Objective To evaluate the application value of ureteroscopy in the diagnosis and treatment of ureteral obstruction.Methods Clinical data of 52 cases of non-calculous ureteral obstruction treated by ureteroscopy were analyzed retrospectively.Results Of 35 cases of ureteral stricture,19 cases of routine dilatation,13 cases of balloon dilatation,and 3 cases of ureteroplasty were accomplished under ureteroscope.Holmium laser resection was employed in 13 cases of ureteral polyps.Conversions to open surgery were required in 3 cases of ureteral cancer,and an ureteroplasty was carried out in 1 case of retrocaval ureter.Complications included 2 cases of ruptured mucous membrane or urethral false passage and 1 case of ureteral perforation.Conclusions Ureteroscopy can clarify the etiology of ureteral obstruction and offer corresponding treatment.

Purpose:In order to explore the feasibility and efficacy of acupoint-injecting method for marrow inhibition caused by chemical medications. Methods: 110 cases of malignant tumors in the phase of marrow inhibition after arterial chemotherapy were treated by puncturing the acupoints, Zusanli (ST 36), Sanyinjiao (SP 6), Xuehai (SP 10) and Qihai (CV 6) plus injection of 5 mg dexamethasone. Results: Acupuncture treatment and acupuncture plus injection of medications can both effectively improve marrow inhibition after chemotherapy, and the therapeutic effect was better in the group by acupuncture plus acupoint-injecting method. Conclusion: Acupuncture can effectively stimulate the acute and short-term marrow inhibition caused by chemical medications, and acupuncture plus acupoint-injecting method can effectively shorten the treatment time and the lower hemogram phase of peripheral blood. The combination of two therapeutic methods can have remarkable cooperative effect and reduce the medical expenses.

Objective To understand the current economical operation of public hospitals in Hubei province and its effect on their public welfare performance. Methods To collect data in field survey and to analyze the current economic situation of such hospitals in the province based on relevant statistics.Results Financial revenue and expenditure of these hospitals keep rising and achieving a balance in general; for the insufficient government financial subsidy, 90% of the revenue of such hospitals come from their medical services and drugs sold; the per capita revenue of these public hospitals maintains a yearly rising trend; their asset-liability ratio was relatively high. Conclusions The public welfare performance of these hospitals tends to be impeded by the reform on the macro economic system and health policy changes, on top of the attraction of economic interests. Improving the government subsidy mechanism for public hospitals and standardizing the financial management mechanism of public hospitals.

BACKGROUND:There are many researches on the finite element analysis of total hip arthroplasty, but the biomechanical distribution after hip surface replacement is little reported.OBJECTIVE: To analyze the biomechanical characteristics after hip surface replacement based on three- dimensional finite element analysis.METHODS: The three-dimensional finite element model after metal-to-metal hip surface replacement was established.The load of 350 N paralleling to the gravity line was loaded on the acetabulum. The stress distribution of the prosthesis and femur and the stress of the different regions of the femoral head were observed.RESULTS AND CONCLUSION: (1) The stress value of the acetabular cup was significantly higher than that of the acetabular body ((0.63± 0.34) vs. (1.89±0.67) MPa, P < 0.05). (2) The stress was concentrated on the femoral neck. The femoral head and femoral neck junction appeared with stress occlusion. The stress around the femoral prosthesis stem was (158.24±28.79) MPa, and the stress value of the femoral prosthesis stem was (186.46±22.37) MPa, showing no significant difference (P > 0.05). (3) The stress value showed significant difference among femoral head regions (P <0.05), and the stress of the regions 6 and 8 was significantly higher than that of the other regions (P < 0.05). (4) These results show that after metal-to-metal hip surface replacement, femoral neck stress is concentrated, the stress of the femoral prosthesis is occluded, and the stress at the medial femoral neck as well as the junction of femoral neck prosthesis and bone is larger.

Objective     To compare the clinical efficacy of subxiphoid video-assisted thoracoscopic surgery (XVATS) and conventional intercostal VATS (CVATS) extended thymectomy for myasthenia gravis (MG). Methods    The clinical data of MG patients who underwent extended thymectomy in the Department of Thoracic Surgery of Xuzhou Central Hospital from October 2016 to October 2021 and finished the follow-up were retrospectively reviewed. They were divided into an XVATS group and a CVATS group according to the procedure. The perioperative variables and clinical efficacy of the two groups were compared. Results    A total of 84 patients were collected, including 43 males and 41 females, with a mean age of 52.3 years. There were 41 patients in the XVATS group and 43 patients in the CVATS group. There was no mortality, cardiopulmonary thrombosis, prolonged air leak, or mediastinal infection. Additionally, the CVATS group recorded 5 (11.6%) patients of conversion to open thoracotomy, 1 (2.3%) patient of postoperative MG crisis, 1 (2.3%) patient of bleeding in thorax, and 1 (2.3%) patient of chylothorax. The operation time (127.4±50.4 min vs. 122.9±38.6 min), intraoperative bleeding [46.9 (25.7, 79.2) mL vs. 45.7 (21.9, 92.1) mL], incidence of complications [0 vs. 7.0% (3/43)], chest tube duration (4.3±1.9 d vs. 4.8±2.8 d), follow-up time (19.1±8.5 months vs. 22.5±13.7 months), the proportion of residual mediastinal fat tissue [12.2% (5/41) vs. 4.7% (2/43)], and total MG remission rate [29.3% (12/41) vs. 51.2% (22/43)] were not statistically different between the two groups (P>0.05). However, the two groups showed  significantly different incidence of conversion to open thoracotomy [0 vs. 11.6% (5/43), P=0.024], postoperative hospital stay time (8.2±3.3 d vs. 11.4±5.8 d, P=0.003) and total drainage volume [396.7 (173.8, 542.5) mL vs. 218.8 (102.1, 430.0) mL, P=0.038]. Conclusion    XVATS extended thymectomy is technically safe and feasible; however, more evidence is warranted before the recommendation of this approach for the treatment of MG.

Objective To observe the effect of advanced oxidation protein products (AOPPs) on articular and synovial in a rabbit model of osteoarthritis (OA).Methods 48 male New Zealand rabbits were randomly divided into 3 groups:AOPPs group,PBS group and sham-operated group.OA model were created in AOPPs group and PBS group by anterior cruciate ligament transection and medial meniscus resection (ACLT+MMx).then intra-articular injection of 1 ml AOPPs or PBS were performed once every other day in AOPPs group and PBS group,respectively.In sham-operated group,the anterior cruciate ligament was just exposed without transection,and then the incision was sutured.All rabbits were saerificed after 4 and 8 weeks of intervention,respectively.Results The India ink seore of 4 and 8 weeks were 4.19±0.60,5.75±0.60 in AOPPs group,and 1.06±0.18,1.38±0.60 in sham-operated group,2.50±0.46、3.06±0.62 in PBS group,respectively.In addition,the differences were statistically significant among the three groups.The Mankin score of 4 and 8 weeks were 8.19±0.70,11.94±0.90 in AOPPs group,and 0.75±0.53,1.06± 0.73 in sham-operated group,4.25± 1.46、4.50±0.89 in PBS group,respectively.The differences were statistically significant among the three groups.Meanwhile,the protein expression level of matrix metalloproteinases (MMP)-3 on synovial at 4 and 8 weeks in AOPPs group were 1.006±0.080,1.098±0.088;0.065±0.006,0.053±0.011 in sham-operated group;and 0.552±0.024,0.839±0.084 in PBS group,respectively.The proteiu expression level of MMP-13 on synovial at 4 and 8 weeks in AOPPs group were 0.966±0.080,1.621 ±0.041;0.101±0.022,0.367±0.033 in sham-operated group;and 0.564±0.030,1.322±0.085 in PBS group,respectively.The differences were statistically significant among the three groups at two times.Conclusion AOPPs participate in the occurrence and development of artieular cartilage by upregulating the protein expression of MMP-3 and MMP-13 on synovial.

Objective To compare the efficacy of elective nodal prophylactic irradiation ( ENI) and involved?field irradiation ( IFI) in radical radiotherapy for early?stage esophageal cancer and to determine the appropriate irradiation range for early?stage esophageal cancer. Methods The clinical data of 121 patients with early?stage esophageal cancer receiving radical radiotherapy in our hospital from January 2006 to December 2011 were collected and respectively analyzed. Sixty?one patients received ENI, and the other 60 patients received IFI. The Kaplan?Meier method was used to calculate local control ( LC) and overall survival ( OS) rates;the log?rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The 1?, 3?, and 5?year LC rates in ENI group and IFI group were 81. 1%, 60. 1%, and 57. 5% vs. 64. 5%, 43. 9%, and 27. 2%, respectively ( P=0. 003 ) . The 1?, 3?, and 5?year OS rates in ENI group and IFI group were 86. 9%, 56. 8%, and 34. 8% vs. 86. 7%, 34. 3%, and 19. 1%, respectively ( P=0. 019) . The 1?, 3?,and 5?year overall failure rates in ENI group and IFI group were 22. 3%, 53. 8%, and 63. 2% vs. 43. 3%, 65. 8%, and 78. 8%, respectively ( P=0. 023) . Multivariate analysis showed that irradiation range was the influencing factor for LC and OS. Conclusions As for the radical radiotherapy for early?stage esophageal cancer, ENI can significantly increase LC and reduce locoregional failure, and therefore improve long?term OS.

Objective To explore the value of elective nodal prophylactic irradiation with intensity modulated radiotherapy(IMRT) for esophageal carcinoma.Screening patients who are suitable for elective nodal prophylactic irradiation (ENI),in order to improve locoregional control and overall survival.Methods The concurrent control study was conducted to esophageal cancer patients who were treated by definitive radiotherapy.A total of 148 patients finished treatment were identified.Seventy-four patients received ENI,while the other seventy-four patients received involved-field irradiation (IFI).Kaplan-Meier method was used for calculation of locoregional control rates and overall survival rates.The univariate and multivariate analysis of prognostic factors were also tested.Results The 1-,3-,and 5-year locoregional control rates of ENI group and IFI group were 72.5％,52.8％,50.6％ and 58.4％,35.8％,21.9％ (x2 =7.881,P ＜0.05),respectively.The 1,3,and 5 years survival rates of the ENI group and IFI group were 74.3％,44.2％,24.5％ and 68.9％,27.6％,15.9％ (x2 =1.903,P ＜ 0.05),respectively.In Cox multivariate analysis,clinical T stage,tumor location,different radiotherapy region were independent factors for the locoregional control of all patients,and clinical T,N stage,the length of esophageal barium meal and chemotherapy were independent factors for the overall survival of all patients.Conclusions Esophageal carcinoma patients treated with ENI could achieve better locoregional control than those treated with IFI.Esophageal carcinoma patients with early stage or middle thoracic lesion could benefit from ENI for local control and overall survival.

Objective To compare the failure pattern between esophageal cancer patients receiving definitive elective nodal irradiation (ENI) and involved-field irradiation (IFI) and to investigate the reasons and influential factors for locoregional recurrence and metastasis.Methods A retrospective analysis was performed on the clinical data of 245 patients with esophageal cancer who received definitive radiotherapy in our hospital from January 2006 to December 2012.One hundred and twenty-six patients received ENI,and the other 119 patients received IFI.Failure patterns were analyzed after treatment.Locoregional failures included local esophageal lesion uncontrol or recurrence and regional lymph node recurrence or metastasis.Distant metastases included distant organ metastasis and distant lymph node metastasis.Comparison of failure pattern between the two therapies was made by chi-square test.Results One hundred and sixty-three patients had failure after treatment.Locoregional failure was observed in 92 patients,distant metastasis in 36 patients,and locoregional failure plus distant metastasis in 35 patients.The 1-,3-,and 5-year overall failure rate for the ENI group were 35.4％,62.5％,and 69.0％,respectively,versus 46.5％,71.5％,and 81.5％ for the IFI group (P =0.036).The 1-,3-,and 5-year locoregional failure rates for the ENI group were 29.9％,48.4％,and 50.0％,respectively,versus 39.6％,62.1％,and 71.4％ for the IFI group (P =0.003).Conclusions For esophageal cancer patients receiving definitive radiotherapy,ENI can significantly reduce locoregional failures and increase locoregional control,thus improving the long-term survival.

Objective To investigate the accuracy for absolute quantification of brain creatine (Cr) concentration using long time echo (TE) point resolved spectroscopy (PRESS) sequence performed with an external standard and postprocessed with the linear combination of model spectra (LCModel).Methods Ten swine (3.1±0.6 kg) and an external standard phantom containing detectable compounds of known concentration were investigated in this study by using 1.5 T GE Signa scanner and a standard head coil. The single-voxel proton magnetic resonance spectroscopy (1H-MRS) data were acquired from the two ROIs (2 cm×2 cm×2 cm) placed in swine brain and external standard solution using PRESS sequence with TE 135 ms,TR 1500 ms,and 128 scan averages.The in vivo quantification of Cr was accomplished by LCModel.After 1H-MRS examination,each animal was sacrificed immediately.In vitro Cr concentration was analyzed by high performance liquid chromatography (HPLC).Results In the 1H-MRS group,the Cr concentration was (9.37±0.14)mmol/kg.In the HPLC group,the Cr concentration was (8.91±0.13)mmol/kg.Good agreement was obtained between these two methods (t=9.038,P=0.491).Conclusion The long echo time PRESS sequence performed with an external standard and processed with LCModel iS proven to be an accurate technique to detect the in vivo brain Cr concentration.