Objective:To explore the efficacy of pedicled bladder muscle flap in the repair of urinary tract obstruction.Methods:The data of 26 patients with urinary tract obstruction admitted to Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2016 to June 2021 were retrospectively reviewed. There were 14 males and 12 females, with the age ranged from 2 to 75 years old. Refractory bladder neck obstruction after prostatic hyperplasia surgery in 12 cases, with the age of (70.0±3.5) years old.They all experienced at least 2 times of transurethral stenosis incisionor resection. Transpubic cystostomy tube was placed in 9 patients. Posttraumatic pelvic fractures lead to bladder neck atresia and urethral injury in 6 girls, with the age of (10.5±2.1) years old. The bladder neck atresia and urethral obliteration length was 1-2 cm determined by urethrography. Eight cases suffered ureteral strictures after gynecological myomectomy or ureteroscopy holmium laser lithotripsy(4 cases of each type), including two males and six females, with the age of (55.0±3.2) years old. The length of ureteral stricture or defect was 5-6 cm determined by intravenous urography(IVU) or CT urography(CTU). The patients with bladder neck obstruction underwent the following surgery: The "Y" incision of the bladder and stenosis of the prostate urethra was performed and the pedicled bladder muscle flap was inserted into the normal urethral mucosa to complete the Y-V plasty. In the 6 girl patients, pedicled bladder muscle flap(2-4 cm) augmented reconstruction were performed. All above 18 patients, whose urethral catheter was indwelled for 3-4 weeks, urinary flow rate and urethroscopy examination were performed to evaluate the effect of surgery 4 weeks and 3 months after the operation. As the 8 cases with ureteral strictures, the pedicled bladder muscle flap (7-8 cm) ureteroplasty was performed and the ureteral stent was retained for 4 weeks. Ultrasonography and IVU/CTU were performed 4 weeks and 3 months postoperatively. The patency of the ureteral lumen and whether it is accompanied by hydronephrosis, lower back pain, and urinary tract infection were assessed.Results:All patients underwent pedicled bladder muscle flap reconstructive surgery successfully and no serious complications occurred postoperatively. The patients were followed up for (8.2± 2.2) months. As urethral catheters were removed, 10 patients with refractory neck obstruction could return to normal urination with the urinary flow Q max (17.2±2.8)ml/s, while 2 patient had dysuria and were treated with regular urethral dilatation. The catheter was removed 4 weeks after the reconstructive surgery in 6 girls with bladder neck atresia and urethral injury after posttraumatic pelvic fracture. Five could successfully urinate with the urinary flow Q max of (16.7±1.1)ml/s, and one girl had urinary incontinence, waiting for further operation.The ureteral stent was removed after ureteroplasty in 8 patients. CTU and IVU examination showed no ureters with obstruction.No one had low back pain, discomfort, or urinary tract infection. Conclusions:The reconstruction using the pedicled bladder muscle flap was a convenient, minimally invasive and effective technique for the management of adjacent lower ureters, bladder neck, and proximal urethra.

Objective:To measure the skin thickness in patients with erysipelas by high-frequency ultrasonography (HF-USG), and to compare the clinical efficacy of systemic antibiotics alone versus their combination with glucocorticoids in the treatment of erysipelas.Methods:Hospitalized patients with erysipelas were enrolled from Zhongda Hospital, Southeast University from January to December in 2021, and randomly divided into the study group and control group according to the order of visits. The study group was treated with systemic cefathiamidine for 7 days followed by oral methylprednisolone at a dose of 0.4 mg·kg -1·d -1, while the control group was treated with cefathiamidine alone. Before and after the treatment for 10 days, the thicknesses of the epidermis-dermis layers and subcutaneous tissues were measured by HF-USG at the sites of the most severe skin lesions on the affected limbs and at the corresponding sites on the healthy limbs, and white blood cell (WBC) counts, neutrophil (NEU) counts, as well as C-reaction protein (CRP) levels were determined. The t test and non-parametric test were used to compare the efficacy between two groups. Results:A total of 23 patients with erysipelas were enrolled. Among the 12 patients in the study group, 8 were males and 4 were females, and their age was 71.4 ± 11.4 years. Among the 11 patients in the control group, 7 were males and 4 were females, and their age was 67.4 ± 11.1 years. Before treatment, the thicknesses of the epidermis-dermis layers (0.33 ± 0.12 cm) and subcutaneous tissues (1.08 ± 0.49 cm) in the study group were not significantly different from those in the control group (0.25 ± 0.09 cm, 0.98 ± 0.46 cm; t = -1.83, -0.49, P = 0.081, 0.626, respectively). After the 10-day treatment, the thicknesses of the epidermis-dermis layers and subcutaneous tissues of the skin lesions on the affected limbs significantly decreased in both groups compared with those before treatment (both P < 0.05), and the decrease in the thicknesses of subcutaneous tissues was significantly stronger in the study group (0.32 ± 0.33 cm) than in the control group (0.10 ± 0.07 cm; t = 2.20, P = 0.039). Before treatment, the WBC counts ([11.16 ± 4.42] × 10 9/L), NEU counts ([8.26 ± 4.16] × 10 9/L) and CRP levels (median [ Q1, Q3]: 72.20 [19.28, 140.50] mg/L) in the study group were not significantly different from those in the control group ([10.10 ± 4.53] × 10 9/L, [7.21 ± 3.00] × 10 9/L, 34.40 [8.00, 74.20] mg/L, respectively; t or Z = 0.60, 0.71, -0.85, P = 0.578, 0.496, 0.196, respectively). After the 10-day treatment, the WBC counts, NEU counts, and CRP levels significantly decreased in both groups compared with those before treatment (all P < 0.05) . Conclusion:The combined treatment with systemic antibiotics and glucocorticoids could effectively alleviate skin inflammation, and more rapidly reduce the thicknesses of inflamed subcutaneous tissues in patients with erysipelas compared with systemic antibiotics alone.

Objective:To explore the effect of segmented individualized jumping training on promoting the excretion of ureteral calculi.Methods:From January to December 2020, 87 patients with ureteral calculi admitted to the Urology Surgery of Henan Province Hospital of Traditional Chinese Medicine were selected as the research object by convenient sampling. The patients from January to June 2020 were set as the control group ( n=42) , and the patients from July to December 2020 were set as the observation group ( n=45) . The control group was given routine nursing, while the observation group was given segmented individualized jumping training on the basis of the control group. The effect, adverse reaction and pain of stone excretion were compared between the two groups. Results:In the observation group, the stone free rate was 91.11% (41/45) , the first stone excretion time was (2.04±0.58) days, and the stone free time was (11.05±4.16) days. In the control group, the stone free rate was 71.43% (30/42) , the first stone excretion time was (3.91±0.80) days, and the stone free time was (18.26±3.55) days. The above differences were statistically significant ( P<0.05) . No patient in the observation group had infection, one patient had gross hematuria, three patients relapsed to surgery. In the control group, five patients had infection, seven patients had gross hematuria, and ten patients relapsed to surgery, and the differences were statistically significant ( P<0.05) . The pain score of the observation group was lower than that of the control group five days after admission, with a statistically significant difference ( P<0.05) . Conclusions:Segmented individualized jumping training can accelerate the excretion of small stones in patients with ureteral calculi, reduce the adverse reactions in the process of stone excretion, and reduce the recurrence to surgery rate.

The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.

Objective:To investigate the clinical efficacy of lingual mucosa graft coupled penis flap urethroplasty for crippled hypospadias.Methods:Between January 2016 and August 2019, 16 patients with crippled hypospadias in Shanghai Sixth People's Hospital were included in this study. Their mean age was 35.2 years (range from 25 to 44 years). All patients presented voiding difficulty and failed after 2 or more times of urethroplasty. Their mean times was 4.6(range from 2 to 7 times). Uroflowmetry examination showed their mean Q max was 6.7 ml/s (range from 3.8 to 9.6ml/s). Chordee was found in six patients. Urethrocele was found in 2 patients. Urethrocutaneous fistula was found in 2 patients. All patients received lingual mucosa graft coupled penis flap urethroplasty. By removing the ischemic and fibrotic urethra, urethral plate was reconstructed with lingual mucosa graft and the penis flap was transplanted to cover the reconstructed urethra plate to form a new urethral lumen, which was used to repair the defective urethra. The catheters were removed three weeks after the surgery. Uroflowmetry examination, cystourethrography and cystoscope were performed after the catheters out. Results:All patients underwent smooth surgery with an average duration of 128.4 minutes (range from 105 to 150 minutes). After mean follow-up of 18.6 months (range from 3 to 30 months), successful outcome was achieved in 14 patients and uroflowmetry examination at the seventh week after surgery showed their mean Q max was 22.4 ml/s (range from 15.6 to 29.8 ml/s). 2 cases had urethrocutaneous fistula which were cured after repair of penile urethral fistula. 2 patients still had a certain level of chordee while they were satisfied with the appearance of their penis, so there was no further treatment. Conclusions:Single stage lingual mucosa graft coupled penis flap urethroplasty has short operation period, relatively high success rate and relatively few complications. Single stage lingual mucosa graft coupled penile flap urethroplasty is an available option for crippled hypospadias with several times of failed urethroplasty.

Objective To investigate effects of N-acetylcysteine (NAC) on changes of the behavior and the monoamine neurotransmitters in prefrontal cortex (PFC), striatum (ST), amygdala (AM) and hippocampus (HIP) in rat model of chronic unpredictable stress (CUS), and to explore the possible mechanisms related to the NAC. Methods Thirty-two male Sprague-Dawle (SD) rats were divided into CUS group, fluoxetine group (FLX), NAC group and control group (n=8 for each group). Rats in CUS group, NAC group and FLX group were all fed alone and received CUS for 6 weeks to establish CUS model. Rats in NAC group and FLX group were given NAC and FLX by daily intragastric administration respectively during the last 3 weeks, while rats in CUS group and control group were given the same volume of solvent. Behavioral assessment including weight measurement, sucrose water consumption test, and opened field test were used for evaluation before and after CUS, and before and after intervention. The concentrations of the monoamine neurotransmitters (NE, DA, 5-HT) in PFC, ST, AM and HIP were measured with Coul array HPLC. Results (1) There were more increases in weight gain, sucrose consumption, and distance of horizontal moving and number of up-right, while the number of feces was less, after intervention in control group, NAC group and FLX group than those of CUS group (P<0.05). (2) Neurotransmitters including NE, DA and 5-HT were significantly decreased in PFC, ST, AM and HIP in CUS group compared with that of control group (P<0.05). The monoamine neurotransmitter (NE, DA and 5-HT) were significantly increased in the brain region (PFC, ST, AM and HIP) in NAC group and FLX group than those of CUS group (P < 0.05). Conclusion NAC and fluoxetine can effectively improve the depressive behavior of the CUS rats, increase the contents of monoamine neurotransmitters including NE, DA and 5-HT in PFC, AM, ST and HIP brain regions.

Objective To explore the role of histone H3 acetylation modification of brain derived neurotrophic factor (BDNF) in the pathogenesis of Alzheimer's disease (AD).Methods 2 months and 8 months SAMP8 mice were used as AD model.Morris water maze was used to detect the impairment of learning and memory.Western blot was used to detect BDNF protein expression in the hippocampus,and chromatin immunoprecipitation (CHIP) was applied to study the changes of histone H3 acetylation in different BDNF promoters.Results The results of water maze test showed that the time across the target quadrant in 8 months SAMP8 mice(0.9±0.4) was significant declined compared with that of 2 months SAMP8 mice(3.7 ± ±0.9) and 8 months SAMR1 mice (3.3±0.6)(all P＜0.05).Meanwhile,compared with 2 months SAMP8 mice ((23.9±4.0) s) and 8 months SAMR1 mice ((21.5± 2.3) s),target quadrant time in the 8 months SAMP8 mice((11.7±2.8) s) was also significantly reduced(both P＜0.05).The western blot showed the expression of BDNF in the hippocampus of 8 months SAMP8 mice was significantly decreased compared with that of 2 months SAMP8 mice and 8 months SAMR1 mice(P＜0.05).Lastly,CHIP assays showed that histone H3 acetylation of BDNF exon Ⅳ and Ⅵ in the hippocampus of 8 months SAMP8 mice were remarkably decreased(P＜0.05) compared with that of 2 months SAMP8 mice and 8 months SAMR1 mice.There was no significant change of histone H3 acetylation of BDNF exon Ⅰ and Ⅲ among all groups(P＞0.05).Conclusion Histone H3 acetylation of BDNF exon Ⅳ and Ⅵ is reduced during the development of AD,which may be the mechanism underlying the impairment of learning and memory in AD.

Objective To identify the role of the IKK / NF-kappa B signaling pathways in the acquisition and consolidation of extinction memory in conditioning fear.Methods Aduh SD rats were treated with nuclei buried surgery.After a week recovery from nuclei buried surgery,adult SD rats accepted auditory fear conditioning training.Before the extinction training,bilateral intra-BLA infusion of sulfasalazine(SSZ),an inhibitor of IKK/NFκ B,and Vehicle were done.The freezing time were tested on the 24h and 1w after the extinction.Results After training,all the rats showed higher percentage of freezing time than the baseline(Vehicle:pre-CS 21.16％,post-CS 71.23％,P＜0.01 ; SSZ:pre-CS 22.23％,post-CS 72.14％,P＜0.01).The percentage of freezing time had no significant difference(SSZ 47.52％,Vehicle 46.20％,P＞0.05)between Vehicle and SSZ at the end of extinction training.However,SSZ groups showed significantly higher percentage of freezing time than the control group on the 24h(Vehicle 41.03％,SSZ 60.51％,P＜0.01) and the same was found on 1 weck test(Vehicle 34.17％,SSZ 57.21％,P＜ 0.01).The rats injection with SSZ showed significant fear response for the auditory fear condition.Conclusion All above results suggest that interference of IKK/NF-κ B signaling pathway impaire the consolida tion but have no effect on the acquisition of fear extinction memory in conditioning fear.The available date could provide us some clinical guidance in the treatment of post-traumatic stress disorder and panic disorder.

Objective To investigate the effect of S-phase kinase-associated protein 2 antisense oligodeoxynucleotide (Skp2 ASODN) on the growth and proliferation of colorectal cancer cells SW480 and its mechanism .Methods The liposome-mediated dif-ferent concentrations of Skp2 ASODN was adopted to transfect SW480 cells ,the final concentrations of 0 .050 ,0 .125 ,0 .250 ,0 .500 , 1 .000 ,2 .000 ,4 .000 μmol/L were respectively set up with Skp2 nonsense oligodeoxynucleotides(NSODN) and blank group as con-trol .Then the inhibited effect of growth and proliferation of colorectal cancer cells were measured by the inverted microscope obser-vationandmethylthiazolyltetrazolium(MTT),thecellcyclewassurveyedbytheflowcytometry(FCM).TheexpressionofmRNA and protein of Skp2 and P27kip1 were inspected by reverse transcription-polymerase chain reaction(RT-PCR) and immunocytochem-istry methods .Results The inverted microscope observed that the SW480 cells had no change in form and grew at a slower speed . When the Skp2 ASODN concentration reached 0 .125 μmol/L ,the inhibition rate was 14 .48% (P<0 .05) .As the Skp2 ASODN concentration increase ,its inhibition action on the growth and proliferation of SW480 cells was enhanced in a dose-dependent man-ner(P<0 .01) .The SW480 cells were increased in G0/G1 phase(P<0 .01) and decreased in S phase(P<0 .05) ,the progression of cell cycle was blocked .RT-PCR and the immunocytochemistry showed that both Skp2 mRNA and protein levels were down-regula-ted(P<0 .05) .Although the P27kip1 mRNA level had no change(P>0 .05) ,but its protein expression was elevates obviously (P<0 .01) .Conclusion Skp2 ASODN can inhibit the growth and proliferation of SW480 cells .Its possible mechanism is that the ubiq-uitin degradation of the Skp2 to P27kip1 is decreased by the gene occlusion effect of Skp2 ASODN ,thus the cell cycle progression is arrested .

ObjectiveTo identify the effects of venlafaxiue on the acquisition and consolidation of fear extinction memory in conditioning fear memory extinction model.MethodsMale Sprague-Dawley rats were treated with fear conditioning training in the A environment.Before the extinction training,all the experimental rats were given different doses of venlafaxine intraperitoneal injection.After 24 hours,all the rats test in the B environment.ResultsRepeated-measures ANOVA were conducted on the percent of freezing time for between-session extinction,test condition (F2,44 =458.958,P＜0.001 ) and VEN dose(F2,22 =43.026,P＜0.001 ) and a Test condition * Treatment interaction (F4,44 =31.363,P ＜ 0.001 ).For the within-session,post hoc comparisons indicated that the three groups that received different dose of VEN (0,20 and 40 mg/kg) did not differ from each other (P ＞ 0.05 ),indicating similar extinction following the post-conditioning.The rats injected with high-dose venlafaxine (40 mg/kg) intraperitoneally before extinction training showed pro,motion of between-subjects extinction of fear memory,but does not affect the within-subjects extinction.There was no significant catabolism in the rats injected with middle-dose (20 mg/kg).ConclusionThe available date indicate that venlafaxine could promote the extinction of fear memory and there is a dose-dependent relationship of venlafaxine in the facilitation of fear memory.Our results could provide some clinical guidance for the treatment of post-traumatic stress disorder and panic disorder.