Thulium fiber laser is a novel laser of good potential in lithotripsy, which gained the attention of urology society in recent years. This article aimed to discuss Thulium fiber laser referring to lithotripsy mechanism, ablation efficiency, laser safety, clinical application and so on. Thulium fiber laser shares a similarity of lithotripsy mechanism with Holmium laser, whereas Thulium fiber laser has a higher ablation rate, thinner fragments, and smaller retropulsion compared to Holmium laser. Thulium laser may bring revolution in the field of laser lithotripsy.

Obstructive sleep disordered breathing (USDB) is a common diseases which caused by upper airway(UA) occlusion, muscle tone problems and collapse of upper airway etc. The article introduces how to select surgical treatment protocol. First, it is necessary of PSG and upper airway evaluation. Then, it is key to master surgical indications. For the children with hypertrophy of tonsillectomy or adenoidectomy, it may first step of tonsillectomy or adenoidectomy, they needed followed up by orthodontic doctor or orthognathic surgeon for tooth and maxillomandibular malformation. For the adult OSDB patients, there are two method, soft tissue reduction/mass excision around UA or maxillomandibular advancement(MMA), and MMA is recommended to the patients such as failure from UPPP and other surgical treatment, but for severe obesity patients, bariatric surgery is commended, it is very effective for soft tissue reduction around UA and weigh loss. For the OSDB patients with craniaomaxillomandibular deformities, such as craniosynostosis syndrome/micrognathia. Finally, it is important of the UA management for the surgical patients around perioperative period. All in all, it is necessary of the multidisciplinary cooperation for the OSDB patients, surgical treatment is useful method but it is not commend to all OSDB patients.
Adenoidectomy ; Adult ; Child ; Humans ; Hypertrophy ; Maxillofacial Abnormalities ; complications ; Sleep Apnea, Obstructive ; diagnosis ; etiology ; surgery ; Tonsillectomy

AIM　The purpose is to study the influences on serum insulin and glucose by different fasting time in alloxan (ALX)-induced diabetic mice. METHODS　Normal mice of serum glucose were determined at different fasting time. According to different fasting time (0 h, 6 h, 12 h, 18 h and 24 h), mice were divided into 5 diabetic experimental model (DEM) groups induced by ip ALX 200 mg/kg and 1 control group. Serum glucose (SG) and body weight were determined at experimental d0, d3, d8 and d13 and serum insulin concentration (SIC) at experimental d13. The death rate and succeeding rate were also observed during experimental time. RESULTS　Along with prolonged fasting time, SG、death rate and succeeding rate were increased in DEM mice, SG of normal mice, and SIC and body weight of DEM mice were decreased. Results showed that the optimal fasting time of ALX-induced diabetic mice was 12～18 h a lower death rate and impairment to pancreatic islets. Fasting 18h diabetic mice had higher succeeding since during this time rate、lower death rate and longer hyperglycemia time. CONCLUSION　This study indicated SG of mice in vivo had a protective effect against impairment action of pancreatic islets by ALX.

Objective To evaluate the possibility and safety of balloon kyphoplasty for the aged osteoporotic thoracolumbar burst fractures. Methods From October 2007 to December 2012, 78 patients with aged osteoporotic thoracolumbar burst fractures were treated by balloon kyphoplasty. The inflatable balloon was inserted through pedicle of vertebal arch to make fracture reduction, then the centrum was stuffed with bone cement. The whole procedure was pinpointed and detected by C-arm x-ray machine. Results All operations were completed successfully. The lumbar and back pain of the patients relieved obviously. The quality of patients' life was significantly improved. Imaging examinations revealed that the vertebrae altitude was recovered and the kyphosis was corrected obviously. Conclusion Balloon kyphoplasty is effective to treat the aged osteoporotic thoracolumbar burst fractures. But the operation had certain risk, we must do a good job in preoperative preparation, strictly handle surgical indication and accurately operate.

Objective To investigate the effects of hippocampal neurogenesis in spatial learning and memory,especially in spatial long-term memory.Methods Totally 24 wistar rats were randomly divided into two groups:normal control group (NC group,n =12) and irradiation group (IRR group,n =12).We use low-dose irradiation at subgranular zone to inhibit adult hippocampal neurogenesis and new neurons were investigated by 5-Bromo-2-deoxyUridine/neuron specific nuclear protein double-labeling.Four weeks after irradiation,Morris water maze,including navigation test and space exploration assay,was used to detect spatial leaming and memory.Then,in the day 8 and day 15 after the navigation test,space exploration assay was repeated to detect spatial long-term memory.The expression levels of postsynaptic density protein 95 and synaptophysin were evaluated using western blot and real-time quantitative PCR.Results Hippocampal neurogenesis was inhibited by low dose irradiation(2.80 ± 0.44 vs 23.50 ± 1.12,t =20.21,P ＜ 0.01).After the inhibition,the escape latency did not change,while the time spent in target quadrant was significantly declined in the day 2((14.76 ±.2.04) s vs (20.47 ± 1.29) s),day 8((11.95 ± 1.34) s vs (19.52±1.43) s)and day 15((11.79 ±1.35) s vs (21.58 ±1.07) s) after the navigation test (t=2.45,P＜0.05; t =3.76,P＜0.01; t =5.39,P＜0.01).The postsynaptic density protein 95 and synaptophysin expressions were significantly decreased in IRR group.As to the RNA levels,there was also a significant difference between the two groups.Conclusion Hippocampal neurogenesis in the dentate gyrus plays an important role for the formation of spatial long-term memory.

Objective To review the ophthalmic features of granulomatosis with polyangiitis (GPA).Methods Clinical data of 164 GPA patients diagnosed in Peking Union Medical College Hospital during the past 10 years were retrospectively reviewed.Results Among 164 patients,48 (29.3％) had ocular involvement with a male to female ratio of 1.4:1 and an average age of (45 ± 15) years.Nine patients (5.5％) were first diagnosed at the ophthalmology department.Scleritis (15.9％,26/164),orbit lesions (13.4％,22/164) and peripheral corneal ulcer (9.1％,15/164) were the three most common ophthalmic complications.Twenty-two patients (13.4％) had positive findings in the orbit imaging.Six patients (3.7％,6/164) lost their vision due to GPA.Conclusion The ocular manifestations of GPA are diverse and complicated.GPA may affect every component of the eye,sclera,orbit and cornea are the most frequently affected sites of the eye.

To investigate the effects of different fluid resuscitation on renal function and glycocalyx in septic shock rats. The septic shock SD rats (induced by lipopolysaccharide) were randomly divided into control group, normal saline resuscitation group, Lactate Ringer′s solution resuscitation group and succinyl gelatin resuscitation group ( n=6 each). The mean arterial pressure, heart rate, serum creatinine (Scr), urea nitrogen (BUN), renal blood flow, renal tissue pathology, serum interleukin-6, tumor necrosis factor α and glycocalyx were measured at baseline, the development of septic shock, 0 hour and 8 hours after resuscitation. When shock was established, the renal blood flow significantly decreased ( P<0.05) and recovered to normal at 0 hour and 8 hours after resuscitation. Compared with normal saline group and succinyl gelatin group, the levels of Scr, BUN and glycocalyx components (heparan sulfate, syndecan-1) were significant lower in Lactate Ringer′s solution group ( P<0.05). The pathology of kidney tissue suggested that the microscopic ischemic damage with Lactate Ringer′s solution were minor than the other two groups. Compared with normal saline and succinyl gelatin, Lactate Ringer′s solution can reduce the damage of renal function and glycocalyx in septic shock rats.

BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods.
OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques.
METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group.
RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P<0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P>0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.

Objective To investigate the effect of midazolam on inflammatory response in patients with moderate and severe craniocerebral injury and its protective effect on the brain and mechanism.Methods A prospective study was conducted.One hundred and twenty patients with moderate and severe craniocerebral injury admitted to the Intensive Care Unit (ICU) of Jiangsu Subei Peoples' Hospital from April 2013 to July 2016 were enrolled,and they were divided into a conventional treatment group (58 cases) and a midazolam group (62 cases) according to the random number table method.Both groups were given conventional western medicine treatment,and in cases with surgical indications,operations were performed;in midazolam group,additionally intravenous injection of midazolam 2-3 mg was given firstly,and then continuous intravenous infusion of the drug 0.05-0.10 mg· kg-1· h-1 was applied by a pump,and in operative patients,the above management was given 3 hours after operation.The mean arterial pressure (MAP),heart rate (HR),Riker sedation agitation score (SAS) and electroencephalogram bispectral index (BIS) were measured before and after treatment for 24,48 and 72 hours,respectively.The levels of interleukin-6 (IL-6) and soluble nerve chemotactic protein (sFkn) in plasm and cerebrospinal fluid (CSF) were measured by double antibody sandwich enzyme linked immunosorbent assay (ELISA) at each time point;the incidence of epilepsy and 28-day mortality were recorded.Results Before and after treatment,the MAP and HR in the two groups of patients were stable,the difference being not statistically significant (both P ＞ 0.05).Compared with those before treatment,after treatment the SAS score and BIS in two groups of patients were gradually decreased,and at 72 hours reached the lowest levels (SAS score:conventional treatment group was 3.8 ± 1.0 vs.5.7 ± 2.0,midazolam group was 3.6 ± 0.9 vs.5.8 ± 1.7;BIS:conventional treatment group was 69± 12 vs.82± 12,midazolam group was 72± 15 vs.82± 12,all P ＜ 0.05),but there were no significant differences between the two groups (all P ＞ 0.05),suggesting that the two groups had achieved the desired goal of sedation.ELISA results showed:compared with those before treatment,after treatment for 24 hours,the CSF IL-6,sFkn and plasm sFkn levels were temporarily increased in short term,and then showed a tendency of gradually decreasing,and the plasm IL-6 presented persistently descending in the conventional treatment group,while in the midazolam group,since 24 hours after treatment,each index showed a trend of decrease and continued to 72 hours.After treatment at each time point,the CSF and plasm levels of IL-6 and sFkn were significantly lower in midazolam group than those of the conventional treatment group,and reached to the minimal levels at 72 hours [CSF:IL-6 (ng/L) was 251.6 ± 145.7 vs.347.3 ± 146.4,sFkn (ng/L):289.7 ± 79.3 vs.423.6 ± 132.8;plasm:IL-6 (ng/L) was 54.4± 27.3 vs.85.6 ± 41.8,SFkn (ng/L):919.9±426.3 vs.1 199.4 ± 414.8,all P ＜ 0.05].The incidence of epilepsy in the midazolam group was obviously lower than that in the conventional treatment group [1.61％ (1/62) vs.10.34％ (6/58),P ＜ 0.05],but there was no significant difference between midazolam group and the conventional treatment group in the 28-day mortality [11.29％ (7/62) vs.10.34％ (6/58),P ＞ 0.05].Conclusion Midazolam can reduce the incidence of epilepsy in patients with moderate and severe traumatic brain injury,and its brain protective effect may be related to the decrease of CSF and plasm IL-6 and sFkn levels.

The combined use of chemometrics and chemiluminescence（CL）measurements,with the aid of the stopped-flow mixing technique,developed a simple time-resolved CL method for the simultaneous determination of captopril（CPL）and hydrochlorothiazide（HCT）.The stopped-flow technique in a continuous-flow system was employed in this work in order to emphasize the kinetic differences between the two analytes in cerium（IV）-rhodamine 6G CL system.After the flow was stopped,an initial rise of CL signal was observed for HCT standards,while a direct decay of CL signal was obtained for CPL standards.The mixed CL signal was monitored and recorded on the whole process of continuous-flow/stopped-flow,and the obtained data were processed by the chemometric approach of artificial neural network.The relative prediction error（RPE）of CPL and HCT was 5.9% and 8.7%,respectively.The recoveries of CPL and HCT in tablets were found to fall in the range between 95% and 106%.The proposed method was successfully applied to the simultaneous determination of CPL and HCT in a compound pharmaceutical formulation.