Objective To explore the advantages and disadvantages between the RapidArc plans and fixed-field IMRT plan (IMRT).Methods Ten cases of cervical cancer,aged 55 (36-70),who were to receive post-operative radiotherapy were selected randomly.Single arc (Arc 1),two arcs (Arc 2),and three arc (Arc 3) RapidArc plans and fixed-field IMRT plan were designed respectively in the Eclipse 8.6 planning system.The designing,treatment time,target area,and dose distribution of organs at risk by these 4 planning techniques were compared.Results The values of average planned treatment time by the Arc 1,Arc 2,and Arc 3 ten cases was 98,155,185,and 46 min,respectively.The values of average treatment time in the Varian IX accelerator were 2.15,3.32,4.48,and 6.95 min,respectively.The average mean doses were (48.99±1.08),(49.40±0.51) ,(49.51±0.62) ,and (48.65±0.92) Gy,respectively.The values of homogeneity index (HI) of target were 1.11±0.07,1.07±0.02,1.06±0.02,and 1.12±0.05,respectively.The values of eonformal index (CI) of target were 0.73±0.13,0.87±0.06,0.87±0.06,and 0.79±0.06,respectively.The doses at rectum,bladder,and small intestine calculated by IMRT plan were the lowest,and the doses at the femoral neck calculated by these 4 plans were similar.Conclusions The RapidArc plan is superior in dose distribution at target,HI,CI,and treatment time to IMRT,but IMRT plan is superior to RapidArc in planned dose calculation time and protection of organs at risk.However,in general,the RapidArc plan is better in clinical application than IMRT plan.

Objective To investigate the security and validity of transabdominal preperitoneal prosthetic (TAPP) in treatment of incarcerated hernia.Methods One hundred and twenty-four patients with incarcerated hernia were divided into 2 groups by random pair method:observation group with treatment of laparoscopic reposition and TAPP (56 cases) and control group with treatment of open reduction and tension-free hernioplasty (68 cases).The operative time,hospital stay,bed time,hospital costs,recurrence rate and complication were compared between the 2 groups.Results All patients in observation group were received laparoscopic surgery successfully.The operation time,hospital stay,bed time in observation group were significandy shorter than those in control group [(37.52 ± 7.78) min vs.(44.23 ± 11.32) min,(4.53 ± 0.89) d vs.(6.85 ± 2.03) d,(9.30 ± 2.65) h vs.(12.63 ± 3.97) h],there were statistical differences (P ＜0.05).The hospital costs in observation group was significandy higher than that in control group [(9 324 ± 599) yuan vs.(7 203 ± 507) yuan],there was statistical difference (P ＜ 0.05).There was no statistical difference in complication rate between the 2 groups (P ＞ 0.05).Follow-up 1 year,there was no recurrence patient in observation group and 1 patient was recurrence in control group,there was no statistical difference between the 2 groups (P ＞ 0.05).Conclusions TAPP is safe and effective with advantages of mini-invasion,quicker recovery but more hospital costs in treatment of incarcerated hernia.The recurrence rate of TAPP is similar to tension-free hernioplasty.

Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with diabetes mellitus and non-diabetic patients. Methods A retrospective analysis was performed to look into the clinical data of 2,796 patients undergoing downward F18minimally invasive percutaneous nephrolithotomy during May 2007 to June 2016 under X-ray guidance Among them,582 diabetic patients were assigned as the diatetes group,aged 26-82 years,279 male,303 female, 174 with pelvic stones,255 with multiple calculi,153 with staghorn calculi,fasting blood glucose 5.4~20.3 mmol/L,postprandial and 2 hours blood glucose 9.1~28.9 mmol/L. In the group,the results of preoperative fasting blood glucose,glycosylated hemoglobin,meal 2 hours blood glucose,diabetes mellitus immune and two others,were in line with diabetes diagnosis and typing standard, and the stones were tested by infrared spectrum analyzer for determination of chemical composition(P<0.05). The rest 2,214 diabetic patients were set as non-diabetic group. The two groups were compared in terms of the operation duration,the rate of stone removal,surgical complications and hospital stay. Results There were no significant differenices in the operation duration,rate of stone removal and operative complications between the two groups(P>0.05),but the hospital stay in the diabetic group was significantly longer than that of the control group. In comparison of the stone compositions,therate of uric acid stones in the diabetic group was significantly higher than that of the control group (P < 0.05). Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of renal calculi in patients with diabetes mellitus. Diabetic patients are susceptive to uric acid stones and those patients at the poor control of blood glucose suffer from a higher recurrence of renal stones , which reminds the importance of doctors to educate the patients on the prevention of kidney stones.

ObjectiveTo investigate the therapeutic effects, safety of pneumatic lithotripsy and 2 μm laser via transurethral ureteroscope for ureteral calculi accompanied with granulation. Methods27 cases (30 sides) of ureteral calculi accompanied with granulation treated with 2 μm laser and pneumatic lithotripsy via ureteroscope were reviewed. Results28 sides were fragmented successfully in a single procedure. The operation time was 15～45 min (mean 25 min). The intraoperative blood loss was 3～15 ml (mean 5 ml). The postoperative hospitalization time was 3～7 d (mean 5.5 d). 1 upper ureteral stone was pushed back to the renal pelvis and extracorporeal shock wave lithotripsy was needed. The insertion of the ureteroscope was failed in 1 cases, who accepted open operation finally. Double-J tubes were pulled out in all the patients after 1 month, and 26 sides were stone-free. They were followed-up for 3～15 months (mean 8 months), no ureteral stenosis or urinary infection was found. Conclusion2 μm laser and pneumatic lithotripsy via ureteroscope is an effective and safe therapy for ureteral calculi with granulation, especially for those on middle or lower levels.

Objective To analyze the cause of delayed hemorrhage after minimally invasive percu- taneous nephrolithotomy(MPCNL),and to summarize the experience in the interventional treatment of severe bleeding after MPCNL by superselective arteriolar embolization.Methods The clinical data of 3812 cases of MPCNL from June 1998 to July 2004 were reviewed.Of them,12 patients(11 men and 1 woman;mean age,45 years)who developed severe hemorrhage after MPCNL were identified.The cause of hemorrhage and the treatment results were analyzed.Results The rate of delayed hemorrhage after MPCNL was 0.31% (12/3812).The mean time to onset of severe bleeding was 10 d after MPCNL.Renal arteriography was per- formed in all 12 patients,showing 5 arteriovenous fistulas and 7 false aneurysms.Superselective arteriolar em- bolization for hemostasis was performed in all 12 cases.All these vascular abnormalities were successfully treated by superselective embolization.Follow-up showed that the hematuria disappeared and renal function recovered well.Conclusions Severe hemorrhage following MPCNL is a rare complication,the incidence of which is significantly lower than that of conventional PCNL.The cause is mainly the arteriolar injury of re- nal puncture passage.Superselective embolization provides effective control of bleeding and currently consti- tutes the treatment of choice based on our experience.

Objective To report the clinical outcomes of applying endoscopic incision in the treatment of ureterovesical anastomosis site obstruction in transplanted kidneys. Methods Between February 2001 and April 2008, 13 men and 5 women with ureterovesical anastomotic site obstruction in their transplanted kidneys were treated by endoscopic incision with electrocautery or holmium: YAG laser. After the anastomosis was completely resected, two Double-J stents were placed in the ureter for 6-8 weeks. During follow-up, renal function, ultrasound examination and wash-out renal scintig-raphy were performed every month for the first 6 months, then every 3 months. Results Total 25 procedures of endoureterotomy were performed and all procedures resulted in successful incision of the obstruction. No complication was recorded during or after the procedure. At the mean follow-up of 51 months (range 4-90 months), 5 patients presented with recurred obstructive uropathy immediately after the Double-J stent removal and finally underwent open surgical correction. Conclusions Endo-scopic incision is safe and effective in the treatment of ureterovesical anastomosis site obstruction in transplanted kidney. However, open surgical reconstruction should be considered if endoscopic inci-sion procedure has failed.

Objective To analyze the clinical characteristics of twin reversed arterial perfusion sequence (TRAP),and investigate its prenatal evaluation and clinical management.Methods Karyotype results and ultrasound data of 25 TRAP cases were retrospectively reviewed,including estimated weight and umbilical blood flow of acardiac twin,cardiac function and middle cerebral artery peak systolic velocity of pump twin.Various managements and the outcomes were analyzed.Results (1) Karyotype of amniotie fluid were tested in 16 pump twins.Mosaicism was found in 1 case (46,XX[36]/46,XY [14]).(2) According to the ultrasound evaluation,large acardia accounted for 87.0％ (20/23) cases.Abundant blood perfusion (inter-twin difference of umbilical resistance index ≤0.20) was indicated in 86.4％ (19/22) cases.Decompensation of cardiac function was suggested in 66.7％ (10/15) pump twins.Fetal anemia of pump twin indicated by middle cerebral artery peak systolic velocity＞1.5 multiples of the median was diagnosed in 75.0％ (12/16) cases.(3) The acardiac twin with abundant blood perfusion was more likely to be a large acardia than those without [94.7％(18/19) vs 1/3,Fisher exact test,P=0.04]; More pump twin with large acardia tended to have cardiac decompensation than non-large acardia pump twins [83.3 ％ (10/12) vs 0/3,Fisher exact test,P=0.02].(4) Eleven patients chose to terminate their pregnancies after being diagnosed.In 14 cases who continue the pregnancies,the survival rate of pump twin was 64.3％ (9/14).In 3 cases of non-large acardia without cardiac decompensation of pump twin,the patients selected conservative observation resulting in 2 term deliveries and 1 termination of pregnancy due to for exacerbation.Among 11 cases with large acardia,which the pump twins were complicated by cardiac decompensation or anemia,five cases selected conservative observation.One ended in spontaneous abortion; three exacerbated (one termination and two cesarean section before term with living births) ; one was stable until delivery.Another 6 cases received bipolar cord coagulation,and successful interruptions of acardiac blood flow were achieved in 5 cases among which 4 pump twins survived.Conclusions Prenatal diagnosis,cardiac function and fetal anemia of pump twin,together with the growth and blood supply of acardia are important indexes for prenatal evaluation of TRAP,on which our prompt management should be based.

Objective To compare the efficiency and safety of double-channel flexible ureteroscopy and electronic flexible ureteroscopy.Methods From April 2007 to 2016 July, clinical data of 836 cases flexible ureteroscopic holmium laser lithotripsy were collected. All the patients were randomly divided into electronic lfexible ureteroscopy group (n = 427) and double-channel lfexible ureteroscopy group (n = 409), the operation time, success rate of surgery, complications, residual stone rate of the two groups were compared.Results The success rate of surgery was 92.5% and 83.6% of the two groups respectively, the difference was significant (P < 0.05); postoperative systemic inlfammatory response syndrome (SIRS) were occurred in 10 cases and 13 cases respectively, which were cured and the difference was not statistically significant (P > 0.05); the average operation time was (81.1 ± 7.9) min and (95.3 ± 7.6) min respectively, the difference was significant (P < 0.05); The formation of stone street of electronic lfexible ureteroscopy group and double-channel lfexible ureteroscopy group were 17 cases and 25 cases. The residual stone rate of electronic flexible ureteroscopy group and double-channel flexible ureteroscopy group were 6 cases and 8 cases, of them were cleared after extracorporeal shockwave lithotrips (ESWL). There were no difference between the two groups (P > 0.05).Conclusion Both double-channel lfexible ureteroscopy and electronic lfexible ureteroscopy are effective and safe therapeutic modalities. Electronic flexible ureteroscopy is better than double-channel lfexible ureteroscopy in success rate of surgery because of its high deifnition and lfexible operation.

Objective To investigate the therapeutic effects, safety of ureteral calculus accom panied with granulation treated with pneumatic lithotripsy and two-macron laser via transurethral uret eroscopic. Methods From June 2007 to March 2010, 38 cases of ureteral calculus accompanied with granulation were treated with 2 μm laser and pneumatic lithotripsy via ureteroscope. All the patients had middle to severe hydronephrosis. The granulation under the calculus was vaporized with the 2 μm laser, and then the ureteral stone was fragmented with pneumatic lithotripsy. The clinical datum,stone disintegration rate, lithagogue rate and complication were retrospectively analyzed. Results Among 38 cases of ureteral stones, rate of successful fragmentation in a single procedure was 92%(35/38). The operation time ranged from 15 to 45 min, mean (23.0±6.5)min. Estimated the intraoperative blood loss was (7.0±4.5)ml. The postoperative hospitalization time was (5.2±0.6)d. Two upper ureteral stones were pushed back to the renal pelvis and a conversion to extracorporeal shock wave lithotripsy (ESWL) was needed. The insertion of the ureteroscope was failed in 1 case who was accepted open operation finally. Among the 37 cases treated via ureteroscopy, stone clearance rate was about 86% after operation 1 month. Follow-up examinations for 3-15 months (mean 8 months)showed no ureteral stenosis or urinary infection. Conclusion 2 μm laser and pneumatic lithotripsyvia ureteroscope could be a highly effective and safe therapy for treatment of ureteral stone with granulation.

Objective To evaluate the effectiveness of web-based mental health services.Methods Web-based mental health services were established in our hospital to offer continuing medical education on mental health and psychological assessments.The access of clinicians to psychiatric knowledge and consultation from psychiatry department was evaluated.Results A total of 803 medical staff took the continuing medical education,and 643 passed the examination.Five hundred and twenty-eight online psychological assessments were completed.The qualification rate of psychiatric examination was 83.3％ vs.31.7％ in educated and non-educated clinicians (x2=32.77,P＜0.01).The common consultation from psychiatry department of the educated group involved anxiety,depression/mania and delirium,of which anxiety and medically unexplained symptoms were comparatively higher while delirium was lower than the non-educated group (x2 values were 4.80,4.59 and 5.16,respectively; all P＜0.05).More use of online psychological assessments was found in the educated group (33.8％ vs.7.6％) before asking for a consultation from psychiatry department (x2=30.04,P＜0.01).Conclusions Online mental health continuing education and psychological assessment could improve psychiatric knowledge and recognition of anxiety and depression in clinicians.