Volume 99 ·  Issue 46 ·  2019

Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are one of the most common diseases in middle-aged and elderly men, which seriously affect the quality of life of men. Minimally invasive surgery for BPH has been recognized as a safe and effective treatment, and at the same time, the probability of iatrogenic urethral injury is on the rise. Among them, the complications of urethral stricture caused by surgery may lead to patients needing regular urethral dilatation treatment, or even carrying a cystostomy tube for life, which seriously affects the postoperative quality of life. Through improving preoperative evaluation, standardizing surgical operation and strengthening postoperative care, the probability of urethral stricture can be reduced, which is beneficial to improving disease symptoms and improving postoperative quality of life.

To investigate the clinical and imaging characteristics of acute histoplasmosis.

The clinical and imaging data of 10 patients with acute histoplasmosis were studied. Their clinical and imaging characteristics were analyzed. All the patients returned from a South American republic in April 2019 and were treated at the Chongqing public health medical treatment center.

All the 10 patients were male, aged 30-56 years old, with an average age of 43.8 years old. Four of them were engaged in soil clearing, 2 in gas cutting, 2 in moving tools, and 2 in inspection. The disease in all the 10 patients was caused by inhaling a large amount of bacteria-bearing dust in a short time, with an incubation period of 9-13 days, and the main clinical manifestations were fever, insomnia, dizziness, headache, cough, poor appetite, rash and diarrhea. One patient′s head CT showed extensive thickening and increased density of bilateral frontotemporal, parietal and occipital meninges, while the other 9 patients showed no obvious abnormalities. Chest CT findings were as follows: (1) Multiple nodular shadow: the chest CT findings of 4 patients were miliary nodular shadow with diffuse distribution in both lungs. Most of the nodules were less than 5 mm in diameter and distributed evenly or unevenly. CT findings of 6 cases showed scattered nodular shadows in both lungs, with diameters ranging from 2 to 15 mm, and obvious distribution in subpleural and inferior lobes of both lungs. (2) Consolidation shadow: in 2 cases, the size of the shadow was uneven and the density increased, mainly distributed in the subpleura and the lower lobe of both lungs. (3) Ground glass density shadow: mainly distributed around nodules, halo signs can be seen around some nodules. (4) Mediastinum and/or hilar lymph nodes were enlarged. (5) Pleural effusion: a small amount of pleural effusion was found in 4 cases. (6) Pericardial effusion in 3 cases. Abdominal CT showed splenomegaly in 8 cases and hepatomegaly in 1 case.

Acute histoplasmosis has no specificity in clinical manifestations. However, there are still some features in CT manifestations, including multiple nodules in both lungs accompanied by halo, enlarged liver, spleen and mediastinal lymph nodes, and multiple serous cavity effusions.

To screen candidate proteins related to maturation arrest of human spermatogenesis.

From March 2015 to September 2016, 3 cases of obstructive azoospermia and 3 cases of patients with maturation arrest, who were admitted to the Shanghai General Hospital, were selected for proteomic sequencing, and the sequencing results were identified and analyzed.

A total of 125 differentially expressed proteins were identified, of which 21 were up-regulated and 104 were down-regulated. Analysis of biological process shows that differentially expressed proteins participate in reproductive and developmental processes. Participation in reproductive processes accounts for 29.00% of the difference proteins. Participation in the development process accounted for 41.00% of the difference proteins. Cell component(CC) analysis showed that 68.00% different proteins were attached to organelles. Molecular function analysis showed that the binding function accounted for 85.00% of the differential proteins. The proportion of proteins involved in transportation, regulation of enzyme activity and anti-oxidation were 11.05%, 4.62% and 8.34% respectively. Signal pathways involved in sperm deformation included MAPK pathway, Ca²⁺/calmodulin pathway.

The candidate proteins and its associated signaling pathways were selected. The abnormal structuration and function of mature arrest could lead to severe male infertility.

To investigate the influencing factors of ureteroenteric strictures (UES) in patients undergoing laparoscopic radical cystectomy plus urinary diversion (UD).

A total of 412 patients who underwent UD after radical prostatectomy from January 2008 to December 2016 were retrospectively included in this study. Age, gender, body mass index (BMI), diversion type, time to diagnosis of UES, duration of ureteral stent, postoperative complications, including urinary tract infections, ureteroenteric leakage and UES were collected. Kaplan-Meier curves were used to describe time to developing UES. Prognostic factors of UES were analyzed using COX proportional hazard regression model.

Median follow-up time was 37 (IQR 17-120) months. A total of 59 patients (70 sides) developed UES, including 34 cases on the left side, 14 cases on the right side and 11 cases on both sides, following UD after radical cystectomy. The median time to diagnosis of UES was 7 (IQR 4-11) months. The total incidence of UES was 14.3%. The incidence of UES was 10.9%, 13.3% and 14.1% at 1, 3 and 5 years after UD, respectively. Cox proportional hazard regression model analysis demonstrated that BMI≥25kg·m^-2 (P=0.008), ureteroenteric leakage (P=0.001) and urinary tract infections (P=0.037) were the independent risk factors associated with UES following UD after radical cystectomy.

The incidence rate of UES following UD after radical cystectomy was relatively high, which occurs more common on the left side. Obese patients, combined with ureteroenteric leakage, urinary tract infection after UD, are more likely to develop into UES.

To summarize the clinical characteristics of pulmonary actinomycosis and analyze its diagnostic methods.

The clinical symptoms, underlying diseases, imaging characteristics, preliminary diagnosis, diagnostic methods, treatment and prognosis of 30 patients with pulmonary actinomycetes admitted into the First Affiliated Hospital of Zhejiang University School of Medicine during the 10 years (January 2007 to November 2017) were retrospectively analyzed.

The 30 patients with pulmonary actinomycetes included were from 47 to 81 years old, with an average age of (59.5±7.8) years, with a course of disease from 5 days to 48 months, and a median course of disease of 1.5 months; 18 patients (60.0%) were complicated with underlying diseases, 10 patients (33.3%) had a history of smoking, 10 patients (33.3%) had a history of alcohol abuse. The main clinical manifestations were cough in 29 cases (96.7%), followed by sputum in 22 cases (73.3%), hemoptysis in 20 cases (66.7%), fever in 12 cases (40.0%), chest pain in 5 cases (16.7%) and shortness of breath in 3 cases (10.0%). Mass, nodules, consolidation, atelectasis can be seen by imaging, there can be a low-density lesion necrosis, formation of voids or vacuoles. Among the 25 patients (83.3%) who underwent bronchoscopy, 14 cases were abnormal, 5 cases showed endotracheal polypoid neoplasms, 9 cases showed endotracheal mucosal inflammatory changes, 2 cases of them showed bronchial foreign body, and 1 case showed broncholithiasis. All cases were diagnosed by pathology. Nine cases (30.0%) were confirmed by bronchoscopic biopsy. Two cases (6.7%) underwent CT-guided percutaneous lung biopsy, 18 cases (60.0%) underwent surgical resection of pathology, and 1 case (3.3%) was diagnosed by puncture of chest wall mass. Sufficient dose and course of penicillin were effective. Surgical excision of the lesion with antibiotics for 2-4 weeks was effective.

The clinical manifestation of pulmonary actinomycosis is lack of specificity, obtaining positive pathological specimens is the key to the diagnosis of this disease, the first choice is bronchoscopy and percutaneous lung biopsy.

To investigate the impact of implant height on the morphology of cervical facet joints in artificial cervical disc replacement (ACDR).

A finite element model of the cervical spine from C₂ to C₇ was constructed. The surgical processes of ACDR were simulated by insertion of 5 mm, 6 mm or 7 mm Prestige-LP artificial cervical discs. The morphological changes of cervical facet joints were recorded in terms of facet overlap distance, facet overlap area and facet angle.

The normal height Prestige-LP cervical disc could restore the natural status of the cervical spine. Compared with the intact condition, the model with ≥2 mm height implant would reduce the overall range of motion (ROM) by 19.2% in flexion, 19.4% in extension, 18.4% in lateral bending and 19.0% in axial rotation. Besides, the ROM at the surgical level reduced by 15.8% in flexion, 15.4% in extension and lateral bending and 19.0% in rotation. The upper and lower adjacent levels (C_4/5 and C_5/6) showed more obvious changes in ROM, which reduced by 26.8% and 26.5% in flexion, 26.6% in extension, 26.5% and 26.4% in lateral bending, and 26.4% and 26.3% in rotation, respectively. The reduction of facet overlap distance, facet angle and facet overlap area with the ≥2 mm height artifact was 9.6%, 30.7%, and 17.9% respectively at the upper adjacent level, and 22.3%, 35.3% and 28.2% respectively at the surgical level, compared with the intact model.The morphology of facet joints at the lower adjacent level were slightly changed.

The implant height selection in ACDR should be in accordance with the physiological intervertebral disc height. Artifact with ≥2 mm in height would obviously change the morphology of facet joints, thus should not be used in clinical practice.

To find the best strategy of embryo transfer, so as to provide theoretical basis for improving the clinical outcomes of in vitro fertilization-Embryo transfer (IVF-ET), we investigate the blastocyst culture of surplus cleavage-stage embryos after D3 embryo transfer and the prediction of clinical outcomes with or without blastocyst formation.

A retrospective study was conducted on 3 568 patients who underwent IVF-ET in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2016 to May 2018, whotransplanted two embryos in D3 with blastocyst culture of surplus cleavage-stage embryos, according to their age, they were divided into three groups: <35 years old group, 35-38 years old group, and>38 years old group.And according to the presence or absence of blastocyst formation, they were also divided into two subgroups: blastocyst formation group and non-blastocyst formation group. The embryo development and clinical outcomes in each group were compared.

(1) Comparisons of the embryo development in the three age groups with the first cycle. The total fertilization rate, cleavage rate and high quality embryo rate of the blastocyst formation group in the three groups were higher than those in the non-blastocyst formation group, P<0.05; In<35 years old group, the embryo utilization rate (75.0% vs 70.6%), pregnancy rate (74.9% vs 70.3%), planting rate (53.6% vs 48.6%), delivery rate (66.7% vs 61.1%) and live birth rate (66.5% vs 61.0%) of the blastocyst formation group were higher than those in the non-blastocyst formation group, P<0.05. (2) Comparisons of embryo development in the three age groups with multiple cycles (≥2 cycles). In<35 years old group, the total fertilization rate (75.0% vs 70.6%),delivery rate (62.7% vs 43.8%) and live birth rate (62.7% vs 43.8%) of the blastocyst formation group were significantly higher than those in the non-blastocyst formation group, P<0.05; In>38 years old group, the pregnancy rate (56.3% vs 25.8%), implantation rate (34.4% vs 14.5%), delivery rate (43.8% vs 11.3%), live birth rate (43.8% vs 11.3%) of the blastocyst formation group were higher than those in the non-blastocyst formation group, P<0.05.

The results of blastocyst culture in different groups can predict the outcomes of embryo transfer in D3. For patients<35 years old with the first cycle, the clinical outcomes of the blastocyst formation group after D3 embryo transfer is better than that of the non-blastocyst formation group. For Patients with multiple cycles (≥2 cycles),the clinical outcomes of the embryo formation group is superior to that of the non-blastocyst formation group<35 years old or>38 years old.

To evaluate the clinical efficacy of endovascular treatment for non-thrombotic right iliac vein compression syndrome with intravascular ultrasound.

The clinical data of 40 patients with non-thrombotic right iliac vein compression syndromereceiving intravascular ultrasound-assisted balloon dilatation combined with stent implantation from January 2012 to December 2018 were retrospectively analyzed. There were 32 males and 8 females, the average age of whom was 63 (46-81) years old. The patients were classified according to the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) classification: 7 cases as C3, 18 as C4, 10 as C5 and 5 as C6. All patients underwent percutaneous right femoral vein puncture, intravascular ultrasound, and balloon dilatation combined with stentimplantation in the right iliac vein lesion location.

The success rate of clinical operations was 100%. There were no serious complications during the perioperative period. All patients were followed up for 4-58 months. During the follow-up period, the relief rate of limb edema was 88.6% (31/35), the pain relief rate was 86.7%(13/15), and the healing rate of ulcers was 100% (6/6). After the stent implantation, the endovascular area of the compression site was significantly enlarged (34.5mm²± 11.1mm²vs129.8 mm²±17.2 mm², P<0.001). The follow-up of color Doppler and/or anterograde angiography for deep veins of lower limb with digital subtraction angiography showed that the blood flow in the stentsweres mooth in all patients. Three cases were observed that the intimal hyperplasia led to mild in-stent restenosis, no obvious in stent restenosis (>50%). The abdominal X-ray plain film showed no obvious displacement and fracture of the stents. The venous clinical severity score (VCSS) was statistically significant (13.0±2.4 vs 6.2±2.0,P<0.001). The statistical results of short-form health surver SF-36 showed that the scores of life quality in all dimensions of the affected limb were significantly improved after operation (P=0.000).

Intravascular ultrasound-assisted balloon dilatation combined with stent implantation is not only a safe and effective treatment for non-thrombotic right iliac vein compression syndrome, but also has a good mid-term patency rate.

To investigate the role of transcription factor peroxisome proliferator-activated receptor-gamma coactivator-1 beta (PGC-1β) on osteoclastogenesis and related regulatory mechanism in the mouse monocyte-macrophage cell line (RAW264.7).

PGC-1β expression and location in RAW264.7 cells was detected by immunofluorescence, flow cytometry and western blot analysis with nuclear protein extraction. RAW264.7 cells were transfected with lentivirus for gene silencing or over-expression of PGC-1β and cultured with macrophage colony-stimulating factor and receptor activator for nuclear factor-κB ligand. Cell viability was detected by cell counting kit-8. Cell apoptosis and cell cycle were detected by flow cytometry. Mature osteoclasts and their bone resorption activity were determined by tartrate-resistant acid phosphatase (TRAP) expression and toluidine blue staining. Western blot analysis was performed for detecting dendritic cell-specific transmembrane protein (DC-STAMP), cathepsin K, TRAP and matrix metalloproteinase (MMP)-9 expression, as well as cytoplasmic NF-κB-inducing kinase (NIK) and nuclear RelB.

PGC-1β expression was observed in the nuclei of RAW264.7 cells. Down-regulation or overexpression of PGC-1β in RAW264.7 cells did not affect cell viability, apoptosis or cell cycle. Down-regulation of PGC-1β decreased the count of mature osteoclasts (49±21 cells vs. 147±42 cells,P=0.004) and the pit area of bone resorption lacunae (42.11μm²±11.30 μm ² vs. 204.80μm²±31.09 μm ², P<0.001), as well as the expression of cathepsin K, TRAP and MMP-9, but not DC-STAMP. Overexpression of PGC-1β promoted osteoclast differentiation and bone resorption activity, as well as the expression of cathepsin K, TRAP and MMP-9. Down-regulation of PGC-1β suppressed the protein expression of cytoplasmic NIK and nuclear RelB in RAW264.7 cells.

PGC-1β can promote the differentiation of RAW264.7 into osteoclasts and improve the bone resorption ability of the cells via activation of NIK/RelB pathway, which might be a promising therapeutic target for osteoporosis.

To observe the effect of primary cilia expression rate on Wnt/β signaling pathway in tibial growth plate chondrocytes from chronic renal insufficiency (CRI) young rats.

Male 2-week-old SD rats were randomly divided into two groups: (1) Sham group: only the left ureter was exposed (n=6); (2) CRI group: the left ureter was ligated (n=6). Rats were sacrificed 2 weeks after the operation and the primary cilia expression rate of growth plate chondrocytes and key protein β-catenin in Wnt/β signaling pathway were observed in histological section of tibia specimen. Chondrocytes isolated from growth plate in two groups were cultured in vitro to P3 generation. The primary cilia expression rate and the level of β-catenin were measured. The primary cilia expression rate was detected by agonists and antagonists Wnt/β signaling pathway in chondrocytes of CRI group. The level of β-catenin was detected by using serum-free culture and chloral hydrate to intervene chondrocytes in CRI group.

The primary cilia expression rate of growth plate chondrocytes in histological section of tibia specimen in CRI group was higher than that in Sham group [(17.5±7.7)% vs (8.7±3.6)%, t=3.237, P=0.005], and the level of β-catenin was higher in CRI group (5.1±0.7 vs 1.9±0.8, t=6.731, P<0.001). The primary cilia expression rate of growth plate chondrocytes cultured in vitro in CRI group was higher than that in Sham group [(20.9±8.1)% vs (11.8±4.7)%, t=3.073, P=0.007], and the level of β-catenin was higher in CRI group (0.49±0.12 vs 0.25±0.11, t=3.297, P=0.011). There was no significant change in primary cilia expression rate after intervention by using Wnt/β signaling agonists and antagonists to change the level of β-catenin [agonists group: (21.3±7.6)%, control: (20.6±6.8)%, antagonists group: (22.4±6.2)%,F=0.173, P=0.842]. The level of β-catenin was significantly changed after intervention by using serum-free culture, chloral hydrate to alter the primary cilia expression rate (serum-free culture group: 0.61±0.23, control: 0.39±0.24, chloral hydrate group: 0.15±0.11, F=6.476, P=0.012). There was a positive correlation between the level of β-catenin and primary cilia expression rate.

The primary cilia expression rate and the level of Wnt/β signaling pathway were higher in tibial growth plate chondrocytes in CRI rats model, and primary cilia might have positive regulatory effects on the Wnt/β signaling pathway.

To explore the pathological mechanism and role of autologous peritoneum transplantation onenterocystoplasty in porcine model.

Randomly, four experimental female swine were chosen, and each of their body weight was 28-33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out (to transplant the peritoneum onto an ileum segment of which the mucosa and submucosa had been removed. These flaps were used to mend and augment the bladder by suturing the edge of detective bladders). After removal of ureteral catheters and balloon catheter at day 5 respectively, their voiding behaviors were monitored, and respectively 2 swine were euthanized at week 3/6 for routine pathology, immunohistochemistry, and electron microscopic examinations.

Four swine underwent reconstruction, but none died for complications such as peritonitis, ileus and urinary fistula. The length of ileum was 35 cm, and the area of peritoneum was 15 cm×10 cm. Voiding behaviorsof the swine were normal, with clear urine after removal of their catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the neobladder had been covered by continuous urothelium while the peritoneum disappeared without ileal mucosa regrowth or residual. Scanning electron microscope showed that the transitional cells of neobladder of swine were complete and orderly, and urothelium around suture border was continuous withoutmalposition.

In porcine model, autologous peritoneal transplantation witnessed no immune rejection response for itself, which was replaced by crawling transitional epithelium around anastomosis, rather than by metaplasia.

This article reports a case of a patient with molecular diagnosis of DiGeorge syndrome. He was diagnosed with hypoparathyroidism (hypoparathyroidism) in adolescence. He was diagnosed with idiopathic hypoparathyroidism because no other systemic abnormalities other than hypoparathyroidism were found, and his condition spontaneously resolved during follow-up. Retrospective analysis after defined molecular diagnosis revealed other systemic manifestations of the patient's DiGeorge syndrome. It is suggested that clinicians should pay attention to the abnormal symptoms and signs outside the parathyroid gland in adolescent patients with hypoparathyroidism, and consider the possibility of hereditary hypoparathyroidism; At the same time, hypoparathyroidism has the possibility of spontaneous remission, especially for patients who retain parathyroid hormone secretion function, should be closely observed and the drug dose should be adjusted in time to prevent renal complications.

Hereditary angioedema (HAE) is mainly caused by excessive production of bradykinin, which leads to vasodilation and increased vascular permeability, resulting in recurrent angioedema, which commonly involves hands and feet, upper respiratory tract and gastrointestinal tract, and is potentially fatal. A patient with typical HAE gastrointestinal attacks with transient peritoneal effusion, who had been misdiagnosed as acute pancreatitis several times, was reported. The frequency of attacks was significantly reduced after danazol treatment.

This patient, a 33-year-old male, was seen for "snoring and holding his breath for more than 10 years and intermittent palpitations for half a year". He was admitted to the hospital and diagnosed with severe obstructive sleep apnea hypopnea syndrome (OSAHS) and sick sinus syndrome (SSS). SSS was considered to be induced by OSAHS. The patient's symptoms improved on the night after continuous positive airway pressure (CPAP) treatment, and the patient's CPAP treatment was followed up for 3 months without recurrent arrhythmia. It suggests that sleep apnea is a potential risk factor for bradyarrhythmia.

To summarize the diagnosis and treatment of a case of primary pancreatic squamous cell carcinoma with liver metastasis, it is suggested that paclitaxel, cisplatin and gemcitabine combined with percutaneous hepatic artery embolization (TACE) is effective in the treatment of this disease, and the clinical characteristics of this disease are understood through literature review. To provide reference for the clinical diagnosis and treatment of patients with primary pancreatic squamous cell carcinoma and liver metastasis.

This article reports the case of a female patient admitted to hospital for 1 month with intermittent nausea. Colonoscopy showed multiple submucosal protuberances of the rectum. Based on the analysis of its morphology, size, texture, surface color and other characteristics, endoscopic diagnosis considered the possibility of neuroendocrine tumors. No positive tissue was obtained by biopsy, and abdominal computed tomography (CT) showed no enlarged lymph nodes and suspected metastases, so the tumors were completely removed under endoscopy. Postoperative pathological diagnosis was arterial thrombosis with organization, fibrosis and hyaline degeneration, which resulted in misdiagnosis and mistreatment.

Mechanical ventilation is an important means of respiratory support in critically ill patients, but mechanical ventilation can also cause diaphragmatic dysfunction, called ventilator-related diaphragmatic dysfunction (VIDD). The pathogenesis involved in VIDD is numerous and interrelated. The important mechanisms of VIDD include mitochondrial damage and mechanical ventilation-induced oxidative stress in the diaphragm. In addition, the activation of diaphragm proteolytic pathway, increased diaphragm autophagy, and remodeling of sarcoplasmic reticulum lanidine receptor-1 are also involved in the occurrence of VIDD. By understanding the mechanism of VIDD, we can better prevent and treat VIDD. In this paper, the research progress of main pathogenesis of VIDD is reviewed.

Missing data are widespread in the field of public health surveys and, if not handled properly, can lead to reduced statistical power and biased results. Multiple fill method is a method to deal with missing data, which is widely used in practice. This paper introduces the multiple fill method and its application in public health investigation research, which provides more scientific and feasible methodological help for data processing and analysis of public health investigation research, and improves the quality of investigation research.

When the previa vessel is compressed or ruptured by fetal presentation, it seriously threatens the life of the perinatal infant. It occurs in patients with in vitro fertilization-embryo transfer (IVE-ET), placenta velata, placenta previa, placenta multilobata, placenta paraplacenta, and multiple pregnancies, among which placenta velata and placenta previa are the most common. Therefore, for patients with high risk factors during pregnancy, ultrasound examination is recommended to determine whether there is previa. Once diagnosed, strengthening monitoring during pregnancy and timely cesarean section to terminate pregnancy can improve perinatal outcome.