Objective:To investigate the efficacy of modified urethral dilatation in the treatment of female bladder neck obstruction.Methods:The clinical data of 33 female patients with bladder neck obstruction who underwent modified urethral dilatation in the Third People's Hospital of Qingdao from March 2015 to March 2020 were retrospectively analyzed. Before treatment, physical examination, routine urine examination, International Prostate Symptom Score, ultrasound examination, urodynamic examination and cystourethroscopy were performed to confirm the diagnosis. All patients were treated with α-blocker for more than 3 months, but obvious effect was not obtained. Under local anesthesia, they underwent modified urethral dilatation. After 3 months of treatment, International Prostate Symptom Score and urodynamic examination were performed to determine residual urine volume, the maximum urinary flow rate, and detrusor pressure at the maximum urinary flow rate. The curative effects of modified urethral dilatation were evaluated.Results:After modified urethral dilatation, dysuria was obviously alleviated in 25 patients. Eight patients who had no obvious improvement in dysuria were scheduled to undergo transurethral bladder neck incision. International Prostate Symptom Score after treatment was significantly lower than that before treatment [(15.18 ± 6.19) vs. (24.86 ± 7.26), t = 3.782, P < 0.001). Residual urine volume after treatment was significantly smaller than that before treatment [(53.69 ± 48.35) mL vs. (181.45 ± 92.15) mL, t = 15.328, P < 0.001]. The maximum urinary flow rate after treatment was significantly higher than that before treatment [(16.21 ± 4.22) mL/s vs. (7.91 ± 1.69) mL/s], t = 6.358, P < 0.001]. Detrusor pressure at the maximum urinary flow rate after treatment was significantly lower than that before treatment [(27.38 ± 5.13) cmH 2O vs. (57.15 ± 8.43) cmH 2O, t = 9.584, P < 0.001]. Conclusion:Modified urethral dilatation is an effective treatment method of female bladder neck obstruction. It can be used as a supplement for surgical treatment.

Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 64 patients who underwent laparoscopic splenectomy combined with pericardial devascularization at the Second Affiliated Hospital of Kunming Medical University from April 2012 to June 2015 were collected.Observed indexes included (1) treatment outcomes,including surgical procedures,operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal,duration of postoperative hospital stay,occurrence of complications,(2) follow-up situation.The follow-up using reexaminations of blood routine,liver function,coagulation function,gastroscopy and color Doppler ultrasonography of portal vein was performed regularly at postoperative month 1,2,3,6,12,24 until reemergence of gastrointestinal hemorrhage.The final deadline was death of patients and performance of liver transplantation.Measurement data with normal distribution were presented as-x ± s.Results (1) Treatment outcomes:of 64 patients,62 underwent total laparoscopic splenectomy combined with pericardial devascularization successfully.One patient was transffered to hand-assisted laparoscopic splenectomy combined with pericardial devascularization due to uncontrollable hemorrhage.One patient received laparoscopic cholecystectomy firstly with volume of blood loss of about 1 500 mL and terminated surgery after infusion of suspension red blood cells of 6 U and plasma of 900 mL,and underwent laparoscopic splenectomy combined with pericardial devascularization again next week.No postoperative hemorrhage,pancreatic leakage or death occurred during the perioperative period.The operation time,volume of intraoperative blood loss,time of postoperative enteral recovery,time of postoperative drainage tube removal and duration of postoperative hospital stay were (146 ± 33) minutes,(214 ± 31) mL,(24 ± 4) hours,7 days and (14 ± 6) days,respectively.Nine patients had postoperative pleural effusion and recovered after thoracic drainage and thoracentesis.(2) Follow-up situation:All the 64 patients were followed up for an average time of 19.7 months (range,3.0-23.0 months).Reexamination of gastroscopy showed improvement of varicosed veins of lower esophagus and fundus of stomach.During the postoperative 3 months,4 patients had portal vein thrombosis with level of PLT ＞ 700 × 109/L.For patients with D-Dimer ＞ 5,low molecular weight heparin of 0.4 U was injected subcutaneously until D-Dimer ＜ 2.Three patients were loss to follow-up at postoperative month 6 without upper gastrointestinal hemorrhage,hepatic encephalopathy or liver failure.Conclusion Laparoscopic splenectomy combined with pericardial devascularization is safe and effective for portal hypertension,and rigorous perioperative management offers guarantee for surgical safety.

Objective To explore the microsurgical treatment of the fourth ventricular tumors. Methods A total of 29 cases of the fourth ventricular tumors were given microsurgical treatment from January 2000 to June 2003 in this hospital. In 5 cases the tumor was located close to the cortex with the superior vermis involvement and the microsurgical operation was performed through the cerebellar vermis. The remaining 24 cases underwent microsurgical resection of tumor through the cerebellomedullary fissure approach. Results A total resection was achieved in 23 cases, and a subtotal resection in 6 cases. Postoperative complications included 2 cases of hemorrhage of the upper digestive tract, 1 case of mutism, 1 case of hematoma of the fourth ventricular, 1 case of epidural hematoma remote from surgical site, and 1 case of irregular breath. Follow-up surveys in 19 cases for 3~12 months (mean, 5.5 months) revealed no tumor recurrence. Conclusions Preoperative proper differentiating characters of tumors, clarifying the position of tumors' basal part, selecting appropriate surgical approach, and understanding microanatomy of the fourth ventricular are the key to successfully complete the procedure.

Recombinase polymerase amplification (RPA) is a novel isothermal DNA amplification technology first re-ported in 2006 by Piepenburg et al.This technology has been shown to typically work at temperatures ranging from 25 to 43℃and can detect products within 5-20 min.RPA technology requires little instrumentation for the nucleic acid amplifi-cation reaction and can be performed not only in PCR tubes , but also in simple devices′such as paper .Combined with probe-based detection methods or lateral flow dipstick assay , it can perform quantitative or visual detection respectively . RPA is a technology that is potentially ideal for point-of-care diagnosis and disease prevention and control ,characterized by high sensitivity, high efficiency, high specificity and user-friendliness.This paper introduces the advantages and develop-ment of RPA technology in reaction conditions and product detection ,summarizes the current applications of this technolo-gy,and predicts the trend of application of RPA technology in point-of-care diagnosis and disease prevention and control .

Objective To study the expression and significance of galanin (GLA) in the prostate carcinoma (PCa).Methods The samples from 50 patients with benign prostatic hyperplasia (BPH) and 50 patients with PCa and 30 PCa patients with bone metastasis were examined by immunohistochemical staining.Results The positive rates of GLA expression in BPH,PCa,and PCa with bone metastasis were 18 ％ (9/50),68 ％ (34/50),and 80 ％ (24/30),respectively,and there were statistically significant differences between PCa patients,PCa patients with bone metastasis and BPH patients (x2 =25.5,29.74,both P ＜ 0.01),but there was no significant difference between PCa patients and PCa patients with bone metastasis (x2 =1.35,P ＞ 0.05).Conclusion GLA has higher expression in prostatic cancer cells,it might be an important indicators for differentiating prostate cancer from benign prostatic hyperplasia and predicting the prognosis of prostate carcinoma.

ction of immune tolerance of T cells to allergens.

The paper analyzed legally the following predicaments of legitimization of rural doctors in China:no legitimacy protection for their practice,vague criteria for practicing medicine,conflicts between legal regulations for medical practice and rural realities,and lack of a liability insurance system.The authors,based on an exploration of the legislative framework for rural doctors,made four corresponding legislative proposals as follows:to clearly define the legal scope and identity of rural doctors,to establish a qualification and employment system for rural doctors,to develop practicing norms applicable for rural doctors,and to set standards for their income.

Objective To investigate the prenatal diagnosis and prognosis of fetuses with mild ventriculomegaly in order to provide evidence for clinical consultation and treatment.Methods The data of 116 mothers with fetal ventriculomegaly who received prenatal care in Peking University First Hospital between January 1,2013 and May 31,2015 were retrospectively analyzed.All cases of fetal ventriculomegaly were found by ultrasound screening,and were subsequently diagnosed by ultrasound consultation as mild ventriculomegaly.The results of fetal cerebral MRI and invasive prenatal diagnosis were analyzed and the growth and development of babies were followed up by telephone using the Gesell developmental scale.All data was analyzed by descriptive statistics.Results Of the 88 cases of solitary ventriculomegaly,48 (54.5％) received karyotype analysis or screening,and only one case was found to be abnormal,which was an unbalanced translocation.Of the 83 mothers with normal delivery,only one infant (1.2％) showed retardation of intelligence and motor development.Of the 28 cases of non-solitary ventriculomegaly,17 (60.7％) received karyotype analysis or screening,and no abnormalities were found.Of the 18 mothers with normal delivery,only one infant showed retardation of growth and development,and was found to have brain hypoplasia before delivery by MRI with normal karyotype.Conclusions The rate of abnormal karyotype in mild vetriculomegaly is very low in this study.The width of the lateral ventricles is stable during pregnancy and the prognosis of infants is good.Thus,whether invasive prenatal diagnosis is necessary for all the fetuses with isolated mild ventriculomegaly remains to be confirmed.

Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P ＜ 0.05).Postoperative incision infection rate in observation group was 5.4％,lower than the control group (19.07％) (chi-square =22.12,P ＜ 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.

Objective To evaluate the effect of the setup error on the dosimetric verification for the nasopharyngeal carcinoma patients and cervical carcinoma patients treated with volumetric modulated are therapy (VMAT).Methods VMAT plans for 10 cervical cancer patients and 10 nasopharyngeal carcinoma patients were transplanted into the Delta4 phantom and calculate the dose,next,implement the treatment on the Varian iX linear accelerator.on the Varian iX linear accelerator.To simulate the setup error by moving the treatment couch in,out,up,down,left,right by 3 mm,5 mm,7 mm.Thereby study the effect of the setup error on the pass rate of the dose verification.Results The results for the dose distribution using the gamma evaluation method showed that the pass rate (3％/3 mm) was less than 90％ when the setup error were greater than 3 mm and 5 mm for the nasopharyngeal carcinoma patients and the cervical carcinoma patients.The pass rate of head direction were (64.7 ± 8.2) ％ and (63.3 ± 3.6) ％ on setup error of 5 mm and 7 mm for nasopharyngeal carcinoma patients and cervical carcinoma patients,respectively.Conclusions Setup error has great effect on the dose verification of the VMAT plans,the greater of the setup error,the lower of the pass rate.The setup error of head direction is more sensitive than other directions especially.