Objective:To evaluate the clinical application of the new "cigarette core" product for oral mucosa roll in hypospadias patients.Methods:From December 2018 to January 2022, patients who visited the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were selected and underwent staged surgical repair. In the first stage, we used the oral mucosa to form the urethra. The length of the oral mucosa was 5.0-6.0 cm and the width was 1.0-1.2 cm. In the control group, we use the handmade gauze roll; in the experimental group, we use the new "cigarette core" product. In the second-stage operation, the urethra was anastomosed. The operation time was recorded, and the mucosal survival, complications, urination and patients’ satisfaction with the operative effect were followed up. The measurement data of normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 107 male patients were included, including 53 in the control group and 54 in the experimental group, aged from 1 to 28 years, with an average age of 8.5 years. The first-stage operation time of control group was significantly longer than that of experimental group [(61.5±11.5) min vs. (43.8±15.2) min], and the difference was statistically significant ( P<0.01). The patients were followed up for 3 to 20 months. In the first-stage operation, the survival rate of oral mucosa was 98.11%(52/53) in the control group and 100%(54/54) in the experimental group. There were 4 cases of urinary fistula in the control group after the second-stage operation, and the complication rate was 7.55%. There was 1 case of urinary fistula in the experimental group, and the complication rate was 1.85%. All patients had good urination after operation. In the satisfaction survey one year after surgery, the satisfaction rate of the control group was 94.34% (50/53) and that of the experimental group was 100% (54/54). Conclusion:The patented "cigarette core" product is good in consistency. In hypospadias repair, it has a high survival rate of mucosal transplantation and a low incidence of postoperative complications. It can effectively reduce operation time and anesthesia time.

Objective:To evaluate the clinical application of the new "cigarette core" product for oral mucosa roll in hypospadias patients.Methods:From December 2018 to January 2022, patients who visited the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were selected and underwent staged surgical repair. In the first stage, we used the oral mucosa to form the urethra. The length of the oral mucosa was 5.0-6.0 cm and the width was 1.0-1.2 cm. In the control group, we use the handmade gauze roll; in the experimental group, we use the new "cigarette core" product. In the second-stage operation, the urethra was anastomosed. The operation time was recorded, and the mucosal survival, complications, urination and patients’ satisfaction with the operative effect were followed up. The measurement data of normal distribution were expressed as Mean±SD and analyzed by t-test. Results:A total of 107 male patients were included, including 53 in the control group and 54 in the experimental group, aged from 1 to 28 years, with an average age of 8.5 years. The first-stage operation time of control group was significantly longer than that of experimental group [(61.5±11.5) min vs. (43.8±15.2) min], and the difference was statistically significant ( P<0.01). The patients were followed up for 3 to 20 months. In the first-stage operation, the survival rate of oral mucosa was 98.11%(52/53) in the control group and 100%(54/54) in the experimental group. There were 4 cases of urinary fistula in the control group after the second-stage operation, and the complication rate was 7.55%. There was 1 case of urinary fistula in the experimental group, and the complication rate was 1.85%. All patients had good urination after operation. In the satisfaction survey one year after surgery, the satisfaction rate of the control group was 94.34% (50/53) and that of the experimental group was 100% (54/54). Conclusion:The patented "cigarette core" product is good in consistency. In hypospadias repair, it has a high survival rate of mucosal transplantation and a low incidence of postoperative complications. It can effectively reduce operation time and anesthesia time.

Objective To study the application of refined nursing intervention in prevention of postoperative urethral stricture in patients with hypospadias.Methods A total of 144 patients who underwent hypospadias surgery in our hospital were selected as study subjects,and were divided into control group and observation group by random number table method,with 72 cases per group.Both groups were treated with targeted surgery according to severity and different sites of hypospadias.The patients in the control group performed routine nursing intervention during the perioperative period,while the patients in the observation group were given refined nursing intervention on the basis of the control group.The response rate,incidence rates of postoperative complications and hypospadias were evaluated.Results The total response rate in the observation group was higher than that in the control group (P ＜ 0.05).After nursing,the incidence rate of postoperative complications such as bleeding,urinary fistula,infection,and urine extravasation was lower in the observation group than that in the control group[6.94％ (5/72) vs.(18.06％) (13/72),P ＜0.05).After nursing,the total incidence rate of mild and severe urethral stricture in the observation group was lower than that in the control group [(2.78％ (2/72) vs.12.50％ (9/72),P＜0.05).Conclusion Refined nursing intervention for patients with hypospadias can effectively enhance treatment efficacy,reduce postoperative complications,and prevent urethral stricture,thereby to improve the prognosis of the disease.

Objective To study the application of refined nursing intervention in prevention of postoperative urethral stricture in patients with hypospadias.Methods A total of 144 patients who underwent hypospadias surgery in our hospital were selected as study subjects,and were divided into control group and observation group by random number table method,with 72 cases per group.Both groups were treated with targeted surgery according to severity and different sites of hypospadias.The patients in the control group performed routine nursing intervention during the perioperative period,while the patients in the observation group were given refined nursing intervention on the basis of the control group.The response rate,incidence rates of postoperative complications and hypospadias were evaluated.Results The total response rate in the observation group was higher than that in the control group (P ＜ 0.05).After nursing,the incidence rate of postoperative complications such as bleeding,urinary fistula,infection,and urine extravasation was lower in the observation group than that in the control group[6.94％ (5/72) vs.(18.06％) (13/72),P ＜0.05).After nursing,the total incidence rate of mild and severe urethral stricture in the observation group was lower than that in the control group [(2.78％ (2/72) vs.12.50％ (9/72),P＜0.05).Conclusion Refined nursing intervention for patients with hypospadias can effectively enhance treatment efficacy,reduce postoperative complications,and prevent urethral stricture,thereby to improve the prognosis of the disease.

Objective Recombinant human parathyroid hormone(1-34) [ rhPTH(1-34)] is the unique anabolic substance acting on the skeleton. The efficacy and safety of long-term administration of rhPTH(1-34) in Chinese postmenopausal women have not been evaluated. This study compared the clinical efficacy and safety of rhPTH(1-34) with elcatonin for treating postmenopausal women with osteoporosis in 11 urban areas of China. Methods A total of453 postmenopausal women with osteoporosis were enrolled in an 18-month, multi-center, randomized, controlled study. They were randomized to receive either rhPTH(1-34) 20 μg(200 U) daily for 18 months, or elcatonin 20 U weekly for 12 months. Lumbar spine ( L1-4) and femoral neck bone mineral density (BMD), fracture rate, back pain as well as biochemical markers of bone turnover ( serum bone-specific alkaline phosphatase was measured by radioimmunoassay; C-telopeptide/ creatinine ( CTX/ Cr) measured by quantitative sandwich enzyme-linked immunosorbent assay) at 6, 12, and 18 months. Adverse events were recorded. Results rhPTH(1-34) increased lumbar BMD more significantly than that did by elcatonin at 6 months( M6), 12 months (M12), and 18 months(M18; 4. 3% vs 1. 94% , 6. 8% vs 2. 72% , 9. 51% vs 2. 86% , P<0. 01). There was only a small but significant increase of femoral neck BMD at M18(2. 64% , P<0. 01) in rhPTH(1-34) groups. There were greater increases in bone turnover markers in the rhPTH(1-34) group than in the elcatonin group at M6, M12, and M18[serum bone-specific alkaline phosphatase(BSAP) 93. 67% vs -3. 56% , 117. 78% vs -4. 12% , 49. 24% vs-5. 81% , P<0. 01; urinary CTX/ Cr 250% vs -29. 5% , 330% vs -41. 4% , 273 % vs -10. 6% , P<0. 01]. rhPTH (1-34) showed similar effect of pain relief as elcatonin. The incidence of clinical fractures was 5. 36% (6 / 112) in elcatonin group and 3. 23% ( 11 / 341 ) in rhPTH ( 1-34 ) group ( P = 0. 303 ). Both treatments were well tolerated. Hypercaluria(9. 38% ) and hypercalcemia(7. 04% ) in rhPTH(1-34) group was transient and caused no clinical symptoms. Pruritus(8. 21% vs 2. 68, P=0. 044) and redness of injection site(4. 40% vs 0, P=0. 024) were more frequent in rhPTH(1-34). Nausea / vomiting(16. 07% vs 6. 16% , P = 0. 001) and hot flushes(7. 14% vs 0. 59% , P<0. 001) were more common in elcatonin group. Conclusion rhPTH(1-34) treatment was associated with greater increases in lumbar spine BMD and bone formation markers. It could increase femoral BMD after 18 months treatment. rhPTH(1-34) could ameliorate back pain effectively. The results of the present study indicate that rhPTH(1-34) is an effective, and safe agent in treating postmenopausal women with osteoporosis.

OBJECTIVETo report a rare case of hemolytic disease of the newborn (HDN) with kernicterus caused by anti-Di(a) diagnosed using high-throughput genotyping multiplex ligation-dependent probe amplification (MLPA).

METHODSConventional serological methods were used to detect the antibodies related with HDN. The genotypes of more than 40 red blood cell antigens for the newborn and her parents were obtained using the high-throughput MLPA assay. The antibody titers were tested using a standard serological method.

RESULTSThe unknown antibody against the low-frequency antigens was predicted based on the primary serological tests. The genotyping results for more than 40 red blood cell antigens of the newborn and her parents showed incompatible antigens of MNS and Diego blood group system, indicating the existence of anti-N or anti-Di(a). Further serological tests confirmed anti-Di(a) existence in the plasma of the newborn and her mother. The titer of anti-Di(a) in the mother's plasma was 1:32.

CONCLUSIONSevere HDN including kernicterus can result from anti-Di(a). High-throughput genotyping MLPA assay can help type some rare antigens in complicated cases. The reagent red cell panels including Di(a)-positive cells are necessary in routine antibody screening test in Chinese population.

Blood Group Incompatibility ; genetics ; Erythroblastosis, Fetal ; diagnosis ; immunology ; Exchange Transfusion, Whole Blood ; Female ; Genotype ; Humans ; Infant, Newborn ; Nucleic Acid Amplification Techniques ; methods ; Rh-Hr Blood-Group System ; genetics ; immunology ; Rho(D) Immune Globulin ; genetics ; immunology

Objective To investigate the bacterial resistance in nationwide and understand the distribution of bacterial and resistance trend.MethodsThe 6507 clinical isolates were collected from 19 hospitals in 17 cities.The susceptibility tests were performed using agar dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The values of MIC50,MIC90 and MICrange were calculated by SPSS 17.0 and the susceptibilities of isolates to antimicrobial agents were determined by using CLSI (2010) guideline.Of all 6507 isolates,4691 strains were collected from target wards and 1816 were isolated from others wards.ResultsAmong 4691 strains,1156 were Gram-positive (24.6％ ) and 3535 were Gram-negative (75.4％).Based on the minimum inhibitory concentration results,the prevalence of methicillin resistant Stapylococcus aureus and methicillin resistant Stapylococcus epidermidis are 51.6％ ( 325/630 ) and 87.0％ ( 228/262 ) respectively.Staphylococci showing intermediate or full resistance to vancomycin were not observed. Coagulase negative Staphylococci showed 2.5％ (16/642)intermediate rate and 1.6％ ( 10/642 ) full resistance rate to teicoplanin,and showed 0.5％ ( 3/642 )resistance rate to linezolid.Antibiotic resistance rate of Enterococcus faecalis to ampicillin was 17.1％(19/111),while the resistance rate of Enterococcus faecium to ampicillin reached up to 85.0％(164/193).Three Enterococcus faecium were resistant to glycopeptides.The prevalence of penicillin resistance Streptococcus pneumoniae and penicillin intermediate Streptococcus pneumoniae were 41.2％ ( 145/352) and 37.2％ (131/352) respectively based on oral penicillin criterion,while the prevalence were 0.0％ (0/352) and 6.0％(21/352) based on vein to non-meningitis criterion.A vast majority of Enterobacteriaceae maintained high susceptibility to carbapenems,with resistance rate less than 2.0％.In addition,tigecycline,moxalactam,fosfomycin and amikacin displayed desirable antibacterial activity against Enterbacteriaceae,and resistance rates to these drugs were all less than 10.0％.For non-fermenting Gramnegative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 23.1％ ( 139/601 ) and 53.5％ (419/784) respectively.Resistance rate of Acinetobacter baumannii was much higher than that during the period 2007 - 2008.Colistin,tigecycline,minocycline and fosfomycin demonstrated good antibacterial activity against Acinetobacter baumannii in vitro.Conclusions Compared with MOHNARIN 2007 -2008year surveillance results, significant increase in resistance rate of Acinetobacter baumannii was demonstrated.Resistant strains to linezolid and tigecycline were found.Bacterial resistance has been a widespread problem in our country,which requires much more attention.

Objective To analyze the efficacy and safety of glimepiride treatment as initial monotherapy in newly diagnosed patients with type 2 diabetes mellitus (T2DM).Methods This was a subgroup analysis of the GREAT study,which investigated the efficacy and safety of glimepiride as initial monotherapy in Chinese patients with T2DM.This analysis was performed in 209 patients with disease duration less than 6 months and never received any anti-diabetic drugs.The change of HbA1C,fasting plasm glucose (FPG),2 h postprandial blood glucose (2hPPG),homeostasis model assessment for β-cell function index (HOMA-β),homeostasis model assessment for insulin-resistance index(HOMA-IR),the percentage of patients with HbA1C ＜ 7.0％ at endpoint and the incidence of hypoglycemia were evaluated after 16-weeks treatment.Results After 16-weeks glimepiride treatment,HbA1C value reduced significantly from baseline to endpoint,the reduction was statistically significant (9.21％ ± 1.65％ to 6.69％±0.83％,P＜0.001),69.7％ of the patients achieved HbA1C ＜7.0％ at study endpoint.Glimepiride-treated patients also achieved a significant improvement in FPG [from (10.15 ± 2.13) mmol/L to (7.23 ± 1.50) mmol/L,P＜0.001] and 2hPPG [from (17.21 ±4.14) mmol/L to (11.62 ± 3.34) mmol/L].HOMA-β was improved from 17.21± 15.19 [11.62 (2.90,115.8)] to 41.13 ± 44.12 [28.00 (5.1,360.00)],and HOMA-IR was reduced from 2.32± 1.90 [1.76 (0.60,12.80)] to 2.07 ± 1.74 [1.63 (0.4,12.3)].The incidence of all reported symptomatic hypoglycemia was 18.2％,and the incidence of confirmed hypoglycemia was 3.8％.Conclusion This analysis showed that glimepiride treatment as an initial mono-therapy could effectively improve blood glucose control in newly diagnosed patients with T2DM,and the treatment may improve islet β cell function,and the safety profile is reasonably good.

Objective To develop questionnaires to indentify research motivation and its related psychological factors for medical postgraduates.Methods The questionnaire was developed based on previous literature and case interview by using self-determination theory as the theoretical framework.Delphi method and stratified factor analysis were used to examine the reliability and validity of the questionnaire.Results The questionnaires included 2 sections:research motivation questionnaire and related psychological factors questionnaire.The Cranach's α of each questionnaire was 0.89 and 0.90 and test-retest reliability coefficient was 0.74 and 0.80.The content validity (CVI) of each questionnaire was 0.958 and 0.935,and stratified factor analysis demonstrated that the items of each dimension could account for more than 40％ of the accumulated variance.Conclusion The questionnaires have good reliability and validity and could be applied.

Objective To compare the clinical efficacy and safety between recombinant human parathyroid hormone ( rhPTH) ( 1 -34) and elcatonin in the treatment of postmenopausal women with osteoporosis in China.Methods This 6 month, multicenter, randomized and controlled study enrolled 205 postmenopausal women with osteoporosis.They were randomized to receive either rhPTH (1 -34) 20 μg (200 U) daily or elcatonin 20 U weekly.Lumbar spine (L1-4 ) and femoral neck bone mineral density (BMD) and biochemical markers of bone turnover were measured. In the meantime adverse events were recorded. Results The results showed that both rhPTH ( 1 -34) and elcatonin increased L1-4 BMD significantly at the endpoint of the study, but femoral neck BMD did not change significantly.From baseline to endpoint, BMD of L1-4 and femoral neck in the rhPTH( 1-34) group increased by 5.51% (P <0.01) and 0.65% (P >0.05), but BMD of L1-4 and femoral neck in elcatonin group increased by 1.55% (P <0.05) and 0.11% (P>0.05).Moreover, the rhPTH(1-34) group had better improvement in L1-4 BMD than the elcatonin group at 3, 6 months, but there was no difference of BMD in these two groups with regard to femoral neck.There were greater mean increases of the bone markers in the rhPTH( 1-34) group than those in the elcatonin group at 3, 6 months [serum bone-specific alkaline phosphatase ( BSAP) 36.79% vs 0.31% ; 92.42% vs -0.17% ; the ratio of urine N-telopeptide of type I collagen and creatinine (NTX/Cr) 48.91% vs -5.32% ; 68.82% vs - 10.86%].Both kinds of treatment were well tolerated and there were no differences between the two groups in the rates of adverse events and serious adverse events.Conclusion It is concluded that rhPTH (1 -34) has more positive effects on bone formation than elcatonin as shown by the greater increments of L1-4 BMD and bone formation markers and the less occurrence of adverse events as well as no significant change in hepatic, renal or hemopoietic function.