvic lymph node dissection. Twenty-one cases (91.3%) had Sheldon stage Ⅲ or above tumors.Results:There were 21 cases of urachal adenocarcinoma and 2 cases of transitional cell carcinoma with adenoid differentiation. Five patients underwent adjuvant therapy (21.7%), including 1 patient of 5-fluorouracil (5-fu)+ cisplatin, two patients of gemcitabine+ cisplatin, and one patient of gemcitabine+ cisplatin+ vascular endothelial inhibitor. One case underwent local pelvic radiotherapy alone. No recurrence or metastasis occurred during the follow-up period. All patients were followed up for 38 months (2 to 68 months). A total of 3 patients developed distant metastasis and died during follow-up. The death occurred at 15 months, 40 months, and 49 months after surgery, all of which were caused by tumor metastasis. Two other patients had recurrence at 9 and 13 months after surgery, respectively, and they were followed up for 55 and 25 months after recurrence. Survival analysis showed that the 2-year cancer-specific survival rate was 94.1%, and the 5-year cancer-specific survival rate was 74.9%.Conclusions:Early diagnosis of urachal cancer is difficult. Emphasizing the examination of the urachus during physical examination may help early detection. Surgery-based comprehensive treatment can achieve good tumor control for localized umbilical carcinoma. The accurate pathological staging through pelvic lymph node dissection and the early postoperative adjuvant therapy may improve the prognosis of the patients.

Objective Studies have shown that problem based learning (PBL) can improve the students' ability of autonomous learning.However,it is unclear whether students' autonomous learning ability will affect students' evaluation in PBL teaching.This study took medical psychology course as an example to explore the influence of medical students' autonomous learning ability on PBL teaching effect.Methods 43 8-year program medical students of Grade 2010 and 2011 were enrolled in this study.Scale was used to assess medical students' autonomous learning ability before the start of the PBL teaching.Self made questionnaire was used to survey the students' evaluation in PBL teaching.Linear correlation analysis was used to detect the relationship between medical students' autonomous learning ability and students' evaluation in PBL teaching and their examination results.Results Medical students' autonomous leaming ability is significantly positively correlated to the students' evaluation of PBL teaching (P＜0.05).The correlation coefficient between learning motivation and "PBL enhanced learning interest" or "PBL enhanced information utilization ability" was high (r=0.507 and 0.536,respectively).It showed that students with stronger autonomous learning ability had more positive evaluation of PBL teaching.The students' learning motivation was also positively correlated to the test score (r=0.416,P=0.006).Students with stronger learning motivation had higher test score in the final exam.Conclusion These results indicate that the relationship between the students' autonomous learning ability and PBL teaching is bidirectional.The students with more powerful ability of autonomous learning will be more active in the process of PBL teaching,and the positive experience will promote their autonomous learning ability in turn.

Objective To discuss the outcomes of transvaginal repair and transabdominal repair for complex vesicovaginal fistula (VVF).Methods The data of complex VVF patients undergoing surgical repair in Peking University First Hospital were retrospectively collected between January 2009 and December 2016.The surgical modalities for complex VVF included transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition.The subtype distribution of complex VVF in transabdominal repair group and transvaginal repair group were recorded.The present study included 63 complex VVF patients with the median age of 46 years (range 26-60 years).There were 32 cases undergoing transvaginal repair with layered closure and 31 cases undergoing transabdominal repair with full thick vascular peritoneal interposition.The proportion of cases having failed previous repairs was significantly higher in transvagical repair group (30/32 vs.23/31,P =0.034).Compared with patients with transvaginal repair,patients with transabdominal repair tended to have multiple VVF without statistic significance (18.8％ vs.29.0％,P =0.338).Patients with transabdominal repair had larger VVF than patients with transvaginal repair (median:1.0cm vs.0.5cm,P ＜ 0.001).Results There were 2 cases suffering from fat liquefaction of surgical incision and 1 case suffering from adhesive intestinal obstruction in patients undergoing transabdominal repair.In the median follow-up duration of 24 months (range 8-102 months)and 29 months (range 8-78 months),the successful rates of transvaginal repair and transabdominal repair were 75％ (24/32) and 93.5％ (29/31).Severe lower urinary tract symptoms occurred in one patient who had urine leakage after transabdomnal repair.The bladder volume of patients in transabdominal group recovered at postoperative 3-6 months.Conclusions In consideration of surgical invasion and fistula condition,transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition should be performed individually for complex VVF.Meanwhile,the surgeons need pay attention to other perioperative management.

Objective To investigate the clinical value of the intervertebral disc morphous in patients with thoracolumbar vertebral compression fracture. Methods The MRI, X-ray and CT data of 75 patients with thoracolumbar vertebral compression fracture were retrospectively analyzed. The intervertebral disc damage degree was observed, and its correlation with vertebral fracture degree and endplate damage degree was studied. The vertebral body leading edge height, intervertebral space height and back convex Cobb angle in patients with different intervertebral disc damage degree were measured. Results The intervertebral disc damage degree height was positively correlated with endplate damage degree (P<0.01), and the intervertebral disc damage degree was positively correlated with fracture degree (P<0.01). With the increase of the intervertebral disc damage degree in patients with Ⅰ - Ⅳtype intervertebral disc damage, the vertebral body leading edge height and intervertebral space height gradually became smaller: (0.68 ± 0.05), (0.61 ± 0.03), (0.58 ± 0.03), (0.42 ± 0.05) mm, and (0.31 ± 0.06), (0.29 ± 0.03), (0.24 ± 0.06), (0.22 ± 0.02) mm, and there were statistical differences (P<0.05). There was no statistical difference in back convex Cobb angle in patients with different intervertebral disc damage degree (P>0.05). Conclusions It is more important to observe the morphological changes of the intervertebral disc in patients with thoracolumbar vertebral compression fracture, and the damage degree is closely related with the vertebral fracture degree and endplate damage degree.

Objective To observe the clinical efficacy of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) by Quadrant channel for grade Ⅱ and Ⅲ spondylolisthesis. Methods Forty-eight patients with grade Ⅱ and Ⅲ spondylolisthesis were treated with MIS-TLIF by Quadrant channel. The patients were followed up for 12 months, The visual analog scale (VAS), Oswestry disability index (ODI), intervertebral height and lose drop of anterior slippage reduction were assessed. Results Surgery was successfully completed in all the patients. The VAS, ODI, intervertebral height and vertebral slippage 1 week after operation were significantly improved compared with that before operation:(4.5 ± 0.8) scores vs. (8.6 ± 1.2) scores, (32.0 ± 1.3) scores vs. (46.0 ± 3.7) scores, (10.5 ± 2.2) mm vs. (4.6 ± 2.1) mm and (2.1 ± 2.0) mm vs. (11.2 ± 1.7) mm, and there were statistical differences (P<0.05). Compared with that of 1 week after operation, there was no significant change in 12 months:(2.1 ± 2.0) scores, (11.0 ± 1.1) scores, (9.8 ± 2.5) mm and (2.2 ± 2.0) mm, P>0.05. Patients did not have the complications such as nerve damage, loosening of internal fixation. Conclusions The MIS-TLIF is a safe and effective minimally invasive treatment for grade Ⅱ and Ⅲ spondylolisthesis by Quadrant channel.

BACKGROUND:Fragile bone in senile osteoporosis patients easily weakened pedicle screw fixation capacity. Therefore, bone cement leakage and screw removal cannot be solved during pedicle screw repair in osteoporotic patients with degenerative lumbar spine. OBJECTIVE:To investigate the biomechanical properties of novel pourable pedicle screws and bone cement application effect in osteoporotic patients with degenerative lumbar spine. METHODS:Six lumbar specimens (T11-L5) at the mean age of (72.9±4.2) years were selected, total y 42 vertebrae. The average bone density was 0.696 g/cm2. Any side of al vertebrae was inserted with pourable pedicle screws. 2 mL of bone cement was perfused under the X-ray fluoroscopy with cement push rod and fil ing cylinder. The same number of conventional screws was inserted into the opposite side of the samples. Three-point bending test was performed in two kinds of screws. The maximum vertebral axial pul out force test and the maximum spin torque test were conducted in vertebra to observe the destruction of the vertebral body and implanted effect. RESULTS AND CONCLUSION:(1) The ultimate strength and yield load of novel pourable cement pedicle screws were significantly more than conventional screws (P<0.05). Ultimate displacement and yield displacement were significantly less in novel pourable cement pedicle screws than in conventional screws (P<0.05). (2) The maximum vertebral axial pul out force and the maximum spin torque were significantly higher in novel pourable pedicle screws than in conventional screws (P<0.05). (3) In summary, novel pourable cement pedicle screw is simple to operate, can effectively control bone cement penetration, and improve screw stability in osteoporotic vertebrae. Moreover, after treatment, the removal of screws is convenient, cannot evidently destroy vertebral body or screw channel, and promote early recovery.

According to the course characteristics and teaching outline of medical psychology,problem-based learning (PBL) case about somatoform disorders was compiled based on a typical clinical real case.The PBL case covered a wide range of topics such as basic medicine,clinical medicine and medical psychology.Just as clinical treatment process,teachers gave information and put forward the corresponding questions in successive steps.By self-study and group discussion,students learned knowledge about anxiety,somatoform disorders,therapeutic relationship,sociocultural factors and individual personality.The course survey showed that PBL teaching was appreciated by medical students.The PBL model can improve learning interest and self-study ability,promote the connection of different subjects and combine theory and practice.The PBL model is useful for improving the quality of medical psychology teaching.