Objective:To investigate the hemodynamic changes of the main arteries and veins of the extremities and the heart in patients with hypertrophic scar secondary to extensive burns after pressure treatment, and to analyze the relevant mechanisms.Methods:A retrospective before-after self-control study was conducted. From January 2017 to February 2022, 37 patients with hypertrophic scar secondary to extensive burns who met the inclusion criteria were hospitalized in the Burn Rehabilitation Department of Guangdong Industrial Injury Rehabilitation Hospital, including 25 males and 12 females, aged 23-52 years. The patients were admitted to the hospital within 12 weeks after wound healing, and within one week after admission, rehabilitation therapists, occupational therapists, and tailors custom-made pressure products such as full-body pressure garment, pressure pants, vests, split finger gloves, split finger socks, hoods, and plastic collars, with the pressure at each part maintained at 2.67-4.00 kPa when wearing. Before the first treatment with pressure products (hereinafter referred to as before pressure treatment) and at 1 h of the first treatment with pressure products (hereinafter referred to as 1 h of pressure treatment), color Doppler ultrasonography was performed to check the pulse rate of the axillary artery, the lumen diameter, peak systolic velocity (PSV), and resistance index of the axillary artery and femoral artery on the left side, the lumen diameter, cross-sectional area, and average blood flow velocity of the axillary vein and femoral vein, and the mitral valve E peak, mitral valve A peak, tricuspid valve E peak, aortic valve PSV, and pulmonary valve PSV of the heart; an optical chromatographic skin detector was used to detect the red color, red pigment, and surface brightness of the scar on the back of the hand to reflect the filling and distribution of the scar microvessels. Data were statistically analyzed with paired sample t test. Results:Compared with those before pressure treatment, the PSV of the axillary artery of patients was significantly slowed down at 1 h of pressure treatment ( t=55.42, P<0.01); the average blood flow velocity of the axillary vein was significantly accelerated ( t=-60.50, P<0.01); the pulse rate, lumen diameter, and resistance index of the axillary artery, as well as the lumen diameter and cross-sectional area of the axillary vein did not change obviously ( P>0.05); the average blood flow velocity of the femoral vein was significantly accelerated ( t=-80.52, P<0.01); the lumen diameter, PSV, and resistance index of the femoral artery, as well as the lumen diameter and cross-sectional area of the femoral vein had no significant change ( P>0.05); the mitral valve E peak and mitral valve A peak of the heart decreased significantly (with t values of 10.71 and 21.96, respectively, P<0.01); the tricuspid valve E peak of the heart increased significantly ( t=7.57, P<0.01); the PSV of the aortic valve and pulmonary valve of the heart did not change obviously ( P>0.05). At 1 h of pressure treatment, the red color and red pigment values of the scar on the back of the hand of patients were 15.3±1.1 and 16.8±1.2, respectively, which were significantly lower than 24.5±1.3 and 23.8±1.2 before pressure treatment (with t values of 8.32 and 8.04, respectively, P<0.01). The brightness value of the scar surface on the back of the hand of patients at 1 h of pressure treatment was similar to that before pressure treatment ( P>0.05). Conclusions:After pressure treatment for the hypertrophic scar in patients secondary to extensive burn, the average blood flow velocity of the axillary vein and femoral vein in patients are obviously accelerated, the PSV of the axillary artery is significantly slowed down, the peak values of mitral valve E and mitral valve A of the heart are significantly decreased, and the tricuspid valve E peak is significantly increased. These hemodynamic changes may be related to the reduction of microvascular blood flow in the local area of scar after systemic pressure treatment.

Ureteral artery fistula (UAF) is a rare complication after long-term indwelling of ureteral stent. In this study, two cases were presented. Both of them underwent pelvic tumor surgery and radiotherapy, and had a history of cutaneous terminal ureterostomy and long-term indwelling of ureteral stents. The first case, a 52-year-old female, was admitted to hospital because of intermittent bleeding from ureteral dermostomy for 1 week on April 2, 2020. CT examination revealed hematocele in the left upper urinary tract, and left nephrectomy was performed.However, bleeding still presented and the distal ureteral resection was performed at the same time, and partial ureteral was ligated. Postoperative diagnostic was ureteral artery fistula. After 8 months of follow-up, no recurrent bleeding presented. Another case, a 82-year-old male, was admitted to hospital because of bleeding at the ureteral dermostomy for an hour on June 15, 2020. Contrast enhanced CT examination revealed intersecting of the left ureter and common iliac artery, and interventional surgery was performed, by which UAF was diagnosed. Embolization of left internal iliac artery and stent implantation of common iliac artery and external iliac artery were performed intraoperatively. The bleeding stopped immediately after the operation, and there was no further bleeding during follow-up of 6 months.

Objective:To evaluate the feasibility and clinical efficiency of robot-assisted laparoscopic radical prostatectomy (RARP) via extraperitoneal PORT-free single incision approach.Methods:The data of 33 patients with prostate cancer underwent the extraperitoneal PORT-free single incision RARP from November 2020 to January 2021 in Sichuan Provincial People's Hospital was retrospectively reviewed. The average age was 66.7 (58-78) years, the median PSA was 20.77 (2.89, 56.44) ng/m, and the mean Gleason score was 7.0 (6.0-9.0). The mean prostate volume was 48.4 (25.0-220.0) ml. Clinical stage: 32 cases was in cT 2a-2cN 0M 0, 1 case in cT 3aN 0M 0. 16 cases had a history of operation. All 33 operations were performed by the same operator. All operations were performed by extraperitoneal PORT-free single-incision approach. The surgical condition, postoperative complication, pathology, and follow-up results were observed. Results:In this study, 33 operations were successfully completed without conversion to open or additional single hole channel instruments. The average operation time was 61.3 (38.0-120.0) min, with the mean intraoperative bleeding volume of 72.2 (45.0-220.0) ml and the mean bladder neck urethral anastomosis time of 11.7 (8.5-15.7) min. The mean postoperative hospital stay was 7.9 (6.0-15.0) d, the mean postoperative indwelling time of urinary catheter was 6.8 (6.0-14.0) d, and the mean postoperative evacuation time was 1.0 (0.5-3.0) d. The average incision length was 5.2 (4.6-5.8) cm. There was no obvious complications. The postoperative pathological stage: 21 cases were in < pT 3a, 12 cases were in ≥ pT 3a, and 6 cases (18.8%) had positive resection margin. 29 cases (88.9%) acquired satisfactory urinary continence after operation, and the frequency of urinary pad use was ≤ 1 tablet/day. Conclusions:The extraperitoneal single-incision RARP surgical channel without PORT is safe and feasible with a satisfying cosmetic effect, which saves costs and requires less specific channel device. Simultaneously, the new approach has strong replicability, short-term tumor control and urinary control effect with rapid postoperative recovery. However, the sample size of this study is relatively small, which needs further research and demonstration

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.

Objective:To explore the early warning and prediction value of GDF15 for sudden death patients.Methods:From January to December 2018, 49 patients with sudden death who were treated in the Emergency Department of the First Clinical Center of PLA General Hospital were included in the case group, and 46 healthy physical examiners in the Physical Examination Center of the Hospital were randomly selected as the control group. The general situation, comparison of myocardial markers and analysis of the basic data of the case group were carried out, so as to evaluate the early warning value of each myocardial marker in sudden death.Results:Patients aged 40-49 years old accounted the highest proportion among sudden death cases, reaching 26.54%. Sudden death under 60 years old accounted for 59.19%, and the ratio of male to female was 3.83:1. There were significant differences between the case group and the control group in CK-MB [(41.35±98.38) vs. (3.13±2.17), P=0.009], CK [(2652.82±6845.66) vs. (102.73±47.93), P=0.012], and GDF15 [(549.80±809.79) vs. (115.70±167.42), P=0.001]. At the same time, the AUC value of GDF15 was 0.816, which has the highest diagnostic value for sudden death. And CK-MB, CK and GDF15 had no correlation with age. Conclusions:GDF15, as a biological marker, has a good early warning function in sudden death.

Objective:To explore the spatiotemporal distribution and macro-related factors of congenital syphilis in Guangdong province and provide suggestions and recommendations for prevention.Methods:Yearly reported cases of syphilis and some influencing factor data of Guangdong province were collected from 2005 to 2017. The spatiotemporal distribution of congenital syphilis was described. Meanwhile, the spatial panel data model was constructed to analyze the relationship between the incidence rates of congenital syphilis and related factors.Results:From 2005 to 2017, 13 361 cases of congenital syphilis were reported in Guangdong province. The number of congenital syphilis cases rose to its highest point during 2005-2011. A slow downward trend followed. The peaks of incidence were observed from August to December. The incidence of the non-Pearl River Delta region has experienced a process of rising first and then decreasing. The spatial panel data model results showed that congenital syphilis had significant positive spatial autocorrelation ( P<0.001). The incidence of primary and secondary syphilis in women ( β=0.822, P<0.001), gross domestic product per capita ( β=3.511, P<0.001), net migrate rate ( β=0.215, P=0.047) and maternal system management rate ?(β=0.017, P=0.021) were all positively correlated with the incidence rates of congenital syphilis. Registered population density ( β=-1.167, P<0.001) and prenatal examination rate ( β=-0.038, P=0.031) was negatively correlated with congenital syphilis. Conclusions:The incidence of congenital syphilis was spatially aggregated in Guangdong province from 2005 to 2017. The intensity of prevention might be strengthened in cities with developed economies and high net migration rates, which have high risks of congenital syphilis. Controlling the incidence of primary and secondary syphilis in women and increasing the prenatal examination rate for pregnant women appears effective prevention measures of congenital syphilis.

Objective:To investigate the clinical effect of different bladder neck separation methods in robot-assisted laparoscopic radical prostatectomy (RARP).Methods:To retrospective analysis the data of robot-assisted laparoscopic radical prostatectomy (RARP)in our center from October, 2014 to October, 2018. All operations were performed by the same urologist. According to the different methods of bladder neck separationAccording to the different methods of bladder neck separation, all the patients were divided into four groups. Group A routine forward peeling method (500 cases): Make a 1cm incision at 12 o'clock on the front of the bladder neck, cut off the detrusor muscle and cut the bladder neck. Group B T-cut incision of the bladder neck (133 cases): identify the bladder and prostate Junction, T-shaped incision of the anterior wall of the bladder neck. Group C conventional stripping method combined with T-shaped incision of the bladder neck (81 cases). Group D lateral approach (36 cases): along the lateral side of the bladder neck and the medial posterior ligament of the prostate is separated and merges with the previously established Dirichlet space. The general data of patients were analyzed statistically.The average ages of groups A, B, C, and D were 63 years (62.5 to 67 years), 65 years (61 to 68 years), 66 years (64.5 to 70.5 years), and 62 years (59.5 to 66.5 years)respectively, there was no statistical significance difference in terms of age in 4 groups( P>0.05); PSA is 13 ng/ml(9.0 to 22 ng/ml), 7.4 ng/ml(6.4 to 26.0 ng/ml), 6.2 ng/ml(5.3 to 27.0 ng/ml), 14ng/ml(8.4 to 21.0 ng/ml), ( P>0.05); Gleason scores of puncture were 6.9(5 to 9), 7(6 to 12), 9(8 to 16), 10(6 to 18), ( P>0.05); the prostate volume was 66ml(42 to 78 ml), 70ml(50 to 89 ml), 53ml (43 to 72 ml), 80 ml (68 to 92 ml), ( P>0.05); the proportions of body mass index ≤25 kg/m 2 were 60.0%, 63.9%, 39.1%, 42.0%, and>25 kg/m 2 were 40%, 36.1%, 60.9%, and 58.0%, respectively, ( P>0.05). The operation time, bleeding volume, anastomosis time, postoperative hospital stay, postoperative complications, positive rate of proximal incision margin, urinary indwelling time, and urinary control rate in the four groups analyzed. Results:All 750 RARP operations were successful, and none were converted to open.The operation time of groups A, B, C, and D were 100 min(70 to 120 min), 89 min(70 to 95 min), 105 min(80 to 127 min), and 110 min(90 to 130 min), ( P>0.05); anastomosis time was 20.5 min (18.0 to 25.0 min)、16.1min (10.7 to 17.3 min)、25.4 min (18.9 to 27.0 min)、and 28.5 min (21.0 to 32.0 min), the anastomosis time in group B was significantly shorter than other groups ( P<0.05); the postoperative hospital stays were 9.3 days (8.0 to 13.0 days), 8.4 days (6.0 to 16.0 days), 10.8 days (8.0 to 16.0 days)and 7.8 days (7.0 to 14.0 days), ( P>0.05). Postoperative complications: Anastomotic fistula and ureteral injury occurred in 3 cases in group A, and no serious complications occurred in the other 3 groups. Proximal marginal positive rate: 40 cases (8.0%) in group A, 0 cases in group B, 6 cases (7.3%) in group C, 3 cases (8.3%) in group D, and low positive rate of margin incision in group B( P<0.05). The urinary indwelling time was 7 d (6 to 8 d), 6 d(4 to 8 d), 12 d(6 to 18 d), 10 d(6 to 13 d), ( P>0.05). Six-month postoperative urine control rate: 381 cases (75.2%) in group A, 102 cases (76.9%) in group B, 61 (75.4%) in group C, and 27 (73.8%) in group D, ( P>0.05). Conclusions:The above four method of bladder neck separation during robot-assisted laparoscopic radical prostatectomy is safe and feasible, which can effectively avoid ureteral damage. Each method can obtain better urine control within six months after surgery rate. The positive rate of proximal incision margin after T-shaped bladder neck was lowest among four groups.

Six patients with prostate cancer, treated by suprapubic extraperitoneal single-port robot-assisted radical prostatectomy, had been studied retrospectively from December 2019 to January 2020. All 6 patients have been treated by suprapubic peritoneum single port robot assisted laparoscopic surgery without other channels. The robot assisted laparoscopic radical prostatectomy via suprapubic peritoneum is safe and feasible when based on reasonable selection criteria of patients. It has been shown that the postoperative recovery was fast and the tumor control and continence rate were good under the short-term follow-up. However, the long-term outcome should be evaluated by a long-term follow-up.

In theory of TCM, the root cause of knee osteoarthritis () is the deficiency of liver and kidney, while the symptoms are involved with multiple damages of muscles, tendons and joints. The exogenous evil of wind, coldness, dampness and heat as well as the blood stasis usually block the meridians and collaterals, which cause the knee osteoarthritis. Professorselects acupoints based on syndrome differentiation, and treats both root cause and symptoms. He attaches importance to thepoints, and takes pain as acupoints. He also treats the lower part of body using the upper acupoints, and treats knees through stimulating the low back. The basic acupoints include the affected Dubi (ST 35), Yinlingquan (SP 9), Yanglingquan (GB 34), Liangqiu (ST 34), Xuehai (SP 10),point (extral) andpoint in the knees and waist. Fengchi (GB 20) and Geshu (BL 17) are added for the symptom of wind; Guanyuan (CV 4) is added for the symptom of coldness; Zusanli (ST 36) is added for the symptom of dampness; Quchi (LI 11) is added for the symptom of heat; Fenglong (ST 40) and Sanyinjiao (SP 6) are added for the symptom of phlegm-stasis; Ganshu (BL 18) and Shenshu (BL 23) are added for the deficiency of the liver and kidney. The technical combination of acupuncture, including needle-knife, fire needle, bloodletting, regular acupuncture, TDP, are applied to regulate the patients' deficiency and excess using the nine-six reinforcing and reducing methods, and pay high attention to the mind regulation. Using this method, the efficacy is significant.

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication,security,selection of cryoablation and outcomes.Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018.Among them,5 cases were senile patients (≥ 80 years),5 cases complicated with other cancers,3 cases complicated with renal insufficiency,4 cases complicated with decompensated cirrhosis,3 cases with bilateral renal cancer,4 cases with solitary kidney cancer and 39 cases with some other complications.The preoperative serum creatinine level was(80.5 ± 38.2)μmol/L.The patients underwent laparoscopic singlesite (LESS) renal cryoablation,conventional laparoscopic renal cryoablation,or percutaneous image-guided cryoablation according to individual situation.Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.Results All operations were completed successfully and technical success was achieved as well in all cases.Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6 ± 0.90) cm,the median volume of blood loss was 50ml(10-110 ml),and the mean operation time was(96.0 ± 24.5) min.The median inpatient hospital stay was 3 d (1-6 d).In one case,digital subtraction angiography (DSA) embolization was performed due to hemorrhage after surgery.None of the other cases had intraoperative or postoperative complications.The serum creatinine level after surgery was not significantly decreased [postoperative (83.8 ±42.1) μmol/L,P =0.64].The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas,which represented complete ablation and regression of the tumor.All cases were followed up regularly.One case showed relapse at the 6 th month follow-up and underwent cryoablation again.Another case,who was not regularly followed up,relapsed at 69th month after surgery.No relapse was observed in the other cases during the follow-up.Conclusions Renal cancer cryoablation is a safe,feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions.