Objective: To explore the efficacy and surgical techniques of ultrasound-assisted transurethral flexible ureteroscopic holmium laser incision and internal drainage in the treatment of special renal cystic diseases，so as to provide reference for the diagnosis and treatment of such diseases. Methods: The clinical data of 48 patients with special renal cystic diseases treated during Jan.2019 and May 2023 were retrospectively analyzed.The diagnosis was made by computed tomography urography (CTU) and three dimensional urinary tract reconstruction before operation.All patients received the abovementioned surgery in semisupine lithotomy position.The general information，clinical data，and incidence of complications were analyzed. Results: There were 27 males and 21 females，with an average age of (48.0±7.5) years，including 22 cases of parapelvic cysts，6 cases of endogenic simple renal cysts with an average diameter of (5.0±1.0) cm，and 20 cases of renal calyceal diverticulum with stones，with an average diameter of (2.5±1.3) cm for the diverticulum and an average diameter of (1.5±1.0) cm for the stones，which were located in the upper or middle calyces.In 7 cases，ureteroscopic localization was difficult，and the surgery was completed with percutaneous renal puncture needle assisted localization.Ureteral stenosis was detected in 2 cases during surgery，and surgery was performed 4 weeks after double J tubes were placed.The remaining operations were successfully completed.The average operation time was (42.0±14.5) minutes，and average hospital stay was (2.0±0.5) days.During the follow-up of (12.0±8.5) months，lumbar pain improved in 27 cases (100%)，renal cysts disappeared in 23 cases (82.1%,23/28)，cysts significantly reduced by ≥50% in 4 cases (14.3%,4/28)，slightly reduced by <50% in 1 case (3.6%,1/28)，and the renal calyx diverticulum disappeared in 20 cases (100%).Gross hematuria and lower back pain occurred in 2 cases，and no other complications developed. Conclusion: Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage is a safe and effective treatment for special benign renal cystic diseases.When ultrasound-guided flexible ureteroscope localization is difficult to perform，percutaneous renal puncture needle may be applied.

Objective:To investigate the effect of smart air cell mattresses on sleep quality.Methods:Twenty healthy young people were enrolled as subjects, and each subject underwent a four-night polysomnographic monitoring experiment, including two nights each on a smart air cell mattress and a general mattress. The differences in sleep quality were compared by self-assessment of sleep quality, objective sleep indicators, and electroencephalogram (EEG) spectral analysis.Results:In the comparison between the smart air cell mattress and the general mattress, the differences in self-assessment of sleep quality and objective sleep indicators were not statistically significant (all P > 0.05), but the smart air cell mattress had a slight overall advantage. The relative power of EEG in the low-frequency band and the relative power of EEG in the high-frequency band were higher in the subjects with the smart air cell mattress. Conclusions:For the healthy young population, the smart air cell mattress can positively influence sleep quality to some extent, and the change in EEG relative power indicates an increase in sleep depth.

OBJECTIVE: To explore the genetic basis of a pedigree affected with Alagille syndrome (ALGS). METHODS: Targeted capture and next generation sequencing was carried out for the proband. Candidate variants were verified by Sanger sequencing among his family members. Their pathogenicity of the variant was predicted with bioinformatic analysis. Clinical characteristics and genotype-phenotype correlation were analyzed. RESULTS: The proband, his elder sister and mother were found to carry a heterozygous c.1270dupG (p.Ala424Glyfs*5) variant of the JAG1 gene, which may lead to premature termination of translation and a truncated protein with loss of function. The variant was unreported previously. The phenotypes of the proband (cholestasis, pulmonary artery stenosis and peculiar faces) have differed from those of his elder sister (cholestasis with pruritus, posterior embryonic ring of cornea) and mother (with no clinical manifestation). Cholestasis and peculiar face of the proband became insignificant with age. CONCLUSION The c.1270dupG (p.Ala424Glyfs*5) variant of the JAG1 gene probably underlay the ALGS in this pedigree with incomplete penetrance.
Aged ; Alagille Syndrome/genetics* ; Heterozygote ; High-Throughput Nucleotide Sequencing ; Humans ; Pedigree ; Phenotype

Objective    To compare the effect on postoperative immune function between da Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) , and to provide clinical support for more effective surgical procedures. Methods    A total of 90 patients undergoing radical resection of pulmonary carcinoma in our hospital from June to November 2019 were included. There were 49 males and 41 females with an average age of 62.67 (37-84) years. Among them, 50 patients underwent da Vinci robot-assisted thoracoscopic surgery (a RATS group) and 40 patients underwent video-assisted thoracoscopic surgery (a VATS group). The perioperative indexes as well as postoperative inflammatory factors and immune level effects between the two groups were compared. Results    Compared with the VATS, RATS could significantly shorten the operation time and decrease intraoperative blood loss (P<0.05). RATS also effectively reduced the increase of postoperative inflammatory factor level (P<0.05). But there was no significant difference in postoperative immune function between the RATS group and the VATS group (P>0.05). Conclusion    RATS is superior to VATS in the treatment of non-small cell lung cancer in perioperative indicators and inflammatory factors.

Objective:To analyze the clinical characteristics and SLC25A13 gene mutation in children with neonatal intrahepatic cholestasis caused by citrin deficiency(NICCD).Methods:The data of 18 children diagnosed with NICCD in Xi′an Children′s Hospital from January 2014 to December 2018 were collected.The clinical manifestations, biochemical characteristics, SLC25A13 gene mutation and prognosis were analyzed.Results:All the 18 cases of NICCD were from North China and the age of initial diagnosis averaged(63.4±19.5)days.The clinical manifestations included jaundice(100%), light yellow or white stool(38.9%), growth retardation(27.8%)and so on.All patients had cholestasis.Of 18 cases, the levels of glutamyltranspeptidase, total bile acid and alpha fetoprotein were all increased, and serum albumin was decreased.Elevated aspartate aminotransferase(94.4%), elevated glutamic pyruvic transaminase(72.2%), prolonged prothrombin time(88.9%), hyperlactemia(83.3%), hypoglycemia(77.8%), anemia(66.7%)and other biochemical abnormalities were observed.Citrulline and other serum amino acids of all cases were elevated in blood samples by tandem mass spectrometry.The increase of 4-hydroxyphenyllactate and 4-hydroxyphenylpyruvate was found in 70%(7/10)urine samples by gas chromatography.Age was negatively correlated with total bile acid( r=-0.469, P=0.049), and positively correlated with blood ammonia, threonine, methionine, ornithine and tyrosine( r=0.472, 0.690, 0.698, 0.678 and 0.769, respectively, P<0.05). A total of 16 SLC25A13 gene mutations were detected, of them c. 851_854del(33.3%)and c. 1638_1660dup(19.4%)were the most common.c.1841+ 3_1841+ 4del, c.980_981del(p.E327Vfs*45)and c. 602A>T(p.E201V)were novel mutations.Among the 17 children who were followed up, 1 case died and 16 cases had normal biochemical parameters within 1 year. Conclusion:The characteristic biochemical changes are helpful for early recognition of NICCD.The prognosis of NICCD is good if the treatment is appropriate and timely.c.851_854del and c. 1638_1660dup are high-frequency mutations of SLC25A13 gene in north China.

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

Objective    To compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma. Methods    From January 2012 to December 2018, 291  patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes. Results     Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS. Conclusion    There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.

Surgery is the most effective way to cure non-small cell lung cancer currently. Although sleeve lobectomy, with less reduction of respiratory function and a lower mortality rate, would not compromise oncological results in well-selected patients with central lung cancer, pneumonectomy is still necessary when complete resection could not be achieved by other surgical procedures. Cardiopulmonary complications are the most common complication after pneumonectomy. Fully understanding the related complications after pneumonectomy can help surgeons make a diagnosis timely, and further take relevant measures to reduce the adverse effects of postoperative complications on patients. What's more, in order to avoid postoperative complications and improve the prognosis of patients as much as possible, it is necessary to fully understand the risk factors to minimize the risk and to make the patients benefit from pneumonectomy as much as possible.

Objective: To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer. Methods: The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ² test, Kaplan-Meier curve and Log-rank test, respectively. Results: Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(Q_R): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups. Conclusion Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.

Objective To explore the effect of tetramethylpyrazine (TMP) on serum cytokines and cardiac function in patients with sepsis myocardial injury.Methods Fifty patients with sepsis myocardial injury were admitted in Hangzhou First People's Hospital from June 2015 to September 2016,and according to the computer generated random number,they were divided into conventional treatment group and TMP treatment group,25 cases in each group.The patients in the conventional treatment group were treated with antimicrobial agents,vasoactive drugs,fluid resuscitation and organ function support,etc.;TMP treatment group was treated with traditional Chinese medicine (TCM) TMP on the basis of routine treatment.TMP 120 mg was added to 250 mL normal saline (NS) for intravenous drip once a day for a therapeutic course of 10 days.Plasma N-terminal pro-B type natriuretic peptidec (NT-proBNP) and serum tmnor necrosis factor-oα (TNF-α) levels were measured before treatment and on 1,5 and 10 days after treatment.Left ventricular internal systolic dimension (LVIDs),fractional shortening (FS) and left ventricular ejection fraction (LVEF) were measured by cardiac ultrasound,3 cardiac cycles were measured and the average results were taken.The intensive care unit (ICU) hospital stay and mortality were calculated in the two groups.Results The levels of NT-proBNP and TNF-α in the two groups after treatment were lower than those before treatment,the differences in the levels were statistically significant between those before treatment and 5 days after treatment in the conventional treatment group [NT-proBNP (ng/L):334.25 ± 36.46 vs.577.72 ± 60.34,TNF-α (ng/L):388.48 ± 43.38 vs.507.74-± 31.63,both P ＜ 0.05],and in TMP treatment group,the levels from 1 day after treatment compared with those before treatment,there were statistical significant differences [NT-proBNP (ng/L):387.44 ± 36.39 vs.571.67-± 56.34,TNF-α(ng/L):403.79 ± 23.20 vs.505.82 ± 31.31,both P ＜ 0.05];the degrees of decrease in TMP treatment group were more obvious than those in conventional treatment group (all P ＜ 0.01).After treatment in the two groups,the LVIDs was decreased gradually,FS and LVEF were increased gradually,reaching the lowest or highest level on 10 days after treatment,and the changes of TMP treatment group were more significant than those in the conventional treatment group,LVIDs and LVEF of the two groups showed statistically significant differences on 5 days after treatment [LVIDs (mm):43.23 ± 5.57vs.48.21 ± 2.29,LVEF:0.47 ± 0.02 vs.0.41 ± 0.02,both P ＜ 0.05],FS on 1 day after treatment showed a statistically significant difference [FS:(23.92 ± 1.81)％ vs.(22.84 ± 1.79)％,P ＜ 0.05].The ICU stay in the TMP group was shorter than that in the conventional treatment group (days:13.16 ± 2.67 vs.16.48-± 3.08,P ＜ 0.05),and the mortality was lower than that of conventional treatment group [20％ (5/25) vs.36％ (9/25)],the difference being not statistically significant (P ＞ 0.05).Conclusions In septic myocardial injury,TNF-α plays an important role;after TMP treatment in patients with myocardial injury caused by viral myocarditis,the serum TNF-α level is decreased showing it has antagonizing TNF-α activity,thus it has protective effect on sepsis myocarditis,improves heart function and the disease prognosis.