Objective To retrospec the efficacy of percutaneous nephrolithotomy on treatment of urinary tract stones in solitary kidney.Methods From June 2008 to April 2011,percutaneous nephrolithotomy technique was used to treat 20 cases of urinary tract stones,with kidney stone or cast form staghorn calculi in 4 cases,single pelvis,calyceal stones 10 cases,6 cases of upper ureteral calculi;Fourteen cases used the standard channel F24;6 cases used F16 Micro Channel.Among the 20 patients,16 cases performed stage Ⅰ single channel surgery;2 cases performed dual-channel surgery in Ⅰ stage;2 patients with severe infection performed stage Ⅱ single channel surgery.Results The average duration of the operation was 66mins.The stone clearance rate was 88.36％ on average(18/20),without laceration or bleeding of pelvis or renal calyces mucosa or any other complications.Postoperative indwelling nephrostomy tubes were removed 6 -7 days later,without complications found during the follow-up period.For the 6 cases with preoperative renal dysfunction before surgery,the levels of blood Cr decreased at 2 weeks after surgery.Conclusion Compared to open surgery,percutaneous nephrolithotomy is safe and effective with small wound in treatment of solitary kidney with invasive upper urinary tract calculi.

Objective To investigate the causes of postoperative severe infection and other complications of percutaneous nephrolithotomy,and to study the principles of prevention and treatment.Methods Five hundred and sixty three cases of patients underwent percutaneous nephrolithotomy from September 2008 to December 2011 in our hospital,after operation,22 patients were found with serious infection.Data of these 22 cases were analyzed retrospectively according to the causes of the infection,corresponding prevention and treatment.Results The occurrence rate of severe postoperative infection was 3.9％ ( 22/563 ) in this group.The condition of 21 patients improved through adjusting antibiotics and taking other necessary measures in time;the condition of 1 case of septic shock patient was under control by giving anti-infective and anti-shock treatment measures.Conclusion Percutaneous nephrolithotomy is a safe and effective minimally invasive surgery,with a certain incidence of postoperative infection which should be timely and effectively controlled.

Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Cardiotonic Agents ; therapeutic use ; Child ; Diuretics ; therapeutic use ; Heart Failure ; drug therapy ; etiology ; surgery ; therapy ; Heart Transplantation ; methods ; Heart-Assist Devices ; Humans ; Pediatrics ; Treatment Outcome

Histone deacetylase 3 (HDAC3) is an epigenetic modification enzyme that plays a crucial role in the development and progression of diabetes and its complications. Studies have reported that increased HDAC3 activity is associated with pancreatic β-cell dysfunction in type 1 diabetes, while in type 2 diabetes, HDAC3 affects insulin resistance and signaling by regulating the metabolism of the liver, adipose tissue, and muscle. Additionally, HDAC3 plays a key role in diabetic complications such as cardiomyopathy, retinopathy, and nephropathy. Selective inhibition of HDAC3 has the potential to improve insulin sensitivity, reduce chronic inflammation, and enhance pancreatic cell function, offering a promising new therapeutic strategy for diabetes and its complications.

Objective Acute bilirubin encephalopathy in neonates is the most serious complication of neonatal hyperbilirubinemia, is one of the main causes of neonatal death and disability. Clinical early diagnosis, early treatment can improve the prognosis in children. Methods Brainstem auditory evoked potential (BAEF) was detected on two patients (40 patients with ABE, 40 cases of normal controls, all full-term) in the state of sleep in children and analysis the difference between the two groups ,all testing was completed by experienced Department of ENT full-time technician in charge,SPSS15.0 statistical analysis software was took for data analysis (using rank sum test method). Results There was significant difference between the two groups of neonatal latency of wave I, latency of waveⅤ, interpeak time , acute bilirubinⅠ-Ⅴencephalopathy group was significantly longer than that of the control group. Conclusions The BAEF detection is the sensitive index of brainstem damage , can objectively and sensitively reflect the function of the central nervous system , can reflect the functional status of cochlear and brainstem structures , often brainstem was slightly damaged but no clinical symptoms and signs , BAEP has changed significantly , so the conventional BAEP examination performed on patients with hyperbilirubinemia help to find bilirubin brain damage as early as possible,and prevent the occurrence of bilirubin encephalopathy.

A 66-year-old man was admitted for a 7-day history of painful blisters and erosions in the upper lip.Real-time PCR with herpes simplex virus (HSV) type-specific primers showed that the blister fluid and crusts were positive for HSV-1,but negative for HSV-2.Observation of the blister wall with transmission electron microscopy (TEM) revealed 3 types of nucleocapsid in the karyoplast of epithelia cells,including the electron-translucent core,granular core and electron-dense core.Numerous matured viral particles with envelope were found in the cytoplasm,which were identified as HSV.The diagnosis was made as herpes simplex in the upper lip based on the above findings.PCR based molecular typing combined with observation of HSV particles via TEM may be an effective approach to the definite diagnosis of primary herpes simplex.

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Objective Determine the common syndrome elements of viral hepatitis.Methods Refering to the syndrome elements hypothesis proposed by Zhang Zhibin,syndrome elements from the collection of 19,341 cases of Viral Hepatitis were extracted which were diagnosed by National Science and Technology Major Project of AIDS and Viral Hepatitis and Other Major Infectious Diseases Prevention and Control.And the results were compared with industry standards.Results There were 27 involved syndrome elements of viral hepatitis.Common syndrome elements were Qi stagnation,internal dampness,internal fire,blood stasis,yin deficiency,Qi deficiency,toxin,pathogenic water,and yang deficiency; The main excessive syndromes were Qi stagnation,internal dampness,internal fire,and blood stasis.The main deficiency syndromes were yin deficiency and Qi deficiency.Conclusion Excessive syndromes were the main syndromes of viral hepatitis.Dampness,heat,blood stasis,and toxin played key roles in the development of viral hepatitis.In addition to this,Qi stagnation,pathogenic water and phlegm were also important syndrome elements.

Objective Following the prognosis of patients with myasthenia gravis(MG) who received both immunosuppressants and thymectomy, to determine whether the sequence and timing of treatment have influences on outcomes of MG and also to select significant predictors of prognosis.Methods It was a retrospective study which reviewed 105 patients with MG who underwent thymectomy and immunosuppressants between Januay, 2000 and December, 2013.All patients were divided into two subgroups based on their order of treatment.Thirty two patients were called as immunosuppressants-first group, and 73 patients were called as thymectomy-first group.The ratios of ideal status of two groups were compared with use of the ChiSquare test.Predictors of ideal status were analyzed by logistic regression.Results (1) After 1 year, 2 years and 5 years of intervention, the proportion of ideal status was significantly higher in the thymectomy-first group than that in the immunosuppressants-first group[(33％-50％) vs.(10％-20％), P ＜0.05].For oMG patients, after 1 year, 2 years and 5 years of treatment, thymectomy-first group had a higher ideal status rates than immunosuppressants-first group[(25％-50％) vs.(11％-18％)].But no significant difference was noted in the rates of ideal status at each follow-up time point.(2)Multivariate logistic regression analysis showed that sequence of treatment (OR =0.154, 95 ％ CI: 0.046-0.518, P =0.002) and symptom-thymectomy interval(OR =0.903,95 ％ CI: 0.835-0.976, P =0.010) were the significant predictors of ideal status.Conclusion Thymectomy prior to immunosuppressants is associated with relatively good prognosis.It is suggested that patients with gMG, or adult patients with oMG who are resistant to drug, will be better to undergo thymecotomy as early as possible.