Objective To evaluate the value of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods From March 2003 to May 2008,78 patients with adrenal tumors received retroperitoneal laparoscopic adrenalectomy in our hospital. During the operation,three trocars were introduced into the lumbar region to establish retroperitoneal space by blunt dissection with the camera. Afterwards,the tumor was removed by using a harmonic scalpel. Results The procedures were successfully completed in all the 78 cases without blood transfusion,the operation time ranged from 45 to 180 min (mean,90 min). Drainage tubes were removed 24 hours after the operation. And the patients were discharged from hospital in 3 to 5 days postoperation. One patient showed regional subcutaneous emphysema after the surgery and was cured spontaneously. The patients were followed up for 3 to 24 months with a mean of 10 months,during which 36 patients achieved normal blood pressure in 3 months,while in the other 7 patients,oral antihypertension drugs were still needed. No patients had recurrent tumor during the follow-up. Conclusions Retroperitoneal laparoscopic can be the first choice for adrenal tumors,as it is safe and effective with minimal invasion,quick recovery,and short postoperative hospital stay.

Objective To screen the best processing technology of prepared Rhubarb by multi- component composite score combined with response surface.Methods The composite score of seven components, i.e., gallicacid, chrysophanol-8-O-β-D-glucopyranoside, aloeemodin, rhein, emodin, chrysophanol, physcion, was taken as indicators. Three factors and three levels of response surface Box-Behnken were used in experimental design. The effects of factors including rice wine volume, moistening time, and steaming time on processing technology of stewed Rhubarb were studied, and the optimized processing parameters were chosen.Results Design Expert 8.05 software was used for data analysis. Multivariate quadratic mathematical model of the sample and examine factors composite score regression equation of seven ingredients content were set up. The best processing conditions of prepared Rhubarb were as following:adding 36.6 mL rice wine into per 100 g raw material;moistening time continued for 2.16 hours;steaming time continued for 10.96 h. According to actual production, the optimized processing conditions of prepared Rhubarb are as following:adding 35 mL rice wine per into 100 g raw material;moistening time continued for 2 h;steaming time continued for 11 h.Conclusion The optimized processing technology can reasonably control the quality of prepared Rhubarb, and provide the basis for the quality standards of its decoction pieces and clinical application.

Objective To evaluate the efficacy and safety of percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction simultaneously. Methods 32 patients with unilateral solitary parapelvic cyst complicated with UPJO, including 25 cases with ipsilateral kidney stones. After percutaneous holmium laser lithotripsy for patients complicated with calculi, then performed incision and drainage through the channels for parapelvic cyst by holmium laser, and antegrade high pressure balloon dilatation for UPJO, drainage by hippocampal tube in 3 ~ 6 months postoperatively. The operation time of fenestration drainage of cyst, narrow hypertensive dilatation and postoperative hospital stay were analyzed. Results Compared with 1 month (46.17 ± 6.33), 3 months (40.47 ± 6.06), 6 months (33.81 ± 7.05), 9 months (28.95 ± 7.92) after surgery, there was a marked improvement of the separation coefficient of renal convergence, the difference was statistically significant (P < 0.05). And compared with 6 months after surgery, the data of 9 months after surgery has statistical significant differences (P < 0.05). The separation coefficient of renal convergence decreases as time goes on. Conclusions Percutaneous micro-channel approach in treatment of pelvis side cyst and ureteropelvic junction obstruction by the same time can effectively relieve symptoms and decrease the separation coefficient of renal convergence. It is safe and effective.

3D printing service in medical librariescan help their users to master the new medical technologies, meet the needs in clinical teaching, and expand their value-added service.The application of 3D printing techno logy in 5 American medical libraries was thus analyzed in terms of its equipments, establishment of biomedical 3D model, and charge of 3D printing service, with the problems stressed for domestic medical libraries in providing 3D printing service, such as rational allocation of fees, solution of intellectual properties, and training of professional librarians.

Objective:To investigate the complication and compliance of different supine time and the degree of obedience in children with leukemia after intrathecal chemotherapy.Methods:A total of 553 children with leukemia after intrathecal chemotherapy from April 1, 2017 to March 28, 2019 in Beijing Children′s Hospital Affiliated to Capital Medical University were selected. Children who received intrathecal injection from April 1, 2017 to December 31, 2017 were selected as control group(274 cases), from January 1, 2018 to March 28, 2019 were selected as research group(279 cases). The children in research group were supine 2 hours but control group were supine 4 hours after intrathecal. The complications that occurred after injection and within one week after injection and compliance were observed.Results:Finally, 457 children included in this study, there were 235 cases in research group and 222 cases in control group. The number of cases of limb numbness and local pressure reddening in the research group and the control group were 18, 20 and 31, 34, respectively, with statistically significant differences between the two groups( χ2 values were 4.74, 5.07, P<0.05). After intrathecal injection, the patients' compliance with the time of supine removal was completely acceptable to the research group, relatively acceptable, acceptable, and required efforts to adhere to the number of cases were 65, 83, 42, 45, respectively, while the control group were 34, 50, 76, 62, respectively, the differences were significant ( χ2 value was 30.04, P<0.05). Conclusions:Supine for 2 hours after intrathecal injection can reduce the incidence of complications and improve compliance, which is safe and feasible. So, supine for 2 hours after intrathecal injection is recommended.

Objective To explore the feasibility and safety of visualization puncture combined with flexible ureteroscopy in the treatment of lower calyx stones.Method Visualization puncture combined with flexible ureteroscopy to treat the lower calyx stones was done in our center from January to August 2016 in our hospital.32 cases of patients were enrolled to have a retrospective analysis.There were 18 males and 14 females,aged from 25 to 65 years,with an average age of 43 years.The diameter of stone was 1.0-2.0 cm,with an average of (1.4 ± 0.6) cm.We used general anesthesia and then adjusted the surgery bed to operation side lateral elevation was 30 °-35.Flexible ureteroscopy with 200μm holmium laser was used firstly to break calculi as much as possible.Ultrasound-guided F4.8 visualization puncture system was used to establish F4.8 channel.The power option was 2001μm hohnium laser to crush calculus of the renal calculi to treat the calculus of the distal end of soft lens which still can not be touched by ureteroscopy.Routine nephrostomy tube was not placed.The soft ureter sheath F5 double-J tube,and indwelling balloon catheter were routinely placed.We removed the catheter after 1-2 days and the double J tube after 4 to 6 weeks.Results The flexible ureteroscopy lithotripsy operation time was 8-25 mins in all of the 32 patients.Visualization puncture channels were successfully established in 3-7 mins,and the visualized puncture stone search rate of 100％ (32/32).The success rate of first stage lithotripsy was 93.8％ (30/32).Two cases of lower calyx stones diverticulum diverted to PNCL due to poor visibility by bleeding.The operation time was 30-60 mins and the average of 45 mins.KUB review at day one after the surgery showed that there were residual stones in 5 cases.The stone free rate at one month after the surgery is 100.0％.The average postoperative hospital stay was (2.0 ± 1.5) days.There were uo bleeding,ureteral avulsion and perforation,septic shock,pleural effusion and intestinal injury and other serious complications.Conclusions Navigation ultrasound-guided visualization puncture combined with flexible ureteroscopy is safe and effective to treat lower calyx stones.

Objective To investigate the clinical efficacy and safety of visual standard channel combined with visual ultrafine channel PCNL precision puncture in treatment of complex renal calculi. Methods From June 2015 to October 2016, 48 cases of complicated renal calculi were treated with multi-channel lithotripsy with visual standard channel ultrasonic pneumatic lithotripsy combined with visual superfine channel PCNL precision puncture holmium laser lithotripsy. Including 10 cases of staghorn stone, 38 cases of multiple renal stones. Results 110 channels were established in 48 patients. 4 cases of preoperative renal insufficiency with infection in the puncture found in the pus and stones load larger, intraoperative diarrhea and PCNL simple treatment of obstruction site stones; 44 cases to complete one of the surgery: There were single channel established in every one of 5 cases, and double channels established in every one of 24 cases, three channels in established in every one of 15 cases; There were two cases of surgery in 8 cases and there were 12 new channels established. The average time of unilateral first operation was 75 (35 ~ 125) min. The first clearance rate was 79.2% (38/48), and the total clearance rate of postoperative stone was 87.5% (42/48). 6 cases of residual stone combined with ESWL and drug row of stone, followed up for 3 months, 6 cases of stone row net, the total stone clearance rate of 100.0% (48/48). Two consecutive postoperative no sepsis, bleeding, ureteral injury and other serious complications. Conclusions Visual standard channel combined with visual superfine channel PCNL precise puncture for the treatment of complex renal calculi is safe and effective, with high fruiting rate and low complication, which can be popularized in clinical practice.

Objective To compare the perioperative outcomes of laparoscopic liver resection (LLR) versus open liver resection (OLR) for hepatocellular carcinoma (HCC).Methods A total of 89 HCC patients undergoing liver resection between January 2012 and November 2016 were enrolled.Nonparametric tests were employed to compare the clinicalpathological characters and preoperative outcomes.Results No significant difference was observed in clinicalpathological features and postoperative morbidity.LLR group had shorter hospital stay (Z =4.642,P ＜0.01),lower serum ALT level in 1st,3rd and 5 day (Z =2.157,3.089,2.384,all P ＜0.05) and AST level in 1st-and 3rd-day postoperatively (Z =2.688,2.566,all P ＜0.05).The growth rate in serum total protein (TP) and albumin (ALB) postoperatively is higher for LLR group (y =2.348 4x + 51.696 vs.y =0.902 9 + 35.532),(y =1.539 9x + 29.68 vs.y =0.732 9x + 30.406).Conclusion LLR allows quicker liver function recovery and shortens patients' postoperative hospital stay.

ObjectiveTo evaluate the diagnosis and surgical management of non-palpable breast cancer (NPBC). MethodsDiagnosis, preoperative localization and surgical management of 26 cases of NPBC were analyzed retrospectively.ResultsAll the 26 lesions were found by ultrasound or mammography.Local-extensive excision was performed under preoperative ultrasound-guided or radio-guided wire localization.Of the 26 lesions, 14 were ductal carcinoma in situ (DCIS), 9 were DCIS with micro-invasion and 3 were invasive ductal carcinoma.ConclusionsCombination of ultrasound and mammography improves the discovery rate of NPBC.Local-extensive excision under preoperative ultrasound-guided or radio-guided wire localization of NPBC shortens the duration of surgical procedure, avoids excessive resection of breast tissues and maintains the apperance of the breast.

Objective To compare the estimated CFR (eCFR) values using the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation with those from the abbreviated MDRD equation in a Chinese cohort with chronic kidney disease (CKD) and to analyze the impact of the new CKD-EPI equation on the staging of CKD. Methods A total of 450 Chinese patients (239 female and 211 male) with CKD were enrolled. eCFRs obtained by the CKD-EPI equation and the abbreviated MDRD equation were compared with the Bland and Altaian method. The agreement between two equations in CKD staging was assessed by Kappa test. Results Mean eGFR was 2.4 ml ·(min)-1 ·( 1.73 m2)-1 higher with the CKD-EPI equation as compared to the abbreviated MDRD equation. The percentage of CKD staging concordance between equations for stage 1, 2, 3A, 3B, 4, and 5 was 97.10% (n=67), 80.77% (n=105), 6 0.86% (n= 48), 87.69%(n=57), 90.38% (n=47) and 98.18% (n=54) respectively. Kappa index was 0.913 (95%C/: 0.881-0.945). The CKD-EPI equation reclassified 19.23% (n=25) and 39.24% (n=31) of patients with CKD stage 2 and 3A,upward to a higher eCFR category. Conclusions The new CKD-EPI equation reclassifies a number of patients to higher CKD stages, especially those classified as CKD stage 2 or 3A by the abbreviated MDRD equation.