Refractory ulcer is a commonly seen disease clinically. We believe the therapeutic strategies for refractory ulcer should include changing life style, standardizing medication, tracing observation, and rechecking in regularity. Traditional Chinese medicine combined with western medicine can be used for the treatment. When the therapeutic effect is not good, diagnosis and therapeutic methods need to be re-judged.Local therapy and operation can be performed if necessary.

The cloning and identification of frc gene from Oxalobacter formigenes in the intestines of Chinese people were conducted. The genomic DNA of Oxalobacter formigenes was extracted. frc gene fragment was amplified by polymerase chain reaction (PCR) and linked with pEGFP-C1. The recombinant plasmid was designated pEGFP-frc and was identified by restriction-enzyme digestion and sequencing. Human embryo kidney 293 cells were transfected with pEGFP-frc, then RT-PCR and Western blotting were performed to detect the expression of frc gene. The length of frc gene was found to be 1287 bp, and the homology of nucleotides and amino-acid residue with the sequence in GenBank was 95.88% and 99.07%. Bright green fluorescent light could be observed in 293 cells transfected with the pEGFP-frc. frc mRNA and fusion protein FCoAT-EGFP were detected in the cells. It is concluded that frc gene cloned from the Oxalobacter formigenes in the intestines of Chinese people can be expressed in eucaryotic 293 cells and keep its enzyme activity.

Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser litho-tripsy on the treatment for upper ureteral calculi of solitary kiden. Methods There were 26 cases of upper ureteral calculi of solitary kidney, including 12 cases of left ureter calculi and 14 cases of right ureter calculi. The diameter of the calculi ranged from 0. 6~2. 2 cm, averagely (1. 38 ± 0. 22) cm. F6 double-J tubes were indwelled postoperatively for 4 weeks, and catheters were indwelled postoperatively for one week. Examine with KUB one day after operation to evaluate the effective rate. Results The Ureteral guiding sheath were successfully implanted in 23 cases, 2 cases underwent second lithotripsy after indwelling D-J tubes 2 weeks later, D-J tubes failed to be implanted only in one case, which has changed to percutaneous nephrolithotomy (PCNL) for ureter stricture. The stone free rates was 88. 5%(23/26)after the first ses-sion,and it was 100%(26/26)at the end of the session. The operation time was 15~45 min, meanly (27 ± 3. 2) min. One patient had ureter perforation during the operation, and one patient had severe infection after operation. Conclusion The modular flexible ureteroscopy com-bined with Holmium laser lithotripsy is an effective and safe treatment, especially for upper ureteral calculi of solitary kideny, and it should be considered as the first choice for solitary kidney calculi.

OBJECTIVE:To investigate the characteristics of pediatric drug-induced liver injury (DILI) in China,and to provide reference for reducing ADR.METHODS:Using"liver injury liver damage hepatotoxicity hepatitis liver disease""drug induced children" as keywords,related domestic literatures were retrieved from CNKI and Wanfang database during 2007-2016,clinical information of DILI children in literatures were recorded in detail and analyzed comprehensively.RESULTS:A total of 363 literatures were retrieved,including 13 effective literatures and 665 children in total.There were 424 boys (63.76％)and 241 girls (36.24％),with ratio of 1.76 ∶ 1.The youngest child was 1 month old,the oldest child was 14 years old;the average age was 7.87 years,337 children aged more then 7 years old,accounting for 50.68％.Top 3 primary diseases were respiratory tract infection (40 cases,31.50％),hematologic diseases (29 cases,22.83％) and tumor (14 cases,11.02％).Top 3 pediatric DILI-inducing drug types were antibiotics (245 cases,34.41％),TCM (143 cases,20.08％) and antipyretic analgesics (113 cases,15.87％).DILI usually happened within 4 weeks (332 cases,82.18％).The most common clinical classification was hepatocellular type (382 cases,65.30％).The severity of liver injury was mainly mild and moderate (505 cases,86.32％),and 80 cases were severe (13.68％),including 31 cases of hepatic failure (5.30％).Clinical symptoms mainly manifested as anorexia,jaundice,nausea,vomiting,hypodynamia and abdominal discomfort.After drug withdreawd and treatment,96.54％ of the patients were recovered or cured,and 4 cases died (0.60％).CONCLUSIONS:Under the premise of rational use of drugs,it is necessary to carry out medication education and supervision for antibiotics,TCM and antipyretic analgesics which mainly induce pediatric DILI,pay attention to allergic history and evaluate the progress of extrahepatic symptoms.When ADR occurred,the timely and drug withdrawal intervention are conducted to improve good prognosis.

Objective:To analysis the construction of the world's top PhaseⅠclinical trial registration agencies, compare their size, composition, operation and funding, to provide further reference for the construction of clinical trial agency in China.Methods:Search for PhaseⅠclinical trial research agencies by region on clinicaltrials.gov. Collecting information about the agency’s management, staffing, implementation in Asia, America and Europe. Descriptive analysis was carried out to explore the type, proportion and operation among different regions, the organizational structure, operational management and effectiveness of each agency from different regions were compared.Results:The United States, Europe and East Asia are dense areas of PhaseⅠclinical research around the world. The types of agencies in the United States, Britain, France, Germany, South Korea, Japan, and Israel are mainly enterprises. Among other types of agencies, the organizational models are diversified. The agencies have different spatial distances from medical institutions, but possess relatively consistent scale and institutional operation. All the agencies have a stable source of funding.Conclusions:In order to strengthen the construction of clinical trial agencies in China, we should speed up the establishment of a close connection mechanism to promote deep cooperation in clinical trials. Control the construction scale and maintain stable input of the agency. Meanwhile, establish and strengthen international exchanges and cooperation.

Objective To observe the influence of ratio of endoscope-sheath diameter on renal pelvic pressure during PCNL.Methods The model of 24 isolated adult porcine kidneys were used to imitate percutaneous nephrolithotomy from September 2016 to June 2017.Each tract was established (F12,F14 and F16).Three kinds of endoscopes (F8 all-seeing needle percutaneous nephroscope,F6/7.5 and F8/ 9.8 rigid ureteroscope),input a 200μm laser,were adopted.There were 8 combinations,and 3 kidneys were used for each one.Renal pelvic pressure was measured 3 times repeatedly in every combination with steady irrigation (50,100,150,200,250,300,350,400,450,500 cmH2O).Results The linear equations,ratios of endoscope-sheath diameter and highest renal pelvic pressures for each combination were:F8-F12,Pr =0.026 P0-1.533,0.67,12.2 ± 0.54;F6/7.5-F 12,Pr =0.112 P0-5.001,0.92,51.2 ± 0.93;F8-F 14,Pr =0.010P0 + 1.067,0.58,6.2 ± 0.48;F6/7.5-F14,Pr =0.020P0 + 1.000,0.79,10.8 ± 0.46;F8/9.8-F14,Pr =0.144P0 +20.933,0.87,84.7 ± 1.17;F8-F16,Pr =0.005P0 + 1.067,0.50,2.8 ±0.34;F6/7.5-F16,Pr =0.009P0 + 0.533,0.68,5.1 ± 0.32;F8/9.8-F16,Pr =0.020P0 + 2.200,0.75,12.6 ± 0.56.The combinations of F6/7.5-F12 and F8/9.8-F14 might lead to a high renal pelvic pressure without proper irrigation (＜401.7 cmH2O for F6/7.5-F12;＜ 132.4 cmH2O for F8/9.8-F14).Conclusion In order to keep a safe pressure,a proper ratio of endoscope-sheath diameter (＜ 0.80) and appropriate irrigation must be considered.

The cloning and identification of frc gene from Oxalobacter formigenes in the intestines of Chinese people were conducted. The genomic DNA of Oxalobacter formigenes was extracted. frc gene fragment was amplified by polymerase chain reaction (PCR) and linked with pEGFP-C1. The recombinant plasmid was designated pEGFP-frc and was identified by restriction-enzyme digestion and sequencing. Human embryo kidney 293 cells were transfected with pEGFP-frc, then RT-PCR and Western blotting were performed to detect the expression offrc gene. The length of frc gene was found to be 1287 bp, and the homology of nucleotides and amino-acid residue with the sequence in GenBank was 95.88% and 99.07%. Bright green fluorescent light could be observed in 293 cells transfected with the pEGFP-frc. frc mRNA and fusion protein FCoAT-EGFP were detected in the cells. It is concluded that frc gene cloned from the Oxalobacterformigenes in the intestines of Chinese people can be expressed in eucaryotic 293 cells and keep its enzyme activity.

Objective To analyse the differential metabolites and related metabolic pathways in stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome by serum metabolomics.Methods This study observed 60 patients with stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome and 60 healthy volunteers in the same period.Liquid chromatography-mass spectrometry(LC-MS)was performed on the serum metabonomics.The differential metabolites were identified by multivariate statistical analysis of the original spectrogram and original data,and enrichment analysis of KEGG metabolic pathway was analyzed.Results A total of 60 patients in the group of stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome participated in the study,and a total of 60 healthy volunteers in the control group participated in the study.There was no statistical difference in general information and biochemical indicators between the two groups(P>0.05);Eighteen differential metabolites were found respectively,including phenylacetaldehyde,orthophosphate,guanosine,diethyl phosphate,2-dehydro-d-gluconate,guanine and 5-(2-hydroxyethyl)-4-methylthiazole down-regulated expression,taurocholate,2-propylglutaric acid,8-amino-7-oxononanoate,l-tyrosine,s-sulfo-l-cysteine,cyclohexanecarboxylic acid,porphobilinogen,(r)-acetoin,octanoylglucuronide,melatonin and solanine up-regulated expression,involving phenylalanine metabolism,thiamine metabolism,purine metabolism.Conclusion The differential metabolites reveal the metabolic essence of stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndrome from the micro level,and can provide clues for clinical early warning of patients with stable angina pectoris of coronary artery heart disease with spleen deficiency and phlegm turbidity syndromet.

Objective To discuss primary experience the clinical use of "All-seeing needle set" combined with Holmium laser to treat the single renal stone lesser than 2 cm in diameter through a super minimal tract (F12).Methods From January 2015 to December 2016,43 patients were enrolled into this retrospective study.There were 23 males and 20 females who were diagnosed as single renal stone less than 2 cm in diameter(age range from 23-65 years).There were 8 upper pole renal stones,13 lower pole renal stones and 22 renal pelvis stones.The mean stone size was (1.63 ± 0.32) cm in diameter (range from 1.2 cm to 2.0 cm)."All-seeing needle system" was applied during percutaneous puncture.After building a F12 minimal tract by fascia dilator,all patients received lithotripsy with Holmium laser.Indwelling catheters for 3 days and an F6 double-J tube was left for 2 weeks without a tube in the percutaneous tract after operation.Finally,KUB and/or urinary CT were used to check the results on day 1.Result All operations were completed successfully.The operation time was 23-65min [averaged (31.0 ±9.2) min].41 cases' renal stones were store free,and the 2 stone residues was clear with later extracorporeal shock wave lithotripsy.No severe complications occurred.Conclusion As an alternative to standard procedures for treatment of renal stones less than 2 cm in diameter,adopting "All-seeing needle set" with Holmium laser through a super minimal tract (F12) is safe,minimally invasive,fast and effective with a low complication rate.

Objective: To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP. Methods: Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment). Results: All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86, P<0.001). Conclusions Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.