Objective To analyze the falling events using root cause analysis (RCA) in hospitalized elderly patients in order to supply theoretic reference for precaution of falling events.Methods RCA method was used to analyze the root cause against 62 cases of nursing adverse events of hospitalized elderly patients' falling.Results Hospitalized elderly patients' falling is related to various factors such as body,disease,medicine,psychology,environment and so on.The root cause lied in the elderly' physical function decline,risk factors of external environment,unfulfilled health education,and lack of the care and support system for the elderly,among which cerebral infarction belonging to the disease factors accounted for 22.58％ (14/62),which was the highest;next was senile dementia [20.97％ (13/62)].The rates of agents against psychiatric disorders belonging to the medicine factors and no braking of bed pulley and no use of blister light belonging to environmental factors were the lowest,all were 3.23％ (2/62).Conclusions The falling reason of elderly inpatients can be found out by RCA in order to attain the purpose of improving procedure and prevention in advance.

Objective To analyze the relationship between bladder trabeculation degrees and the urodynamic findings in patients with benign prostatic hyperplasia (BPH). Methods A total of 358 patients with BPH were included.Based upon the urethrocystoscopy, the bladder trabeculation degree was divided into 4 grades:Grade 0-no bladder trabeculation;Grade 1-mild to moderate;Grade 2-severe;Grade 3-severe with formation of pseudo-diverticula.We analyzed the relationship between the bladder trabeculation found by fiber urethrocystoscopy and the urodynamic findings such as maximum flow rate (Qmax),P Qmax.Watte factor,compliance and residual urine volume.For statistical analysis AVOVA (analysis of variance) and Spearman correlation were used. Results In the 358 cases,the bladder trabeculation degrees were as follows:Grade 0,21 cases;Grade 1,228 cases;Grade 2,82 cases and Grade 3,27 cases.A significant correlation was found between bladder trabeculation and the urodynamic findings.As the degree of bladder trabeculation increased,Qmax decreased (Grades 0 to 3:11.50?1.13,10.28? 2.29,9.80?0.98,7.36?1.37 ml/s,respectively;F=22.43,P

Objective To investigate the influence of treatment with milkvetch root and red sage root injections on changes in blood viscosity and renal function in patients with early diabetic nephropathy(EDN).Methods 160 patients with EDN were randomly divided into two groups.The control group (n=80) was treated with conventional therapy for diabetes,and the treatment group (n=80) was treated with milkvetch root injection combined with red sage root injection based on conventional therapy for 4 weeks.Results After the above-mentioned therapy the parameters of blood viscosity were significantly decreased(P

Objective To investigate and compare the effects of minimally invasive percutaneous nephrolithotomy for renal upper calyceal stones with approaches through upper edge of the 1 lth rib and lower edge of the 11th fib.Methods Two hundred and sixteen cases of kidney stones in our hospital from July 2008 to July 2010 were reviewed.Of which 66 patients were renal calyceal stones.Thirty-two patients underwent the approach through upper edge of the 11th rib (group A),with 15 males and 17 females,with a mean age of 42 years.Ten cases with stone were located on the left side,right 21 cases,and bilateral 1 case,with calculi average maximum diameter of 1.9 cm.Thirty-four cases underwent the approach through lower edge of the 11th path (B group),with 14 males and 20 females,with a mean age of 44 years.Thirteen cases with stone were located on the left side,right 21 cases,with calculi average maximum diameter of 1.7 cm.The two groups underwent minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy lithotomy.The average puncture time,one-time success rate of puncture and disposable stone-free rate were compared.Results Puncture time of group A was 3.0-14.0 min,with an average of 5.8 min,and group B was 3.0-17.0 min with an average of 6.4 min.The disposable puncture success rate of the two groups was 100％.Disposable stone-free rate was 100％ in group A (32/32),and 88％ in group B (30/34) (P ＜ 0.05).There were no pneumothorax,hemothorax,abdominal viscera injury in two groups.Conclusions The minimally invasive percutaneous nephrolithotomy through the approach of upper edge of the llth fib was better than through the approach of conventional lower edge of 11 subcostal margin,with shorter percutaneous renal access distance,and higher stone-free rate.

Objective To compare the different expression patterns of survivin and caspase-3 between the larger part and the smaller part of the dissymmetric enlarged prostates in BPH patients, and to clarify the role of apoptosis in BPH etiology. Methods BPH tissues from 25 patients were embedded in paraffin. The specimens constituted of two prostate parts from each patient. One part was from the larger enlarged gland and the other was from the smaller enlarged counterpart. 50 paraf-fin blocks were cut into sections and stained with survivin and caspase-3 polyclonal antibodies against human. All the data was analyzed by SPSS13.0 software. Results Survivin immunoreactivity was localized in prostatic cell nuclei. Survivin expression in larger enlarged parts (22.08±16. 33)0% was significantly higher than the smaller parts (7. 645±5. 45)%(P<0.01). Positive nuclear or cytoplasm staining was also observed in the Caspase-3 immunoreactivity. Caspase-3 expression was higher in smaller enlarged parts (51. 525±27. 27%) than in larger enlarged parts (33. 125±21.01%) (P< 0.01). Survivin expression in larger part of the enlarged prostates was inversely correlated with caspase-3 expression (r=-0. 474, P<0. 05). However, in smaller part of the enlarged prostates, the expression of the two factors had no relation (r=-0. 313,P>0. 05). Conclusions Survivin and caspase-3 expression patterns are different in the two parts of the dissymmetric enlarged prostates. These different patterns indicate apoptosis playing an important role in BPH development.

Objective To evaluate the feasibility and effectiveness of full-size three-dimensional individual printed model (3D-IPM) for improving the patient's understanding of laparoscopic partial nephrectomy (LPN) preoperatively.Methods Between June 2015 and June 2016,37 patients with cT1 renal tumors underwent retroperitoneal LPN.The 3D individual digital models (3D-IDMs) were created using 3D medical image reconstructing and guiding system (3D-MIRGS) and the full-size 3D-IPMs were fabricated correspondingly.For each patient and his/her closest accompanying immediate family member (CAIFM),two preoperative conversations with a single surgeon were held by using patient's CT films,the entity of 3D-IPM combined with 3D-IDM demonstration separately.The preoperative levels of comprehension to the renal anatomy,mass characteristics,the upcoming PN procedure,potential complication risks and postoperative prognosis were evaluated using a self-made scoring questionnaire in the patient and CAIFM groups.Results All the fabrications of full-size 3D-IPMs were technically successful.Both in patient and CAIFM groups,the total preoperative comprehending score (total-PCS) elevated significantly by presenting 3D-IPM combined with 3D-IDM demonstration than CT films (42.7 vs.31.5 in patient group,P ＜ 0.05;44.6 vs.33.1 in CAIFM group,P ＜ 0.05).Sub-PCSs in all 5 aspects also showed a uniformed climbing pattern with the assistance of 3D-IPM combined with 3D-IDM demonstration rather than CT films.Conclusion The application of 3D-IPM combined with 3D-IDM demonstration can improve the preoperative comprehension of the patient and CAIFM to LPN with more intuitionistic and verisimilar presentation.

Objective To evaluate the effect of auxiliary trocar located on various positions on obese patients treated with retroperitoneoscopic radical nephrectomy.MethodsRetrospective analysis was performed for 61 consecutive obese patients who underwent retroperitoneoscopic radical nephrectomy for localized renal cell carcinoma at our institution from March 2004 to December 2010.An auxiliary trocar was placed into retroperitoneal space according to the position of tumor.It was placed infro-costal magin in the mid-axillary line with uppre-median pole tumor,and 4 cm medial to mid-axillary line and 1 cm cephalad to illac spine with lower-median pole,respectively.ResultsAll 61 patients were completed successfully with no conversion to open surgery.Mean operating time was ( 153.1 ± 23.5 ) min.Mean estimated blood loss was (57.6 ±29.7) ml.Mean hospital stay after operation was (5.7 ±2.6) d.The rupture of peritoneum and liquefaction of fat were occurred in 5 and 4 patients respectively.There was no major intraoperative and postoperative complications occurred.Conclusions Reasonable position of the auxiliary trocar according to the tumor's location would be safe and feasible on obese patients treated with retroperitoneoscopic radical nephrectomy.Obese patients with localized renal cell carcinoma would better benefit from minimally invasive procedure.

Objective To study the expression of NF-κB and COX-2 protein in renal cell carcinoma, and to investigate the clinical value of it in the occurrence, progression and metastasis of renal cell carcinoma as well as the prognosis of patients. Methods 48 cases of renal cell carcinoma tissues and 5 cases of normal renal tissues were detected by using immunohistochemical method, and following up the patients who were included in the study. Then we analyzed the relationship between NF-κB and COX-2 protein level and clinic pathological parameters as well as the prognosis of patients. Resalts The expression of NF-κB and COX-2 protein were increasing in renal cell carcinoma, the protein levels were significantly different compared with that in normal renal tissues(P <0.05). There were significantly positive correlation between the expression of NF-κB protein and the clinic stages of renal cell earcinoma(P <0.05), but no correlation between the expression of COX-2 protein and them(P >0.05). There were significantly negative correlation between the expression of COX-2 protein and the pathological grades of renal cell careinoma(P <0.05), but no correlation between the expression of NF-κB protein and them (P>O.05). The survival rate of these patients whose expression of NF-κB protein were positive was significantly lower than those of negative expression of NF-κB protein(P <0.05), and there was opposite result for COX-2, but not significanfly(P >0.05). The expression of NF-κB and COX-2 protein in renal cell carcinoma had no significant correlation (P >0.05). Conclusion There may be relationship between the expression of NF-κB and COX-2 protein and the occurrence, progression of renal cell carcinoma, the expression of NF-κB may also have association with metastasis of renal cell carcinoma as well as the prognosis of patients. Detecting the expression of NF-κB and COX-2 protein may be useful in early diagnosis of renal cell carcinoma as well as prognosis evaluation of patients.

Objective To explore the imaging characteristics and clinical value of multispectral cystoscopy.Methods From May 2011 to May 2013,31 male and 4 female patients were included in this study,including benign prostatic hyperplasia in 14 patients,bladder tumor in 16 patients,upper urinary tract disease alone in 5 patients.The mean age in this group was 56 years (range 43 to 84 years).All patients accepted the bladder CT scan for diagnosis.TURBT procedure and pathological examination were performed in those patients with bladder tumor.Under the epidural anesthesia,the 27 F resectoscope was inserted to bladder through the urethra.Then,the conventional light source was replaced by multispectral endoscope light source.The white light,UV-light (401.0 nm),blue light (467.6 nm),green light (534.2nm),red light (660.6 nm),and near-infrared light (763.8 nm) were used,subseqently.Meanwhile,the following data were recorded,such as the visibility of bladder cavity,the color of bladder tumors and bladder mucosa,the density of blood vessels,three-dimensional structure of blood vessels,the mobility between mucosa and submucosa.Results When UV-light and near-infrared light irradiated bladders,there were not any imaging on monitor.However,the bladder mucosa and submucosa blood vessels were showed clearly and constituted the three-dimensional blood vessel network when using green light.The density of blood vessels in mucosal and submucosal layer was increased but less clarity when using blue light.The mucosal surface was covered in red when using red light,which vascular and mucosal can not able to be distinguished.Among 16 patients who were accepted the TURBT procedure,seven cases with T1 stage tumors were resected to the submucosa by TURBT.The superficial muscle layer with integrity structure could be observed under white light.While,blood vessels were not appeared when using green light.In six cases with Ta stage tumors,the clear connection of blood spots between mucous blood vessels and the blood vessel from the tumor could be observed under the green-light conditions.In three patients with Tis stage tumors,the mucosal blood vessels were normal under the white-light after tumor resection.However,structural disorder could be found under the green-light,which should be highly suspected as Tis stage tumors.Conclusions Without any photosensitizer or fluorescent dye,tumor blood vessels and bladder mucosal vascular can be showed under the green light.This technique is useful for identify the minimal tumor and evaluate the carcinoma infiltrated depth.

Objective To explore the feasibilities and clinical applications for sharing the medical resources and recycles by applying digital medicine technology and making the most of medical CT films from other hospitals.Methods Based on scanning data of medical CT films from other hospitals,which were in 85 cases of undergo retroperitoneal laparoscopic surgery,the 3D models were reconstructed in the computer,then were verified and navigated during operations.Meanwhile,coincidence rates were compaired between group A (slice thickness =5 mm) and group B (slice thickness ＞5 mm) in 53 cases whose renal pedicle blood vessels were exposed during the operations.Results All the 85 procedures were successfully completed.The 3D models,which could be observed freely,were consistent with intraoperative screenshots and participated in intraoperative guidance.Coincidence rates were 82.4％ (28/34) in group A and 52.6％(10/19) in group B (x2 =5.306,P =0.021).Conclusions Based on medical CT films of 5 mm slice thickness,the 3D models which are verified to have some accuration and fineness can be successfully reconstructed.The method not only can effectively avoid unnecessary repeated inspection,but also directly render in 3D form to participate in preoperative planning and intraoperative guidance.