BACKGROUND:Urothelial cells are important seeding cells for urinary tissue engineering, but they are difficult to proliferate in vitro. Several studies have shown that bone marrow mesenchymal stem cells can differentiate into urothelial cells, but how these cells functions in vivo in epithelium generation after implantation, and the application of these cells in tissue engineering, are rarely studied. OBJECTIVE:To explore the isolation and proliferation of rabbit bone marrow mesenchymal stem cells that are induced into urothelial cells in combination with rabbit bladder acellular matrix to construct tissue-engineered grafts, and to assess the effect of the induced cells as seeding cells. METHODS:Twelve 8-week-old male New Zealand white rabbits were chosen to obtain bone marrow samples through tibia puncture, and to isolate bone marrow mesenchymal stem cells by density gradient centrifugation. Then the fourth or fifth generation of bone marrow mesenchymal stem cells were cultured in conditioned medium for 2 weeks, and then identified by PCR and immunofluorescence. After that, the induced cells were seeded on rabbit bladder acellular matrix to construct tissue-engineered grafts for bladder repairing. Another 12 rabbits served as control group, and urothelial cells combined with bladder acellular matrix was used for bladder repairing. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells were successful y cultured and proliferated in vitro. After induction, PCR detection suggested that stem cellmarker (CD44) expression decreased, and epithelial cellmarker (UP1a) expression increased in the induced cells. Immunofluorescence staining demonstrated that the induced cells rather than bone marrow mesenchymal stem cells were positive for specific urothelial marker, UP1a. A stable continuous epithelial layer was observed on tissue-engineered grafts constructed by induced cells after 2 weeks, similar to the grafts built by urothelial cells. Induced bone marrow mesenchymal stem cells can differentiate into urothelial cells that can be used as seeding cells for urinary tissue engineering, which may be another choice out of urothelial cells.

Objective To explore the relationship between job burnout feeling and sleep quality in psychiatric female medical staff.Methods 100 female medical staff were randomly selected from two mental hospitals in Wenzhou,and the Pittsburgh sleep quality index was used to evaluate and Maslach burnout inventory;and the relation-ship between sleep quality and job burnout was analyzed.Results Female psychiatric and medical personnel to the personality dimension score was (10.84 ±4.75)points,which was higher than Maslach norm (7.12 ±5.22)points;emotion exhaustion scores of (14.44 ±6.38)points,low achievement sense score of (15.07 ±6.89)points,below the Maslach often die emotion exhaustion scores of (22.19 ±9.53)points and low achievement sense scores (36.54 ± 7.34)points.The differences were statistically significant (t =-12.15,7.84,-31.15,all P <0.01).Job burnout and there were significant correlations between sleep quality and the emotional exhaustion and personification and PQSI seven dimensions and the total score was a positive correlation,low sense of achievement and PQSI total score and negatively correlated with seven dimensions.Conclusion Wenzhou psychiatric female medical staff burnout is significantly higher than the general population,there is a correlation between staff burnout and sleep quality,and the more serious burnout,poorer quality of sleep.Improving the quality of sleep of medical staff is one of the ways to relieve job burnout.

ObjectiveTo investigate the therapeutic effect of narrow band ultraviolet B ( NB VUB)and its influence on the expression of IL23/Th17 axis in peripheral blood of patients with Psoriasis vulgaris,and to further explore the mechanism of action of NB UVB.MethodsForty - eight cases of Psoriasis vulgaris were treated with NB-UVB irradiation for 20 times,the therapeutic effect was evaluated by the Psoriasis Area and Severity Index (PASI) scores.Peripheral blood was obtained from normal healthy controls and patients with Psoriasis vulgaris before and after NB-UVB irradiation.Three color flow cytometry was carried out to quantify Thl7 cells,and ELISA was used to examine the levels of serum IL17 and IL23.Results The mean PASI scores were significantly decreased after treatment with NB UVB irradiation[ (8.12±4.05)score vs (3.98±2.03) score,P＜0.01 ].Levels of Th17[ (2.78 ± 1.93)％ vs (0.98±0.56)％ ],IL-17[ (23.85±7.98) pg/ml vs (6.53±4.26) pg/ml] and IL-23 [ (29.73 ± 12.08)pg/ml vs ( 16.73±8.91 )pg/ml] were significantly higher in patients with Psoriasis vulgaris than that in healthy controls ( P ＜0.01 ).After treatment with NB-UVB irradiation,levels of Th17 [ ( 1.13 ± 0.51 ) ％ ],IL-17 [ ( 8.03±5.01 )pg/ml ],and IL-23 [ ( 17.03 ± 9.85 )pg/ml ] were significantly decreased than before ( P ＜ 0.01 ),and were positively correlated with PASI ( P ＜0.05).ConclusionsNB-UVB may affect IL23/IL17 to achieve its therapeutic effect on patients with Psoriasis vulgaris.

BACKGROUND:The main way for long-segmental ureteral reconstruction may cause a lot of traumas and complications. Therefore, to seek a new repair method is urgent. OBJECTIVE:To investigate the feasibility of a tissue-engineered tubular graft for ureteral reconstruction. METHODS:Bone marrow mesenchymal stem cels and smooth muscle cels of rabbits were seeded into the two surfaces of bladder acelular matrix and cultivated for 7 days. Then the graft was used to prepare a 4-cm long tissue-engineered tubular graft, which was regarded as experimental group. Smooth muscle cels seeded onto the bladder acelular matrix was used to construct the tissue-engineered tubular graft as control group. Twenty-five New Zealand rabbits were randomly divided into experimental group (n=20) and control group (n=5), and two kinds of tubular grafts covered with omentum were implanted into the two groups, respectively, for repair of ureteral defects. Hematoxylin-eosin staining and immunohistochemical detection were performed at 2, 4, 8 weeks after implantation. RESULTS AND CONCLUSION:In the experimental group, hematoxylin-eosin staining showed epithelial coverage and muscle fibers on the lumen of tissue-engineered tubular grafts at 8 weeks after implantation; immunohistochemistry showed that anti-AE1/AE3 antibody and anti-uroplakinⅢa antibody were positive, confirming that there were mature epithelial cels on the lumen of tissue-engineered tubular grafts. In the control group, five rabbits were dead within 2 weeks after removal of ureteral scaffold, and autopsy showed scar formation inside the graft and severe hydronephrosis. These results demonstrate that it is feasible to construct the tissue-engineered tubular graft using bone marrow mesenchymal stem cels and smooth muscle cels into the bladder acelular matrix for ureteral reconstruction. Bone marrow mesenchymal stem cels can potentialy promote urothelial regeneration.

Objective To evaluate if the flexible ureteroscopy could treat stones located in lower calyx with the infundibulopelvic angle (IPA) less than 30°.Methods Thirty-six patients with inferior caliceal calculi on whom flexible ureteroscopic procedures were performed between November 2009 and June 2015 were reviewed.The mean age of the patients was 52.1 years (34-71),with the mean stone diameter of (1.5 ± 0.8) cm (1.2-2.6 cm).IPA was smaller than 30° in all 36 cases,which confirmed by CTU examination.IPA was less than 10° in 15 patients,between 11 ° and 20° in 13 patients and between 21 ° and 30° in 8 patients.Results The success rate was 63.9％ (23/36 patients) in patients with IPA smaller than 30° after first session of procedure,and the stone free rate reached 100％ after the second session of procedure.The mean operation duration was (95.5 ± 31.4) min(51-127 min).The mean hospital stay after operation was(4.1 ± 1.2)days (3-5 days).No major complications were recorded and no patients needed to convert to open surgery.Double J tube was removed after 4 weeks postoperatively.Patients were followed up for 4-12 months,during which ultrasound and CT scan were used for stone detection.Conclusions The small IPA (＜30°) negatively affected the SFR in the first session operation.However,its negative effect was solvable by using modern endoscopes.A complete stone clearance was achievable even in case of unfavorable anatomic conditions in experienced hand.

Objective To observe the effect of scalp-body acupuncture plus psychological intervention in treating post-stroke depression.Method Seventy-eight patients with post-stroke depression were divided into a treatment group (40 cases) and a control group (38 cases). In addition to ordinary neurological treatments, the treatment group also received scalp-body acupuncture plus psychological intervention while the control group also received Fluoxetine hydrochloride (Prozac). The interventions were given once a day, 4 weeks as a treatment course, for 2 courses in total. Hamilton Rating Scale for Depression (HAMD) and neurological impairment severity scale (NISS) were observed before intervention, after 1 treatment course and at the end of the intervention.Result After intervention, the HAMD and NISS scores dropped significantly in both groups, and the treatment group was markedly better than the control group (P＜0.05). The total effective rates of anti-depression and recovery of neurological function in the treatment group were significantly higher than those in the control group (P＜0.05).Conclusion Scalp-body acupuncture plus psychological intervention can produce a content efficacy in improving depression and recovering neurological function.

Objective To establish a long-term culture system for mouse spermatogonial stem cells(SSCs). Methods Testis cells from 4-6 days postpartum male transgenic BALB/C mice were collected by a modified two-step enzymatic digestion method.After three differential adherence selections,the enriched germ cells were finally suspended in StemPro-34 SFM medium supplemented with other nutrients factors and plated on mouse embryonic fibroblast(MEF)feeder layer.20 ng/ml Glial cell line-derived neurotrophic factor,10 ng/ml basic fibroblast growth factor and 200 ng/ml GDNF-family receptor al were added to the serum-free medium to promote SSCs proliferation.Aduh male BALB/C mice,4-5 weeks old,underwent intraperitoneal injection of 40 mg/kg busulfan as recipient mice.Cultured SSCs were also injected into the seminiferous tubules of the left recipient testis through micromanipulator and right testis as self-control.Testes of recipient mice were observed by a fluorescence stereomicroscope and HE stains at 2 months after transplantation. Results By improved digestion method,the vitality of isolated testis cells was more than 98%and the stem cells was enriched about 18.5 fold. 1-2 days after transferred to MEF feeder, the round germ cells started to proliferate and had the shape of paired or aligned undifferentiated spermatogonia connected by cytoplasmic bridges. After 3-4 days, SSCs proliferated continuously and formed typical colonies. SSCs from BALB/c mice could be cultured and passaged in a steady state for 3 months. Cryostat section through the transplanted testis showed that most of seminiferous tubules were filled with germ cells expressing EGFP.HE staining further showed clearly that seminiferous tubules contained complete spermatogenesis.Conclusions SSCs from BALB/c mice could be cultured in an improved culture system for 3 months.The culture system could facilitate understanding the regulatory mechanism that governs SSCs and might provide an opportunity for the cure of infertility.

Objective To monitor the renal pelvic pressure and to investigate its clinical significance during retrograde flexible ureteroscopic lithotripsy (RFUL).Methods The data of renal pelvic pressure measured in 60 cases of RFUL with the mean irrigation pump speed and pressure of 30 ml/min and 30 mmHg were analyzed retrospectively.The influence factors of renal pelvic pressure and its correlation with postoperative fever were analyzed.Renal pelvic pressure was measured by baroceptor,which was connected to PHILIP-MP4 monitor IBP channel and ureteric catheter positioned in renal pelvis through a dual channel ureteral access sheath (UAS).The renal pelvic pressure data was collected and analyzed in every 2 seconds by computer.The 60 cases were divided into 3 groups according to their intra-pelvic pressure situations:normal pressure group(NP,IPPmax ≤30 mmHg),high pressure group(HP,IPPmax＞30 mmHg,but high pressure duration≤ 10 min),and backflow pressure group(BP,IPPmax＞30 mmHg and high pressure duration＞ 10 min).Results The baseline intra-pelvic pressure (IPP0) and max imum intra-pelvic pressure (IPPmax) were (13.2±5.6) mmHg and (95.6±2.3) mmHg respectively.IPP levels during the RFUL were significantly higher than the IPP0(P＜0.001).There were 32,17 and 11 cases in NP,HP and BP groups,respectively.There were 6 cases with fever higher than 38.5 ℃ (10％),in which there were 1 case in NP,1 case in HP group and 4 cases in BP group.The postoperative fever rate in NP,HP and BP group were 3％,6％ and 36％ respectively,which were significantly different between groups(P＜0.01).There were 12 cases with procalcitonin ＞0.1 ng/ml and 8 cases with procalcitonin ＞0.5 ng/ml,in which 2 cases in HP group and 6 cases in BP group.Conclusions RFUL would result in a temporal elevated intrapelvic pressure greater than 30 mmHg.Postoperative fever is relevant with renal perfusion pressure and perfusion time.It's necessary for the surgeons to adjust the perfusion pressure during operation.

Timely reporting, effective analyses and rapid distribution of surveillance data can assist in detecting the aberration of disease occurrence and further facilitate a timely response. In China, a new nationwide web-based automated system for outbreak detection and rapid response was developed in 2008. The China Infectious Disease Automated-alert and Response System (CIDARS) was developed by the Chinese Center for Disease Control and Prevention based on the surveillance data from the existing electronic National Notifiable Infectious Diseases Reporting Information System (NIDRIS) started in 2004. NIDRIS greatly improved the timeliness and completeness of data reporting with real time reporting information via the Internet. CIDARS further facilitates the data analysis, aberration detection, signal dissemination, signal response and information communication needed by public health departments across the country. In CIDARS, three aberration detection methods are used to detect the unusual occurrence of 28 notifiable infectious diseases at the county level and to transmit that information either in real-time or on a daily basis. The Internet, computers and mobile phones are used to accomplish rapid signal generation and dissemination, timely reporting and reviewing of the signal response results. CIDARS has been used nationwide since 2008; all Centers for Disease Control and Prevention (CDC) in China at the county, prefecture, provincial and national levels are involved in the system. It assists with early outbreak detection at the local level and prompts reporting of unusual disease occurrences or potential outbreaks to CDCs throughout the country.

Objective To evaluate the safety and efficacy of ultrasound guided flexible ureteroscopic lithotripsy.Methods From January 2015 to December 2016,a randomized clinical trial enlisted 130 patients,presenting symptomatic renal stones with 1.3-2.0 cm,in our center.Patients were randomly assigned to ultrasound or radical guided retrograde intrarenal surgery (RIRS) with flexible ureteroscope.There were 37 male and 28 female patients in ultrasound group.Their mean age,BMI index and stone size were (47.7 ± 21.3) years,(22.1 ± 4.7) kg/m2 and (1.4 ± 0.2) cm,respectively.In radical group,there were 22 male and 43 female patients.Their mean age,BMI index and stone size were (51.3 ± 19.2) years,(21.6 ± 3.3) kg/m2 and (1.6 ± 0.1) cm,respectively.There was no significant difference of those items between ultrasound and radical group.In ultrasound group,the transducer was placed at the dorsal and ventral to visualize the real time image of ipsilateral renal collecting system.The safety wire placing,ureteroscope passing through the uretheral access sheath and the lithotripsy detail could be easily monitored.We compared stone size,operative time,stone-free status and complication rates between the ultrasound and radical group.Results All patients accepted the operation successfully.Operative time was significantly shorter in the ultrasound group than that in radical group.[(62.4 ± 31.7) min vs.(80.4 ± 42.1)min,P ＜0.05].The average radical exposure during was (37.5 ± 25.2)seconds in radical group.Ureteral injury was seen in 20.0％ (13/65),18.5％ (12/65) cases in ultrasound and radical group,respectively.The mucosal injury rate in each group was 92.3％ (12/13) and 83.3％ (10/12) (P ＞ 0.05),respectively.Muscle layer injury was recorded in 1 case of in ultrasound group and 2 cases in radical group.Clavien grade Ⅳ or higher grade complications was not observed in both groups.Fever,pain,nausea or vomiting,persistent hematuria in ultrasound group were 2 cases,3 cases,1 cases and 5 cases.In radical group,those complications were in 2 cases,3 cases,7 cases and 1 cases,respectively.There was no significant difference between the two groups (P ＞ 0.05).The ultrasound group showed no significant difference in the stone-free rate [90.8％ (118/130)vs.89.2％ (116/130)] or the complication rate compared to those in radical group(P ＞ 0.05).Conclusions The retrograde intra-renal lithotripsy guided solely by ultrasound can be carried out in the general population in an effective and safe fashion without ionizing radiation,which has the potential to replace radical guided in flexible ureteroseopy.