Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.
Male ; Humans ; Premature Ejaculation/surgery* ; Intraoperative Neurophysiological Monitoring/methods* ; Prospective Studies ; Neurosurgical Procedures/methods* ; Penis/surgery* ; Retrospective Studies

Objective    To construct a prognostic model of esophageal squamous cell carcinoma (ESCC) based on immune checkpoint-related genes and explore the potential relationship between these genes and the tumor microenvironment (TME). Methods     The transcriptome sequencing data and clinical information of immune checkpoint genes of samples from GSE53625 in GEO database were collected. The difference of gene expression between ESCC and normal paracancerous tissues was evaluated, and the drug sensitivity of differentially expressed genes in ESCC was analyzed. We then constructed a risk model based on survival-related genes and explored the prognostic characteristics, enriched pathway, immune checkpoints, immune score, immune cell infiltration, and potentially sensitive drugs of different risk groups. Results    A total of 358 samples from 179 patients were enrolled, including 179 ESCC samples and 179 corresponding paracancerous tissues. There were 33 males and 146 females, including 80 patients≤60 years and 99 patients>60 years. 39 immune checkpoint genes were differentially expressed in ESCC, including 14 low expression genes and 25 high expression genes. Drug sensitivity analysis of 8 highly expressed genes (TNFRSF8, CTLA4, TNFRSF4, CD276, TNFSF4, IDO1, CD80, TNFRSF18) showed that many compounds were sensitive to these immunotherapy targets. A risk model based on three prognostic genes (NRP1, ICOSLG, HHLA2) was constructed by the least absolute shrinkage and selection operator analysis. It was found that the overall survival time of the high-risk group was significantly lower than that of the low-risk group (P<0.001). Similar results were obtained in different ESCC subtypes. The risk score based on the immune checkpoint gene was identified as an independent prognostic factor for ESCC. Different risk groups had unique enriched pathways, immune cell infiltration, TME, and sensitive drugs. Conclusion     A prognostic model based on immune checkpoint gene is established, which can accurately stratify ESCC and provide potential sensitive drugs for ESCC with different risks, thus providing a possibility for personalized treatment of ESCC.

Objective:To investigate the clinical and pathological characteristics and prognosis of upper tract urothelial carcinoma (UTUC) with concurrent other histological variants.Methods:The clinical data of 566 UTUC patients admitted to Peking University People's Hospital from January 2007 to April 2021 were retrospectively analyzed. Among them, 289 were males and 277 were females, with an average age of (67.3±10.0)years old. Among the patients, 97 had a history of smoking, 29 had undergone kidney transplantation, 120 had diabetes, 76 had coronary heart disease, 146 had hyperlipidemia, 271 had hypertension, and 50 had a history of chronic kidney disease. Among the UTUC cases, 366 had concurrent hydronephrosis, 55 had concurrent bladder cancer, and 43 had a history of previous bladder cancer. The distribution included 210 cases of renal pelvis carcinoma, 5 cases of carcinoma at the renal pelvis-ureter junction, 226 cases of ureteral carcinoma, and 125 cases of multifocal tumors. Patients were classified into the pure UTUC group and the UTUC with concurrent other histological variants group based on postoperative pathology, and their clinical and pathological features were compared. Logistic regression analysis was used to explore risk factors for the occurrence of histological variations in UTUC. The log-rank test was employed to compare the overall survival (OS) and cancer-specific survival (CSS) between the two groups, while Cox regression analysis was performed to investigate prognostic factors.Results:Among the 566 cases, 511 were pure UTUC and 55 were UTUC with concurrent other histological variants. Among the latter, 30 cases had squamous differentiation, 6 had glandular differentiation, 5 had mucinous differentiation, 5 had sarcomatoid carcinoma, 2 had micropapillary carcinoma, 2 had neuroendocrine carcinoma, 1 had giant cell carcinoma, and 4 had other mixed histological variations. The proportion of patients with a history of kidney transplantation was higher in the UTUC with concurrent histological variants group than that in the pure UTUC group [14.5% (8/55) vs. 4.1% (21/511)], with statistically significant difference ( P=0.003). In the UTUC with concurrent histological variants group, the proportion of postoperative high-grade tumors [98.2% (54/55) vs. 80.2% (410/511)], muscle-invasive tumors [89.1% (49/55) vs. 68.1% (348/511)], lymph node metastasis tumors [10.9% (6/55) vs. 2.3% (12/511)], and maximum tumor diameter [(3.60±2.64) cm vs. (2.96±1.98) cm] were higher than those in the pure UTUC group ( P<0.05). Multivariate logistic regression analysis showed that a history of kidney transplantation ( OR=4.991, 95% CI 1.749-13.615, P=0.002) was an independent predictive factor for the occurrence of histological variants. Follow-up was conducted for 1 to 174 months, with a median follow-up time of 32.8 months. UTUC with concurrent histological variants was significantly associated with worse OS and CSS ( P<0.05). Multivariate Cox regression analysis indicated that histological variants were an independent risk factor for OS ( HR=1.860, 95% CI 1.228-2.816, P=0.003) and CSS ( HR=2.146, 95% CI 1.349-3.412, P=0.001). Conclusions:UTUC with concurrent other histological variants exhibited higher postoperative tumor grade and stage compared to pure UTUC, and UTUC with concurrent other histological variants was an independent risk factor for worse prognosis.

This study explored the protective effect of atractylenolide Ⅰ(AO-Ⅰ) against acetaminophen(APAP)-induced acute liver injury(ALI) in mice and its underlying mechanism. C57 BL/6 J mice were randomly divided into a control group, an APAP group(500 mg·kg~(-1)), a low-dose combination group(500 mg·kg~(-1) APAP + 60 mg·kg~(-1) AO-Ⅰ), and a high-dose combination group(500 mg·kg~(-1) APAP + 120 mg·kg~(-1) AO-Ⅰ). ALI was induced by intraperitoneal injection of APAP(500 mg·kg~(-1)). AO-Ⅰ by intragastric administration was performed 2 hours before APAP treatment, and the control group received the same dose of solvent by intragastric administration or intraperitoneal injection. The protective effect of AO-Ⅰ against APAP-induced ALI was evaluated by detecting alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels in the plasma and H&E staining in liver tissues of mice. The malondialdehyde(MDA) and glutathione(GSH) content and catalase(CAT) activity in mouse liver tissues were detected to evaluate the effect of AO-Ⅰ on APAP-induced oxidative stress in the liver. The proteins in the liver p38 mitogen-activated protein kinase(p38 MAPK), c-jun N-terminal kinase(JNK), and nuclear factor kappa-B p65(NF-κB p65) signaling pathways were measured by Western blot, and the liver inflammatory cytokines interleukin-1β(IL-1β) and interleukin-6(IL-6) were detected by real-time PCR. Compared with the APAP group, the combination groups showed reduced APAP-induced ALT level and liver MDA content, potentiated liver CAT activity, and elevated GSH content. Mechanistically, AO-Ⅰ treatment significantly inhibited APAP-up-regulated MAPK phosphorylation and NF-κB p65, and significantly reduced the transcriptional activities of IL-1β and IL-6, downstream targets of NF-κB p65. AO-Ⅰ can improve APAP-induced ALI and the underlying mechanism is related to the inhibition of the MAPK/NF-κB p65 signaling pathway in APAP-challenged mice.
Acetaminophen/adverse effects* ; Animals ; Chemical and Drug Induced Liver Injury/drug therapy* ; Lactones ; Mice ; NF-kappa B/metabolism* ; Sesquiterpenes ; Signal Transduction

Objective:To investigate the effectiveness and safety of transcatheter closure of atrial septum defect(ASD) in adults using echocardiography as the only imaging tool.Methods:From April 2017 to August 2019, 118 patients with congenital atrial septum defect were treated by cardiac surgery in Zhongshan Hospital affiliated to Fudan University. There were 31 males and 87 females, aged 15-72 years old[mean(40.3±15.3) years old]. 117 cases of atrial septum defect were secondary foramen and 1 case was residual shunt after repair of atrial septum defect by transthoracic echocardiography. The patients with tricuspid insufficiency and pulmonary hypertension were followed up by transesophageal echocardiography.Results:The transcatheter closure of atrial septum defect(ASD) was successfully performed in 114 patients. 3 patients were successfully treated with right fourth intercostal small incision atrial defect occlusion due to the coaxial problem of occlusive device and atrial defect. One patient underwent repair of atrial septum defect during the correction of right ventricular injury. The selected size of occluder ranged from 12 mm to 38 mm. One case of ethmoidal orifice was successfully blocked with double occlusive device. There was no occlusive device displacement, no obvious residual shunt, peripheral vascular injury and other complications occurred in successful occlusive patients. 110 patients were directly transferred back to the general ward after extubation. The postoperative hospital stay was(2.3±1.1) days and the total hospitalization time was(4.5±1.7) days. There were 7 patients with tricuspid regurgitation above mild to moderate before operation, and 6 patients with tricuspid regurgitation decreased to mild regurgitation after occlusion. One month after operation, the pulmonary artery pressure of 51 patients with moderate and severe pulmonary hypertension decreased from(50.4±11.4)mmHg to(38.9±12.9) mmHg( P<0.05). The occlusive device was well fixed and no residual shunt was found. Conclusion:Transesophageal echocardiography guided transcatheter closure of atrial septum defect is not only safe and effective in adult cardiac surgery, but also can avoid radiation and contrast agent injury.

Objective To explore the clinical effect of the semi-shoulder arthroplasty in the treatment of humeral head necrosis.Methods Twenty patients with head necrosis of the humerus in first hospital affiliated to army medical university from February 2008 to January2018 were collected, including 8 cases of males, 12 cases of females, 7 cases of left shoulder and 13 cases of right shoulder.The patients were aged from 45 to 83 years old, mean (67.40±5.06) years old.All patients were followed up for at least 6 months, the anterior flexion angle, abduction angle, external rotation angle and internal rotation angle of shoulder joint were measured, the function of shoulder joint was evaluated by ASES, UCLA, SST, and VAS, and the imaging examination was conducted.Results All patients were followed up for 6 to 37 months after surgery, with average (18.50±5.31) months, 2 patients presented mild pain during shoulder joint activity, 1 patient presented brachial plexus nerve damage, but returned to normal 3 months after surgery.No complication happened.X-ray reexamination showed good position and angle of the prosthesis during the follow-up period.The preoperative anteflexion angle, angle of outreach, swing angle and swing angle of the shoulder joint were respectively (55.24±8.21) °, (42.58±6.21) °, (12.95±2.74) °, (17.79±3.65) °, the last follow-up were respectively (120.76±13.15) °, (103.08±10.54) °, (33.51±3.14) °, (50.10±7.25) °, the differences were significant (P＜0.01);The preoperative ASES score, UCLA score, SST score, VAS score of the shoulder joint were respectively (38.24±5.21), (12.58±3.93), (3.25±1.42), (6.79±1.65), the last follow-up were respectively (75.74±9.69), (33.08±4.5), (9.11±1.85), (1.45±0.24), the differences were significant (P＜0.01).Conclusion Artificial semi-shoulder replacement for the treatment of humeral head necrosis can significantly improve the range of limb function, relieve the pain symptoms of patients and improve patients'quality of life, which has excellent and good shoulder function rate and fewer complications.

Selective dorsal penile neurotomy is a surgical method proposed for the treatment of primary premature ejaculation in recent years. In view of the inconsistency of surgical methods and the controversy of the operation itself, Large-scale, multi-center research evidence is needed for comprehensive evaluation. This article starts with the etiology of premature ejaculation, and reviews the anatomical basis, indications, contraindications, surgical methods, efficacy evaluation, complications and combined treatment methods of selective dorsal neurotomy.

Objective To evaluate the effect of the rehabilitation software based on information-motivation-behavioral skills(IMB)model on meeting the rehabilitation needs, increasing the continuation of rehabilitation and the rehabilitation compliance, improving the outcome of rehabilitation among elderly patients with fracture. Methods Based on the theory of"information-motivation-behavior"and the unity of human- computer interaction as the design concept, the status quo of rehabilitation training and rehabilitation needs of elderly patients with fracture were reviewed. The rehabilitation training test was applied to 30 patients with fracture in orthopedic department of our hospital. 30 patients in the same period were randomly selected as control group. All patients underwent Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores before and 1 and 3 months after operation. Differences were tested using Student's t test. Results Developed rehabilitation application software based on information module、motivation module and behavior module. The test group using this software for rehabilitation training was compared with the control group. The results showed that there was no significant difference in preoperative SAS and SDS scores between the two groups (t=-0.648,-0.284, P>0.05). At 1 and 3 months after operation, the SAS scores in the test group were (40.05 ± 6.77), (32.01 ±5.86), which were lower than (45.50 ± 11.32), (39.55 ± 5.67) in the control group (t=-4.14,-4.89, P<0.01). The SDS scores in the test group were (42.30 ± 9.86), (33.23 ± 6.56), which were lower than (46.50 ± 10.32), (38.45 ± 7.80) in the control group (t=-3.52,-3.82, P=0.001). Conclusion Rehabilitation software can influence the rehabilitation behavior of elderly fracture patients from information and motivation factors, provide professional guidance and rehabilitation intervention, and promote the implementation of active rehabilitation.

To investigate the genetic characterization of Human parainfluenza virus-3 (HPIV-3) circulating in Gansu and Shaanxi Provinces of China, 719 throat swabs were collected from pediatric patients with acute respiratory infections from 2009-2011. Multiplex RT-PCR was used to screen common respiratory viral pathogens. For HPIV-3-positive specimens, nested RT-PCR was used to amplify the HN gene of HPIV-3. The nucleotides of Hemagglutinin-neuraminidase(HN)gene of 13 HPIV-3 positive strains identified in Gansu and Shaanxi Provinces were successfully sequenced and compared with those downloaded from GenBank. The phylogenetic analysis based on the nucleotides sequence of HN gene showed that 13 HPIV-3 strains belonged to sub-cluster C3 with little sequence variation (overall nucleotide divergence of 0.2%-2.3% and amino acid divergence at 0-1.1%). Compared with the complete gene of HPIV-3 strains from U.S.A., Canada, and Australia, the biggest divergence of the nucleotide and amino acid lovels was 6.0% and 3.4%, respectively. The nucleotide divergence between shaanxi09-2 and shaanxi10-H0091 was 0.9%, while the nucleotide divergence between shaanxi10-H005 and gansull-62110372 was 0.5%, between shaanxi09-2 and BJ/291/09 was 0.6%. However, there was no amino acid divergence among them. It is likely that HPIV-3 virus had been transmitting in Gansu and Shaanxi Provinces for several years. Human parainfluenza virus-3 (HPIV-3) circulated in Gansu and Shaanxi Provinces from 2009 to 2011 belonged to sub-cluster C3.
Adolescent ; Adult ; Child ; China ; epidemiology ; Female ; Genetic Variation ; HN Protein ; genetics ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Parainfluenza Virus 3, Human ; classification ; genetics ; isolation & purification ; Phylogeny ; Respirovirus Infections ; epidemiology ; virology ; Seasons ; Young Adult

ObjectiveTo examine the clinical features of fractures and related risk factors in patients with rheumatoid arthritis(RA) in China.MethodsSix hundred and eighty-one RA patients were randomly selected from department of rheumatology of 18 hospitals of China.Data were obtained from the questionnaire,including age,sex,disease duration,the involvement of joints,treatment regimen,features of fractures etc.The possible risk factors of fracture in patients with RA were analyzed with a multi-variate Logistic regression analysis.Results① In 681 RA patients of the survey,48 patients had 54 fractures,and the incidence of fractures was about 8％.② Fractures occurred at various sites.Foot/ankle,femur,spine and wrist were the mostfrequent sites.③ The Logistic regression analysis showed that several factors increased the risk of fracture in RA patients,including long disease duration (OR:1.245,95％CI:0.987-1.570,P=0.065),male gender(OR:0.433,95％CI:0.199-0.942,P=0.035),more deformed joints(OR:1.042,95％CI:1.006-1.079,P=0.023),family history of RA (OR:2.201,95％CI:0.984-4.923,P=0.055),and high scores of SF-36(OR:1.017,95％CI:1.002-1.033,P=0.028).④ According to the degree of correlation from strong to weak,the risk factors of fracture were disease duration,SF-36,sex,number of deformed joints and family history of rheumatoid arthritis.ConclusionThe incidence of fracture is high in patients with rheumatoid arthritis.Several factors could increase the risk of fractures in RA patients,including long disease duration,male gender,more deformed joints,and family history of RA.In order to prevent the occurrence of fractures,cautions should be taken to prevent the development of fractures and treat the disease aggressively to suppress the disease activity of RA.