Objective: To explore the key factors affecting the selection and effectiveness of bladder management modalities in patients with spinal cord injury，so as to provide reference for the optimization of individualized bladder management strategies. Methods: The clinical and follow-up data of 78 patients with spinal cord injury treated in our hospital during Jan.1,2013 and Dec.31,2022 were retrospectively analyzed.The distribution of bladder management modalities among different grades of injuries was analyzed. Bowker symmetry test was used to evaluate the difference between bladder management modalities at discharge and at the end of follow-up. Multiple linear regression was used to explore the influencing factors of bladder management effects. Plotting Kaplan-Meier survival curves were adopted to calculate the median time of changes in bladder management. Results: At discharge，there were 9 cases of self-catheterization，19 cases of intermittent catheterization，22 cases of reflexive voiding，26 cases of long-term catheterization，and 2 cases using urinary collector.At the end of follow-up，there were 15 cases of self-catheterization，8 cases of intermittent catheterization，34 cases of reflexive voiding，14 cases of long-term catheterization，and 7 cases using urinary collector.There was a significant difference between the modalities of bladder management at discharge and at the end of follow-up (χ =21.43，P=0.018).Multiple linear regression showed a significant decrease of 8.60 in the total neurogenic bladder symptom score (NBSS) for grade D injuries compared with grade A injuries (P=0.026). The median time to bladder management change was 7.93 months (95%CI:5.44-9.44), with approximately 50% of patients experiencing a change in bladder management within 8 months after discharge. Conclusion: The modalities of bladder management changed significantly after discharge.The grade of injury was a key factor affecting the effectiveness of bladder management.Higher grade was associated with worse effectiveness of bladder management.

Objective: Previous observational studies have confirmed the correlation between gut microbiota and bladder cancer，but the causal relationship is still unclear.This study aimed to explore the causal relationship between them with Mendelian randomization. Methods: Genetic variation summary data of 211 gut microbiota and bladder cancer genome-wide association studies (GWAS) were obtained from the MiBioGen Consortium and Finngen database.Single nucleotide polymorphisms (SNPs) closely related to these studies were screened as instrumental variables.The causal relationship between gut microbiota and bladder cancer were analyzed with inverse variance weighting (IVW)，MR-Egger，weighted median，maximum likelihood，robust adjustment feature score and MR-PRESSO，with IVW as the primary analysis method.Additionally，sensitivity analysis was used to test the heterogeneity (Cochran Q) and horizontal pleiotropy (MR-Egger intercept term and global test from MR-PRESSO estimator) to ensure the robustness of the results. Results: The IVW results indicated that Lachnospiraceae UCG004 (OR：1.42)，Desulfovibrionales (Order) (OR：1.48)，Eubacterium ruminantium group (OR：1.33)，Olsenella (OR：1.24)，Ruminococcaceae UCG002 (OR：1.39)，Ruminococcaceae UCG005 (OR：1.42) and Ruminococcaceae UCG013 (OR：1.64) significantly increased the risk of bladder cancer.Conversely，Bacteroidetes (Phylum) (OR：0.61)，Eubacterium brachy group (OR：0.80)，Ruminococcaceae UCG004 (OR：0.73)，Rikenellaceae (Family) (OR：0.67)，Lachnospiraceae ND3007 group (OR：0.47), Adlercreutzia (OR：0.73) and an unknow genus (OR：0.75) were associated with a reduced risk of bladder cancer.Sensitivity analyses did not reveal any heterogeneity or horizontal pleiotropy. Conclusion: This study reveals the causal role of 14 gut microbiota in the pathogenesis of bladder cancer，among which Lachnospiraceae UCG004，Desulfovibrionales (Order)，Eubacterium ruminantium group，Olsenella，Ruminococcaceae UCG002，Ruminococcaceae UCG005 and Ruminococcaceae UCG013 are risk factors for bladder cancer，while Bacteroidetes (Phylum)，Eubacterium brachy group，Ruminococcaceae UCG004，Rikenellaceae (Family)，Lachnospiraceae ND3007 group，Adlercreutzia and an unknown genus are the protective factors.

To construct a single-cell transcriptomic map of testicular tissue under hypobaric hypoxia exposure and perform diversity analysis of supportive cells, aiming to provide new insights into the mechanisms of reproductive toxicity for future research.

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPO) and minimally invasive intramedullary nailing osteosynthesis (MINO) in the treatment of humeral shaft fractures. Methods The clinical data of 53 patients with humeral shaft fractures treated with MIPO and MINO were retrospectively analyzed. The patients were divided into MIPO group of 25 patients and MINO group of 28 patients according to differed surgical approaches. The operation time, blood loss, length of hospital stay, fracture healing time, University of California at Los Angeles (UCLA) shoulder function score at 1 year postoperatively, and Mayo elbow performance score at 1 year postoperatively were compared between the two groups. Results All 53 patients successfully completed the surgery, and no postoperative complications such as surgical site infection, radial nerve injury, fracture nonunion, implant breakage, or loosening occurred. There were no statistically significant differences between the two groups in terms of operation time, blood loss, length of hospital stay, fracture healing time, and Mayo elbow performance score at 1 year postoperatively (P>0.05). The UCLA shoulder function score at 1 year postoperatively was better in the MIPO group than in the MINO group (P < 0.05). One patient in the MIPO group experienced wound fat liquefaction, and one patient in the MINO group experienced radial nerve palsy. Conclusion Both MIPO and MINO can achieve satisfactory results in the treatment of humeral shaft fractures, and both minimally invasive techniques are worthy of clinical promotion. However, MIPO has lesser impact on shoulder function.

The epidemic of coronavirus disease 2019 (COVID-19) has become a severe and complicated situation. As of February 23, 2020, there have been more than 77,038 confirmed cases of new coronavirus infection nationwide. COVID-19 is highly infectious and has a long incubation period and a variety of clinical manifestations, which has a great impact on society and economy and also seriously affects the daily operation of hepatobiliary surgery. This article discusses and recommends the medical protection measures required for outpatient, ward, and operation of hepatobiliary surgery, in order to reduce the risk of nosocomial infection in hepatobiliary surgery during the COVID-19 epidemic.

Hepatocellular carcinoma (HCC) has high morbidity and mortality rates worldwide, and due to the complexity of the development of HCC, the management strategy for HCC has not been completely unified. During the past decade, the treatment of HCC has developed into a multidisciplinary and multimodality therapy centered on surgical operation. Besides hepatectomy and liver transplantation, ablation therapy is another radical treatment, and at present, it can be used as the first-line treatment regimen for HCC patients who have a tumor diameter of ＜3 cm and cannot undergo liver transplantation. Transarterial chemoembolization is the preferred treatment for advanced HCC not suitable for radical treatment. Molecular targeted therapy is mainly used in patients who are diagnosed with advanced HCC or progress to advanced HCC after treatment failures. Cellular immunotherapy is a new treatment for HCC and can help patients with progressive HCC to achieve good remission rate and survival benefit. A deep understanding of the features of each treatment method for HCC, development of individualized treatment regimens, and rational multimodality therapy for HCC can help to improve the overall therapeutic outcome of HCC.

ObjectiveTo make ultrasound anatomy teaching samples of odynopoeia fetus heart with complex abnormity consistent with echocardiographic view,and utilize them in echo teaching.MethodsTen odynopoeia foetus hearts were cutted comparing to different echocardiographic imaging respectively.Results Dissections of fetus heart were obtained including 5 cases of single cardiac ventricle(2 case with interruption of aortic arch),4 cases of double outlet of right ventricular,and 1 case of hypoplastic left heart syndrome with serious coarctation of the aorta.The apical long axis view,the three blood vessel view,as well as the long axis view of the aortic arch were typical views of ultrasound diagnosis and teaching.ConclusionsIt is profit to raise and accurate rate of fetus echocardiography diagnosis by studying dissection of fetus heart anatomic structure with complex abnormity,which would make ultrasound imaging visualization.

Objective To assess the left ventricular systolic asynchronicity in chronic ischemic model with real-time three-dimensional echocardiography (RT-3DE), and to explore the affection of low-dose dobutamine to it. Methods A chronic ischemic model was induced by placing an Ameroid constrictor in the left circumflex(LCX) in swines,then full volume RT-3DE was performed by Philips iE33 with X3-1 probe combining rest and stress(dobutamine stress echocardiography, DSE) every week after LCX constriction.Ten normal pigs before operation served as controls (group A). Examination of all the models post operation were grouped into group B (mild stenosis, LCX stenosis＜50% ), group C (moderate stenosis, LCX stenosis 50%～75%) and group D (severe stenosis, LCX stenosis≥75%) according to the results of coronary angiography. Images were copied to QLAB 5.2 postprocess workstation,and 3DQA software was used to analyze the full volume data sets. The time to the point with minimal systolic volume (Tmsv) in each segment was taken to derive the following indexes of systolic synchrony: the maximum difference of Tmsv (Tmsv-dif) and standard deviation(Tmsv-SD) among various segments and standard index (Tmsv-dif% and Tmsv-SD%), to evaluate left ventricular dyssynchrony. Tmsv3-6 represented the maximum difference of Tmsv between lateral segment and posterior septum (Tmsv3-5: between lateral segment and inferior) in basal level. Results Tmsvl2-Dif%, Tmsv6-Dif%, Tmsv3-6% and Tmsv3-5% under stress condition in group C and D were significantly higher than those at rest;all the data in group D were significantly higher than in group A and B, and in group C higher than group A ( P ＜0.05,0.01 ). Compared with group A,Tmsv6-Dif,Tmsv3-6 and Tmsv3-5 in group B were significantly increased under stress condition,and so did their standardize data under both rest and stress conditions ( P ＜ 0.05, 0. 01 ). Conclusions RT-3DEcombined with DSE could display sensitively the left ventricular asynchrony caused by chronic ischemia,and that will be more significant in lateral wall in LCX stenosis than in normal segments.

Objective To explore the value of diagnostic ultrasound mediated microbubble destruction in improving the myocardial perfusion and left ventricular systolic function when cooperated with the mecsenchymal stem cells(MSCs) transplantation in rabbit myocardial ischemia. Methods One week after myocardial ischemia (MI) modeling,36 rabbits were divided into 3 groups,the control group(group Ⅰ) ,intravenous injection of MSCs group(group Ⅱ) and ultrasound + microbubble + MSCs group (group Ⅲ). Myocardial contrast enhancement (MCE) was performed and quantification analysis of anterior wall was assessed with Photoshop. Left ventrieular systolic function was assessed with M-mode echocardiography and bi-plane Simpson's method. CD34 expression in heart was detected with immunohistochemisty(IHC). Western blotting was applied to detect the level of VEGF in three groups. Results The differences of gray scale analyzed with histogram of Photoshop in anterior wall of ischemia myocardium between the group Ⅰ and group Ⅱ or group Ⅲ were significant,and P value was 0. 032 and 0. 000 , respectively. There were significant differences of FS between group Ⅲ (30. 43±4.09)% and group Ⅱ (26.29±2.93)%, P<0.01, and similar to group Ⅰ (19.28 ± 2.84)%. The difference of EF(%) between group Ⅲ and group Ⅱ was significant [(61.5±5.8 vs 53.6±4. 71), P<0. 05] ,or markedly significant between group Ⅲ and group Ⅰ [(61.5±5.8 vs 42.6± 5.0), P <0.01]. EF(%) assessed with bi-plane Simpson's method was significantly increased from (34.64 ± 4.59) in group Ⅰ to (41.78 ± 4.21) in group Ⅱ and (48.6±3.96) in group Ⅲ. The expression of CD34 assessed with immunohistochemistry was the highest in group Ⅲ. The level of VEGF with western blotting in group Ⅲ was significantly higher than other two groups. Conclusions It is an efficacious transplantation means of MSCs infusion under the ultrasound mediated microbubles destruction in improving the myocardial perfusion and cardiac systolic function.