To report the management of urinary tract obstruction and infection in a pregnant woman with unrepaired bladder exstrophy. A 27-year-old pregnant woman with unrepaired bladder exstrophy was referred to our hospital with a complaint of bilateral flank pain in the second trimester. After two-dimensional abdominal ultrasound, magnetic resonance imaging and a urine analysis, she was diagnosed with an upper urinary tract infection due to ureteral obstruction secondary to unrepaired congenital bladder exstrophy and an intrauterine pregnancy. J-tube insertion was performed after locating the ureteral orifices and antibiotics were administered. Symptoms rapidly resolved. She delivered a normal male infant by caesarean section at 34 weeks of gestation. Standard urological management of the ureteral obstruction in pregnancy was successful in this extreme case of unrepaired bladder exstrophy associated with an intrauterine pregnancy. The perinatal outcome was good.
Contrast and linewidth, which depend on the microwave (MW) and light powers, are critical for optimizing magnetometer sensitivity based on high-density nitrogen vacancy (NV) centers in diamond. Therefore, the tradeoff between laser and MW powers can be adjusted to optimize the contrast and linewidth extracted from the magnetic resonance. In this paper, we developed a pulsed electron spin resonance (ESR) measurement to enhance the magnetic field sensitivity of an NV magnetic sensor with high-density NV centers in diamond by narrowing the linewidth while keeping the contrast almost constant. Furthermore, for a wide range of experimental settings of MW and light powers in the continuous-wave (CW) method, the contrast and linewidth always increase with increasing MW power. However, by using a simple pulsed ESR sequence based on the repetitive excitation of NV centers, linewidth broadening under relatively high MW power is avoided. The magnetic field sensitivity reaches less than by eliminating the power broadening of the linewidth of ESR, which is one third of that achieved using CW measurements. Finally, the possibility of enhancing magnetic-field sensitivity utilizing the light-narrowing effect is discussed.
Abstract Background Heterotopic pregnancy occurred after frozen embryo transfer with two D3 embryos, and the case had a history of bilateral salpingectomy due to salpingocyesis. An ectopic heterotopic pregnancy was implanted in the left psoas major muscle, which has not been previously reported. Case presentation A 33-year-old woman presented with left back pain after curettage due to foetal arrest in the uterus without vaginal bleeding and spotting, and painkillers relieved the pain initially. When the painkillers ceased to work, the patient returned to the hospital. The β-human chorionic gonadotropin (β-hCG) level remained increased compared with the time of curettage, and a diagnosis of retroperitoneal abdominal pregnancy was suggested by ultrasonography and computerized tomography (CT) with the gestational sac implanted in the left psoas major muscle at the left hilum level. Laparotomy was performed to remove the ectopic pregnancy. During the operation, we carefully separated the adipose tissue between the space of the left kidney door and left psoas major muscle, peeled away the gestational sac that was approximately 50 mm × 40 mm with a 25-mm-long foetal bud, and gave a local injection of 10 mg of methotrexate in the psoas major muscle. Fifty days later, β-hCG decreased to normal levels. Conclusion It is necessary to pay more attention to the main complaints to exclude rare types of ectopic pregnancies of the pelvis and abdomen after embryo transfer.
Objective
To investigate and analyze the clinical features of patients with idiopathic retroperitoneal fibrosis (IRF) for improving clinical diagnosis and treatment.
Methods
The medical records of 31 cases diagnosed as IRF in Shanxi Dayi Hospital from 2011 to 2017 were reviewed retrospectively and summarized with recent relevant literatures.
Results
The average age of patients was 48 years old, ranging from 25 to 72 years old, with 19 males and 12 females. Among them, 3 men were defined as IgG4 related retroperitoneal fibrosis. Hydronephrosis to some extent was found in 28 patients, of which 23 patients were implanted with 37 uieteral stents (D-J tubes), 14 cases were with bilateral hydronephrosis, 9 cases were with unilateral hydronephrosis (two on the right and seven on the left). The reexamination by ultrasound or CT showed that the hydronephrosis was reduced or disappeared after surgery at 3 months, 6 months and 1 year after treatment. Five patients refused implanting D-J tube, of which three cases underwent reexamination of ultrasound for aggravated syndrome suggesting exacerbation of hydronephrosis, two human beings received remedial D-J tube implanting and the result was favorable, one case suffered secondary deep venous thrombosis and was given immunosuppressive agents for having no chance to implant tube, and the patient was lost after leaving hospital. It was only three cases who got complications such as lower fever and urinary tract irritative syndroms during the 1-year follow-up. After been diagnosed with urinary infection by bacterial culture, the 3 patients took sensitive antibiotics orally and then recovered. Thirty-one patients were treated with corticosteroids, of which 27 patients were treated by corticosteroidst associated with tamoxifen, 19 patients were treated with immunosuppressive agents; the D-J tubes were exchanged or extubated after half a year; twenty-eight tubes showed stone formulated on the wall of ureteral stents. No condition of extubating difficultly occured. On the basis of the drug therapy, the extubated rate at 6 months and 1 year was 16%(4/25) and 80%(20/25), the diffience was statistially significant(P<0.05).
Conclusions
IRF is rare in clinic and its prognosis is relatively good. The diagnosis of IRF is primarily based on histopathologic study. Glucocorticoid and immunosuppressive therapy are the basic treatments for IRF. It is convenient and safe to implant the D-J tube for patients with hydronephrosis in time, by which the incidence of complications are not increased, such as infection, hematuresis and so on, and it has good tolerability. The patients defined as IgG4 related retroperitoneal fibrosis are recommended to perfect the imageological examination of the whole body, lest missing foci.
Key words:
Ureteral stent; Retroperitoneal fibrosis; Immunoglobulin G
Cerebral ischemia-reperfusion (CI/R) injury is caused by blood flow recovery after ischemic stroke. Chlorogenic acid (CGA, 5-O-caffeoylquinic acid) is a major polyphenol component of
In opposed-piston, opposed-cylinder (OPOC) two-stroke diesel engines, the relative movement rules of opposed-pistons, combustion chamber components and injector position are different from those of conventional diesel engines. In this study, the combustion and emission characteristics of the OPOC which is equipped with a common-rail injection system are investigated by experimental and numerical simulation. Different split injection strategies involving different pilot injection/fuel mass ratios and injection intervals were compared with a single injection strategy. The numerical simulation was applied to calculate and analyze the effect of split injection strategies on the combustion and emission after validation with the same experimental result (single injection strategy). Results showed that using split injection had a significant beneficial effect on the combustion process, because of the acceleration effect that enhances the air-fuel mixture. Additionally, the temperature of the split injection strategies was higher than that of single strategy, leading to the nitrogen oxides (NOx) increasing and soot decreasing. In addition, it has been found that the split injection condition with a smaller pilot injection/fuel mass ratio and a medium injection interval performed better than the single injection condition in terms of the thermo-atmosphere utilization and space utilization.
Objective
To evaluated the clinical efficacy of transurethral en bloc resection of bladder tumor with 2 μm laser in the high-risk elderly patients with bladder cancer under local anesthesia.
Methods
All of 64 high-risk elderly patients having underwent surgical treatment from April 2015 to October 2016 were divided into 2 groups, 2 μm laser group (30 patients) and transurethral resection of bladder tumor (TURBT) group(34 group) according to surgical methods. The area and degree of pain was observed and recorded using visual analogue scales (VAS) during the 2 μm laser operation. The operation time, bladder irrigation time, catheter indwelling time, hospital stay, complications and 1-year cumulative recurrence rate were compared between 2 groups.
Results
The ASA grade in 2 μm laser group was higher than that in TURBT group and there was significant difference (P 0.05). The bladder irrigation time, catheter indwelling time and hospital stay were shorter in 2 μm laser group than those in TURBT group: (40.00 ± 19.06) h vs. (56.47 ± 14.55) h, (4.33 ± 1.40) d vs. (5.65 ± 0.93) d, (4.13 ± 1.51) d vs. (6.24 ± 0.75) d, P<0.05 or<0.01. The overall incidence of complications was lower in 2 μm laser group than that in TURBT group: 13.33%(4/30) vs. 64.71% (22/34), χ2 = 8.719, P = 0.003. Compared with that of pre-treatment, the quality of life was higher after treatment in two groups, but there were no significant differences between the two groups. There were no significant differences in 1-year cumulative recurrence rate between the two groups after treatment (χ2 = 0.496, P = 0.481).
Conclusions
Transurethral 2 μm laser treatment in bladder cancer under urethral surface anesthesia is safe and reliable for the high-risk elderly patients and complications are fewer than TURBT. The recent curative effect is satisfied.
Key words:
Bladder tumor; Transurethral resection of bladder tumor; Lasers
To evaluate the safety and effect of transurethral holmium laser enucleation of the prostate (HoLEP) in comparison with bipolar transurethral plasmakinetic prostatectomy (TUPKP) in the treatment of benign prostatic hyperplasia (BPH).We searched the databases of PubMed, SCI, Ovid, The Cochrane Library, CNKI, CBM, VIP, and Wangfang Data for controlled clinical trials about HoLEP versus TUPKP in the treatment of BPH published up to April 2016. The studies were screened according to the inclusion and exclusion criteria, the data extracted, and their quality evaluated by 2 reviewers independently, followed by a meta-analysis using the RevMan 5.3 software.A total of 7 studies were included, involving 2031 cases. In comparison with TUPKP, HoLEP showed significantly longer operation time (WMD = 24.61, 95% CI 11.88, 37.34, P lt; 0.001), shorter hospital stay (WMD =－1.91, 95% CI －3.74, －0.07, P = 0.04), shorter bladder irrigation time (WMD = －21.50, 95% CI －34.95, －8.06, P = 0.002), shorter catheter-indwelling time (WMD = －27.60, 95% CI －48.17, －7.03, P = 0.009), less hemoglobin loss (WMD = － 0.42, 95% CI －0.78, －0.07, P = 0.02); lower postvoid residual urine (PVR) at 3 months (WMD = －3.35, 95% CI －4.46, －2.23, P<0.001) and 6 months after surgery (WMD =－1.11, 95% CI －2.18, －0.05, P = 0.04); higher maximum urinary flow rate (Qmax) (WMD = 0.42, 95% CI 0.04, 0.80, P = 0.03) and fewer urinary tract irritation symptoms (OR =0.58, 95% CI 0.41, 0.81, P = 0.002) at 12 months after surgery. No statistically significant differences were found between the two groups in the volume of resected tissue, serum sodium reduction, urethral stricture, erectile dysfunction, retrograde ejaculation, or transient urinary incontinence (P>0.05), or in the improvement of the quality of life (QoL) at 1, 3 and 12 months, International Prostate Symptom Score (IPSS) at 1, 3, 6 and 12 months, Qmax at 1, 3 and 6 months, or International Index of Erectile Function-5 (IIEF-5) at 6 months after surgery (P>0.05).HoLEP is preferred to TUPKP in clinical application for its advantages of higher Qmax at 12 months after surgery, lower PVR at 3 and 6 months, higher peri-operative safety, faster recovery, and fewer urinary tract irritation symptoms. However, for the quantity and quality limitations of the included publications, our findings are to be further supported by large-sample, multi-center, and high-quality prospective controlled clinical studies.目的: 系统评价经尿道钬激光前列腺剜除术（HoLEP）与经尿道前列腺等离子双极电切术（TUPKP）治疗良性前列腺增生（BPH）的安全性及疗效。方法: 计算机检索PubMed、SCI、Ovid、The Cochrane Library、CNKI、CBM 、VIP 及万方数据库，全面收集有关HoLEP与TUPKP比较治疗BPH的临床对照试验，检索时限为2000年1月至2016年4月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后，采用RevMan 5.3 软件进行meta分析。结果: 纳入7篇研究，共2031例患者。Meta分析结果显示：与TUPKP组相比，HoLEP组手术时间较长［WMD =24.61，95％CI(11.88,37.34)，P lt;0.001］，住院时间短［WMD =－1.91，95％CI(－3.74,－0.07)，P =0.04］，膀胱冲洗时间短［WMD =－21.50，95％CI(－34.95,－8.06)，P =0.002］，留置导尿时间短［WMD =－27.60，95％CI(－48.17,－7.03)，P =0.009］，血红蛋白丢失量更少［WMD =－0.42，95％CI(－0.78,－0.07)，P =0.02］，术后3个月残余尿量（PVR）较少［WMD =－3.35，95％CI(－4.46,－2.23)，P<0.01］，术后6个月残余尿量（PVR）较少［WMD =－1.11，95％CI(－2.18,－0.05)，P =0.04］，术后12个月后最大尿流率（Qmax）速率较大［WMD =0.42，95％CI(0.04, 0.80)，P =0.03］，HoLEP组尿路刺激症状较少［OR =0.58，95％CI(0.41, 0.81)，P=0.002］，而切除组织重量、血清钠下降、尿道狭窄、ED、逆行射精、短暂性尿失禁，术后1、3、12个月的生活质量评分（QoL），术后1、3、6、12个月的国际前列腺症状评分（IPSS），术后1、3、6个月的最大尿流率(Qmax)，术后6个月的国际勃起功能指数评分（IIEF-5）差异均无统计学意义（P >0.05）。结论: HoLEP组术后12个月的Qmax较大，术后3、6个月的PVR减少，围手术期安全性高、恢复快，尿路刺激症状发生率较低方面优于TUPKP，建议在临床推广应用。由于纳入研究数量和质量存在局限性，尚需要大样本、多中心、前瞻性、高质量的随机对照研究进一步验证。.
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