Objective To compare the safety and efficacy between RevoLix 2 μ m continuous-wave (CW) laser resection of bladder tumor and transurethral resection of bladder tumor (TURBT) in patients with non-muscle-invasive bladder tumor, and to evaluate clinical value of 2 μ m CW laser resection for nonmuscle-invasive bladder tumor. Methods 62 patients with non-muscle-invasive bladder tumor were divided into 2 groups including 2 μ m CW laser resection group (32 cases) and TURBT group (30 cases) according to the random number table.The intravesical instillation of pirarubicin was performed regularly. The operative time,drop in hemoglobin,indwelling catheterization time,and operative complications were analyzed.Results All cases were completed successfully. The mean operative times of 2 μm CW laser resection group and TURBT group were 32.5±10.5 min and 31.3± 9.8 min, respectively, and no statistical difference could be found between both groups (t =0.364,P=0.674).3 cases were found to have obturator nerve reflex in TURBT group,but no obturator nerve reflex was found in 2 μn CW laser resection group.Bladder irrigation time of 2 μm laser resection group was statistically shorter than that of TURBT group [ (6.2±2.6)h vs (23.8±6.5)h,t =8.294,P=0.006]. There was also no significant difference in postoperative catheterization time between both groups [(4.2±1.5)d vs (5.2±1.8)d,t=1.468,P=0.103 ]. Postoperative hospitalization time of the two groups was not shown significant difference [ (5.3± 1.5) d vs (5.8±2.8) d,t =0.627,P =0.531 ].All cases were followed up for 6～18 months,and there were no significant difference in the recurrence rate between both groups (x2=0.481,P =0.562). Conclusion 2 μm CW laser resection is a novel excellent treatment for non-muscle-invasive bladder tumor and has the similar effect as TURBT with the advantage of significantly less blood loss and rapid recovery after surgery.

Objective To measure the level of circulating endothelial progenitor cell (EPC) and serum vascular endothelial growth factor (VEGF), and to investigate its clinical significance in patients with different stages of renal cell carcinoma (RCC). Methods The level of circulating EPC was quantified by assaying CD45-CD34+VEGFR-R2 +cell phenotype in 45 patients with RCC (RCC group), 30 patients with benign renal tumors(benign renal tumors group) and 30 healthy controls (control group). Serum VEGF was quantified by enzyme- linked immunosorbent assay (ELISA). The results were compared. Results The level of EPC in RCC groups was (0.265 ± 0.042)%, in benign renal tumors group was(0.053 ± 0.008)% , and in control group was (0.048 ± 0.006)%. The level of EPC in RCC group was significantly higher than that in benign renal tumors group and control group (P<0.05). The level of EPC in Ⅲ- Ⅳ stage patients was significantly higher than that in Ⅰ-Ⅱ stage patients:(0.312 ± 0.038)%vs. (0.215 ± 0.021)%, P<0.05. Three months after operation, the level of EPC in 33 RCC patients without pretreatment was (0.078 ± 0.003)% and significantly lower that before treatment (P<0.05). The level of VEGF in RCC groups was (305.5 ± 29.1) ng/L, in benign renal tumors group was (29.8 ± 3.2) ng/L, and in control group was (25.1 ± 2.8) ng/L. The level of VEGF in RCC group was significantly higher than that in benign renal tumors group and control group (P<0.05). The level of VEGF inⅢ-Ⅳstage patients was significantly higher than that inⅠ-Ⅱstage patients:(365.6 ± 34.6) ng/L vs. (256.2 ± 23.2) ng/L, P<0.05. Pearson association analysis showed that the level of EPC had positive associations with VEGF (r=0.714, P<0.01). Multiple linear regression showed that the size of kidney neoplasms was a dependent factor for the level of EPC. Conclusions The level of EPC has a positive association with VEGF. EPC maybe a new biomarker for RCC.

Objective To evaluate the impact of 120 W 2 μ m continuous-wave laser vapoenucleation versus and transurethral resection of the prostate (TURP) in patients with symptomatic benign prostatic hyperplasia (BPH) on sexual function.Methods One hundred and twenty-two patients with BPH were selected,63 cases were treated with 120 W 2 μ m continuous-wave laser vapoenucleation versus(2 μ m laser group),59 cases were treated with TURP(TURP group).International index of erectile function(IIEF) scores and self-made general assessment questions were completed before and 12 months after treatment to determine the impact on sexual function.IIEF scores included erectile function (EF),sexual desire,orgasm,sexual satisfaction and overall satisfaction.Results The IIEF scores difference was no significant before treatment between two groups (P ＞ 0.05).In two groups,there was no significant difference in EF,sexual desire,sexual satisfaction and overall satisfaction score between before treatment and 12 months after treatment(P＞ 0.05),orgasm score 12 months after treatment was significantly lower than that before treatment [2 μm laser group:(5.9 ± 1.5) scores vs.(8.6 ± 2.7) scores;TURP group:(5.5 ± 1.6) scores vs.(8.7 ± 1.8) scores] (P ＜0.05).Multiple linear regression analysis showed that two groups EF score and the international prostate symptom score,quality of life score and Q.~ positive linear correlation.Logistic regression analysis showed that the incidence of retrograde ejaculation and orgasm reduced significantly assoeiated(P ＜ 0.05),as an independent predictor of orgasm reduced after treatment(P ＜ 0.05).Conclusions There is no difference between these two surgical techniques regarding to impact on sex function.No significant EF improvement after surgery in both groups,but these two techniques can significantly decrease the IIEF orgasmic function domain and this is mainly caused by retrograde ejaculation.

Adrenal tuberculosis is still the main cause of primary adrenal insufficiency (Addison Disease) in China. A case of bilateral adrenal tuberculosis without PAI symptoms was admitted to Department of Urology, Shanxi Provincial People’s Hospital. Pathological report showed adrenal tuberculosis. We present an overview and discuss how to diagnose early adrenal tuberculosis and reduce misdiagnosis rate so as to preserve residual adrenal function to the greatest extent.

Objective To observe the effect of saikosaponin-d on transcriptional activation of estrogen receptor in rat hepatic stellate cells(HSC-T6), and to explore its pharmacological mechanism. Methods The rat HSC-T6 were cultured in vitro for the study. After transient transfection of HSC-T6 with the ER-specific reporter gene ERE-tk-Luc by liposome, the effect of saikosaponin-d and estradiol on luciferase activity was observed by Dual-Luciferase Reporter Assay System under the conditions of various drug concentrations, various treatment time and addition of estrogen receptor inhibitor ICI182. 780. Results When the concentrations of saikosaponin-d and estradiol were in the range of 0.01-5 μmol/L, 0.01-1 μmol/L respectively, luciferase activity was increased in a dose-dependent manner . Luciferase activity arrived the highest when saikosaponin-d concentration was 5 μmol/L and estradiol concentration was 1 μmol/L, but the effect was weakening when estradiol concentration reached 5μmol/L. In respect of the effect of treatment time, when HSC-T6 were separately treated with 5μmol/L of saikosaponin-d and 1 μmol/L of estradiol for 24 h, the luciferase activity was the highest. And ICI182.780 could significantly inhibit the induction of saikosaponin-d and estradiol for luciferase activity. Conclusion Saikosaponin-d has an effect on promoting the transcriptional activation of estrogen receptor in HSC-T6.

Objective To investigate methods and results of endovascular treatment in TASC (Ⅱ) D-type femoral artery occlusion. Methods From January 2012 to May 2013, 26 cases (26 branches) of superficial femoral artery occlusion with endovascular treatment of TASC (Ⅱ) D-type superficial femoral artery occlusion were retrospectively reviewed. The effi-cacy was evaluated through ABI, CTA, DSA and symptoms improved. Results 26 branches were treated with endovascular methods. Technical success rate was 80.7%(21/26), including 13 branche with stent implantation, 6 branches with Silver-hawk atherectomy and 2 branches with Viabahn stent implantation. All patients were followed up for a mean period of (10.3 ± 1.2)months, primary patency rates at 6 months were 69.2%in stent group, 66.7%in Silverhawk atherectomy group and 100%in Viabahn stent group. Conclusion Endovascular treatment of TASC (Ⅱ) D-type femoral artery occlusion can lead to satisfactory short term patency rates, and Viabahn stent is the latest treatment.

Objective To compare the effect and safety of stenting versus directional atherectomy (DA) in the treatment of TASCⅡ A and B superficial femoral artery lesions.Methods 100 patients with TASC Ⅱ A and B lesions were divided into percutaneous transluminal stenting(PTS) group (n =50) and DA group (n =50).Patients were compared in terms of technical success rate,treatment success rate,first operation cost,postoperative ankle brachial index (ABI),limb salvage rate,survival,and patency.Results The technical success rate in both PTS and DA group was 100％.The treatment success rate was 98％ vs.86％,P＞0.05.Postoperative ABI:0.82 ±0.19 vs.0.80 ±0.27,P＞0.05.First operation cost:(34 820 ± 1 051) yuan vs.(45 635 ± 1 358) yuan,P ＜0.001;All patients were followed-up for up to 2-year,the cumulative patency rate was 81.6％ vs.72.9％ (P＞0.05).Limb salvage rate was 97.9％ vs.93.8 ％,P ＞ 0.05.Conclusion There were no significant differences in the effect and safety of PTS versus DA in the treatment of TASCⅡ A and B superficial femoral artery lesions.

Objective To monitor the quality of intravenous infusions in a constructed closed-loop tracking system,and to discuss its application effect.Methods The information program is reinvested in a team for the closed-loop tracking system of the intravenous infusion.There are modules of processing medical orders,pharmacy preparations,execution procedures with the doctor's orders,as well as the computing module.The system was put into clinical trial operation in November 2021 and officially applied in January 2022.Specifically,the number of infusion-related adverse events/red-light alert is recorded and compared before(January to December 2021)and after(January to December 2022)the application of the system.Random sampling method has been performed in a ward to investigate the amount of abnormal infusion for the comparison.Results It is shown that it occurred 3 times for the infusion-related adverse events before the operation of the system,and a time after that.In the neurological inpatients,we observe the amount of red-light alert as 5,120.25±775.82 before the system operation,and 1,518.25±74.77 after that.It is shown to decline by 70.35％on average with statistical significance on the total difference(P＜0.001).Monthly amount of infusion in the ward is 5,184 with 155 times of overfast(2.99％)for 775 minutes in total,and with 207 times of slow(3.99％)for 1,035 minutes in total.The average handling time per contact is 5 minutes.Conclusion The closed-loop tracking system for intravenous infusion quality monitoring can track and record the whole process of intravenous infusions.It is expected to provide accurate and objective data for closed-loop quality inspection on clinical nursing practice,which is conducive to nursing managers for any potential problems during infusion processing timely,to promote standardized nursing operations,and to further improve the safety of inpatients with intravenous infusion and medication.

Objective To establish an animal model of postmortem redistribution of amantadine,and to study its postmortem redistribution in rats,so as to provide experimental evidence for forensic identification.Methods One hundred and twenty-six male SD rats were randomly divided into 3 groups and subjected to intragastric administration according to the maximum dose of treatment(L),LD50(M)and 2LD50(H).Those who did not die were killed according to the average time of death of LD50.Heart-blood,peripheral blood,heart,liver,spleen,lung,kidney,brain,muscle and testis were collected at 0 h,6 h,12 h,24 h,48 h,72 h and 96 h after death,and amantadine content was detected.Results For the rats in the L group,the concentration of amantadine decreased within 6 h after death and then increased in the heart-blood,heart and liver,unchanged within 48 h and reached the peak at 96 h in the spleen,kidney,brain,muscle and testis,while decreased in the lung.For the rats in the M group,the concentration of amantadine decreased within 24 h after death and then increased in all samples,and it reached the peak at 48 h after death in the peripheral blood,spleen,kidney and muscle tissues,at 72 h after death in the heart-blood and testis,and at 96 h after death in the liver,lung and brain tissues.For the rats in the H group,the concentration of amantadine showed a downward trend within 12 h after death in the heart and liver tissue,showed a downward trend within 48 h after death in the lung,brain and muscle tissue,and reached the peak at 96 h after death in the heart,liver,spleen,muscle and testicle tissues.Conclusion The postmortem redistribution was found in amantadine poisoning dead rats,which could provide experimental evidence for the forensic identification of death cases caused by amantadine poisoning.

Objective To investigate the efficacy and safety of intravesical instillation of BCG vaccine in the prevention of early recurrence of middle and high risk non-muscle invasive bladder cancer.Methods From July 2015,patients with non-muscle invasive bladder cancer aged 18-75 years with informed consent were screened and underwent transurethral resection of bladder tumor (TURBT).Immediately intravesical instillation of epirubicin 50 mg was given postoperatively.After pathology was comfirmed,patients was enrolled in group 1 (BCG15) or group 2 (BCG 19) or the control group (epirubicin 18) randomly with SAS 9.3 software.Data of follow-up and Adverse event was collected and analyzed.Results By May 31,2019,531 patients were enrolled in the study.The drop-off rate was 20.1％.167 patients (143 males and 24 females)in group 1,172 patients (141 males and 31 females)in group2 and 84(75 males and 9 females) in the control group with follow-up data were analyzed.There were no significant differences in age,gender,BMI,ECOG score,risk stratification between the three groups (P =0.8641,P =0.2906,P =0.9384,P =0.6126).The median follow-up time makes no statistical difference between the groups (P =0.9251),12.0 (6.0,22.5) months,13.0 (6.0,22.3) months,and 13.0 (7.0,22.3) months.The median recurrence time of the three groups was 4.0 (3.0,6.0) months,4.5 (3.0,9.8) months,4.5 (3.0,8.8) months.There was no statistical difference between the three groups (P =0.2852).Risk stratification in the patients got no significant difference between the three groups (P ＞ 0.05).The 1-year recurrence-free survival rates were 80.0％ in the group 1 and 88.3％ in the group 2 and 73.7％ in the control group.The group 2 was superior to the group 1 and the control group (P =0.0281,P =0.0031).There was no significant difference between group 1 and control group (P =0.2951).There was no significant difference in the cumulative recurrence-free survival between the experimental group 1 and the experimental group 2,(95％ CI 0.80-2.43,P =0.2433).The cumulative recurrence-free survival in the group 1 and the group 2 was better than the control group (95 ％ CI 0.31-0.92,P =0.0266;95 ％ CI 0.20-0.65,P =0.0008).All the cases underwent instillation were analyzed for adverse events.The incidence of overall AE(adverse events) in group 1 was 68.5％ (152/222),the incidence of grade Ⅰ-Ⅱ AE was 53.2％ (118/222),the incidence of grade Ⅲ-Ⅳ AE was 15.3％ (32/222).The incidence of overall AE in the group 2 was 71.8％ (160/223),the incidence of grade Ⅰ-Ⅱ AE was 60.1％ (134/223),and the incidence of grade Ⅲ-Ⅳ AE was 11.7％ (26/223).The overall AE rate in the control group was 53.2％ (59/111),of which the incidence of grade Ⅰ-Ⅱ AE was 42.4％ (47/111),and the incidence of grade Ⅲ-Ⅳ AE was 10.8％ (12/111).There was no difference in the incidence of overall AE between the group 1 and the group 2 (P =0.4497).The incidence of AE in the two experimental groups was higher than that in the control group (P =0.0062,P =0.0008).There was no difference in the incidence of grade Ⅲ-Ⅳ AE between the three groups (P =0.3902).Conclusions BCG(19 instillation schedule) has a better effect on preventing recurrence after 1 year of bladder surgery,which is superior to epirubicin group.The long-term efficacy of BCG in preventing recurrence and the efficacy of different schedules need to be further followed up.The lower urinary tract symptoms,which are mainly urinary frequency,are one of the causes of case fallout and should be fouced in future.Compared with epirubicin,BCG perfusion does not increase the incidence of grade Ⅲ-Ⅳ adverse reactions,and is safe to use.