Objective: To summarize the long-term efficacy and safety of sacral neuromodulation (SNM) in treating refractory interstitial cystitis/bladder pain syndrome (IC/BPS)，so as to provide clinical evidence for this therapeutic approach. Methods: This study retrospectively analyzed the data of 27 patients with refractory IC/BPS treated at our hospital during Jan.2015 and Dec.2021.All patients underwent SNM Ⅱ.The therapeutic effects were evaluated with Global Response Assessment (GRA).The preoperative and postoperative daily urinary frequency，nocturia frequency，functional bladder capacity，O'Leary-Sant score，pelvic pain，urgency and frequency (PUF) score，quality of life (QoL) score，and visual analogue scale (VAS) score were compared. Results: During the follow-up of (55.55±16.33) months，12 patients showed no symptom relief (GRA≤4)，while 15 experienced symptom relief (GRA>4)，resulting in an efficacy rate of 55.56% (15/27).The average daily urination frequency decreased from (28.74±13.84) to (24.74±16.33) times,the O'Leary-Sant score decreased from (30.19±5.35) to (25.63±9.34)，PUF score decreased from (25.63±5.34) to (22.04±8.29)，QoL score decreased from (5.67±0.55) to (4.33±1.57)，and VAS score decreased from (8.04±1.91) to (5.33±3.09)，the differences were statistically significant (P<0.05). No complications such as incision infections or pain at the implant site were observed. Conclusion: SNM is safe and effective for refractory IC/BPS，but there is a risk of long-term failure.Therefore，patients should be discreetly selected.

Objective:To investigate the clinical efficacy of bilateral V-Y advancement island flaps on buttocks in repairing postoperative defects in patients with perianal Paget′s disease.Methods:From January 2009 to January 2021, a retrospective analysis was performed on clinical data collected from 13 patients with perianal Paget′s disease, whose perianal defects resulting from the tumor resection were reconstructed with bilateral V-Y advancement island flaps on the buttocks in the Department of Dermatology, Hangzhou Third People′s Hospital. The postoperative recovery of the buttocks and the effects on the defecation function were evaluated.Results:The areas of perianal defects in 13 cases ranged from 4.8 cm × 5.6 cm to 12.2 cm × 6.4 cm. All defects were successfully repaired by using the bilateral V-Y advancement island flaps, and all surgical wounds healed primarily. One case first received temporary ileostomy, and then received ileostomy closure 3 months later, resulting in the recovery of defecation function; in another 1 case of perianal Paget′s disease comorbid with rectal cancer, the permanent sigmoid colostomy was performed to divert feces, and the defecation function was lost. After the follow-up for 1 - 6 years, the buttocks were symmetrical in shape in all the 13 patients, and 12 with preserved anus had normal defecation function. No tumor recurrence was observed in 12 patients without other malignant tumors after the operation, while 3 patients experienced mild anal stenosis without anal mucosa eversion or wound dehiscence; 1 patient with perianal Paget′s disease complicated by anal canal adenocarcinoma developed bilateral inguinal lymph node and internal iliac lymph node metastasis 1 year after the operation, and died 6 months later.Conclusion:The bilateral V-Y advancement island flaps on the buttocks have the advantages of reliable blood supply and sufficient advancement mobility, and can be used to repair large skin defects around the anus.

Objective:To analyze the clinical efficacy of electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation in the treatment of vitiligo-associated leukotrichia.Methods:Clinical data were retrospectively collected from 25 patients with stable vitiligo-associated leukotrichia in the Department of Dermatologic Surgery, Hangzhou Third People′s Hospital from January 2019 to January 2021. All the patients received electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation. Outpatient follow-up visits were conducted in the first week, as well as the first, third and sixth months after surgery. The texture and growth status of transplanted hair were observed, and the survival rate of transplanted hair follicles and the proportion of newborn white hair in white hair in the original lesions were recorded.Results:Among the 25 patients with stable vitiligo, there were 14 males and 11 females, and their disease duration ranged from 2 to 15 years, with the average duration being 5.8 years. A total of 30 white patches accompanied by leukotrichia were included, including 9 on the scalp, 7 on the eyebrows and 14 on the eyelashes. One week after surgery, the transplanted hair survived well in all patients, without obvious shedding or local infection. Six months after surgery, repigmentation was observed in most hair in the original lesion area, and only a small amount of white hair grew out, without obvious scarring; the survival rate of transplanted hair follicles was 76.5% ± 10.0%, and the proportion of newborn white hair in white hair in the original lesions was 16.7% ± 7.8%.Conclusion:Electrolysis of depigmented hair using a trichiasis electrolyzer combined with hair follicle transplantation was effective in the treatment of vitiligo-associated leukotrichia, with a simple treatment process and few postoperative complications, which provided a reliable choice for the clinical treatment of vitiligo-associated leukotrichia.

Objective:To investigate the efficacy and safety of laparoscopic subtotal cystectomy with augmentation ileocystoplasty(SC-CP) and laparoscopic total cystectomy with ileal conduit (TC-IC) for refractory interstitial cystitis/bladder pain syndrome (IC/BPS).Methods:Clinical data of 39 patients diagnosed with refractory IC/BPS treated with SC-CP and TC-IC in Beijing Chaoyang Hospital of Capital Medical University from January 2008 to December 2023 were retrospectively analyzed. All patients were female, and had unsatisfactory results after more than three types of conservative + minimally invasive treatments. There were 12 patients in the SC-CP group and 27 patients in the TC-IC group. In the SC-CP group, the patients had the age of (50.8±14.4) years old, preoperative medical history of (4.7±2.5) years, daytime voiding frequency of 25.0 (18.5, 45.0) times/day, nocturia frequency of 12.5 (10.0, 15.0) times/night, functional bladder capacity of 40.0(18.5, 47.5) ml, and anesthetized bladder capacity of 150.0 (150.0, 195.0) ml. The patients in TC-IC group had the age of (60.3±8.0) years old, preoperative medical history of (6.5±3.6) years, daytime voiding frequency of 30.0 (20.0, 40.0) times/day, nocturia frequency of 10.0 (8.0, 15.0) times/night, functional bladder capacity of 50.0(30.0, 60.0) ml, and anesthetized bladder capacity of 200.0 (150.0, 330.0) ml. SC-CP was performed to resect the bladder wall beyond the trigone and bladder neck, and bladder enlargement was performed by using an ileal segment anastomosed to the remaining bladder. TC-IC was performed to resect the entire bladder, and a segment of free ileum with a mesentery was taken, which was closed proximally and then anastomosed to the ureters on both sides, and a cutaneous ureterostomy was performed at the distal end. The patients in the two groups were followed up after the operation, and the intraoperative conditions and postoperative complications were recorded. The visual analogue scale (VAS) score, quality of life (QOL) score, O′Leary-Sant score, pelvic pain and urgency/ frequency patient symptom scale (PUF) score were recorded before and after the operation, and the differences were compared to evaluate the improvement of symptoms.Results:In the SC-CP group, the operation time was 240.0 (202.8, 293.8) min, the intraoperative hemorrhage was 50.0 (27.5, 50.0) ml, and the postoperative hospital stay was 12.0 (7.3, 16.5) days. In the TC-IC group, the operation time was 300.0 (240.0, 329.0) min, the intraoperative hemorrhage was 100.0 (50.0, 100.0) ml, and the postoperative hospital stay was 10.0 (8.0, 12.0) days. The median follow-up time of 39 patients was 31.0(10.0, 70.0) months, and the follow-up time of SC-CP group and TC-IC group was 11.0 (4.0, 22.0) and 56.0 (13.0, 75.0) months, respectively. Compared with preoperative data of SC-CP group, the postoperative VAS score [10.0 (10.0, 17.5) points vs. 90.0 (90.0, 98.8) points], the QOL score [1.0 (1.0, 2.0) points vs. 6.0 (6.0, 6.0) points], the O′Leary-Sant score [10.0 (8.5, 13.5) points vs. 35.0 (33.3, 35.8) points], and the PUF score [11.0 (7.3, 12.8) points vs. 29.5 (28.3, 32.0) points] of SC-CP group were all significantly reduced ( P < 0.05). Compared with preoperative data of TC-IC group, the postoperative VAS score [0 vs. 95.0 (90.0, 96.0) points], the QOL score [2.0 (1.0, 3.0) points vs. 6.0 (6.0, 6.0) points], the O′Leary-Sant score [1.0 (1.0, 2.0) points vs. 35.0 (35.0, 36.0) points] and the PUF score [3.0 (3.0, 4.0) points vs. 32.0 (29.0, 32.0) points] of TC-IC group were all significantly reduced ( P< 0.05). Two patients in the SC-CP group required postoperative clean intermittent catheterization, and one patient underwent TC-IC for residual bladder pain. Three patients in the TC-IC group had postoperative bowel obstruction relieved by conservative treatment, and two patients had postoperative wound infection cured by dressing change. Conclusions:Both SC-CP and TC-IC have better efficacy in patients with refractory IC/BPS. Although TC-IC has more potent relief of pain symptoms, SC-CP is closer to the normal human urination habit, eliminating the need to carry an ostomy bag, which is especially suitable for young patients with recalcitrant IC/BPS.

Von Hippel-Lindau (VHL) syndrome, also known as cerebral retinal angiomatosis, is a kind of neuroendocrine tumor. The incidence rate is high, and the heredity is very high, which can involve the retina, central nervous system, various organs and various tissue parts. This paper reports a case of VHL syndrome with hypertension and diabetes as the main manifestations, in order to improve the understanding of the disease and reduce misdiagnosis and missed diagnosis.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Objective:To summarize and analyze the efficacy of the upper eyelid orbicularis oculi myocutaneous island flap in repairing secondary defects after resection of eyelid and periorbital skin tumors.Methods:A retrospective analysis was carried out on clinical data collected from 28 patients, whose secondary eyelid and periorbital defects were repaired with the upper eyelid orbicularis oculi myocutaneous island flaps in the Department of Dermatology, Hangzhou Third People′s Hospital from August 2019 to June 2021. The survival condition of the flaps was observed after the operation, and the appearance of the upper eyelid and periorbital skin as well as tumor recurrence were evaluated during the follow up.Results:Among the 28 cases, there were 6 males and 22 females; their ages ranged from 47 to 87 years (70.5 ± 10.9 years), 7 patients were aged 80 - 89 years, 8 aged 70 - 79 years, 8 aged 60 - 69 years, 4 aged 50 - 59 years, and 1 patient was aged 40 - 49 years. Skin defects were distributed at the upper eyelid in 1 case, at the lower eyelid in 9 cases, at the inner canthus in 1 case, at the outer canthus in 3 cases, at the upper eyebrow in 1 case, at the dorsum of the nose in 3 cases, and at the junction of the external nose, inner canthus and lower eyelid in 10 cases. The skin defects varied from 1.0 cm × 0.5 cm to 3.1 cm × 2.3 cm in size. The designed upper eyelid orbicularis oculi myocutaneous flap was 0.5 - 1.8 cm in width and 3 - 4 cm in length, and the length of the subcutaneous tunnel was 1.2 - 2.5 cm. During the follow-up of 6 months to 1.5 years, all flaps survived; scars on the upper eyelid donor sites were not obvious; there was no upper eyelid ectropion, no trichiasis, and no eyelid closure abnormality after the operation.Conclusion:The medium- or small-sized defects of the eyelid and periorbital skin can be successfully repaired by the upper eyelid orbicularis oculi myocutaneous island flap, with a favorable cosmetic effect and concealed donor areas.

Objective:To evaluate the clinical efficacy of Bazheng Powder combined with Traditional Chinese Medicine (TCM) fumigation in the treatment of refractory urinary tract infection patients with Yin deficiency damp-heat syndrome.Methods:Randomized controlled trial design. Ninety-seven patients with Yin deficiency and damp-heat syndrome of refractory urinary tract infection in our hospital from April 2021 to May 2022 were selected as observation objects, and were divided into observation group (49 cases) and control group (48 cases) by random number table method. The control group was treated with antibiotics, and the observation group was treated with Bazheng powder plus or minus plus TCM fumigation on the basis of control group. Both groups were treated for 14 days. TCM syndrome score was performed before and after treatment. Test tube method was used to measure WBC, urine routine nitrite was used to measure urinary bacteria count, and the time to return to normal urine routine, symptom remission time and symptom disappearance time were recorded. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate was 95.92% (47/49) in the observation group and 81.25% (39/48) in the control group, and the difference between the two groups was statistically significant ( χ2=5.19, P=0.022). After treatment, TCM syndrome score of observation group was significantly lower than that of the control group ( t=13.18, P<0.01), WBC and urinary bacteria count were significantly lower than those in the control group ( t values were 19.77 and 22.99, P<0.01). The time of urine routine recovery, symptom remission and symptom disappearance in the observation group were significantly faster than those in the control group ( t values were 23.61, 9.80, 7.34, P<0.01). During the treatment period, the incidence of adverse reactions was 8.33% (4/48) in the control group, and no adverse reactions occurred in the observation group, the difference between the two groups was statistically significant ( χ2=4.26, P=0.039). Conclusion:The addition and reduction of Bazheng Powder combined with TCM fumigation can improve the clinical symptoms and clinical efficacy of patients with Yin deficiency damp-heat syndrome of refractory urinary tract infection, and no adverse reactions occurred.

Objective:To investigate the application of transverse closure of longitudinal incisions in repairing pentagonal full-thickness defects of the lower eyelid margin.Methods:A retrospective analysis was performed on clinical data collected from 26 patients with melanocytic nevi at the lower eyelid margin in Department of Dermatology, The Third People′s Hospital of Hangzhou from July 2016 to June 2019. Among the 26 patients, 10 were males, and 16 were females. After lesion resection, all the pentagonal full-thickness defects of the lower eyelid margin were repaired via transverse closure of longitudinal incisions.Results:All the pentagonal defects of the 26 cases were successfully repaired. The longitudinal incisions perpendicular to the eyelid were successfully converted into transverse incisions parallel to the eyelid margin and near the eyelash, and all incisions healed primarily. After surgery, mild congestion of the lower eyelid occurred in 3 patients, and temporary blurred vision in 1. During 1 - 2 years of postoperative follow-up, 26 patients all achieved symmetrical appearance of the skin and soft tissues around the eyes, without obvious postoperative scars or lower eyelid ectropion.Conclusions:Horizontal closure of longitudinal incisions can be used to repair the pentagonal full-thickness defects of the lower eyelid margin, because it can convert the incision closure line perpendicular to the lower eyelid margin into a horizontal transverse incision closure line parallel to the lower eyelid margin, so that the incisions and scars of the lower eyelid can be hided with a satisfactory cosmetic effect.