Objective To explore the application of combined penile and scrotum skin flap in the reoperation process for operation failure cases with hypospadias.Methods A retrospective analysis was performed with the inclu-sion of 1 5 failure cases with hypospadias who received combined penile and scrotal skin flap treatment for reoperation from January 201 3 to December 201 5 in the First Affiliated Hospital of Guangxi Medical University.These cases aged from 7 to 1 5 years old,with a median age of 1 0.2 years old.Among them,a 3 rd operation was performed in 4 cases,4th operation in 5 cases,5 th operation in 4 cases,and 6 th operation in 2 cases.The procedure of Onlay island flap urethro-plasty +tubularized incised plate (Onlay +TIP)urethroplasty was performed in 4 patients,and the other 1 1 cases were treated with urethral mouth basal vascular skin tube urethroplasty (Mathieu)+TIP urethroplasty.F8 or F1 0 silicone balloon catheter were used as stent in new urethra,outer dressing after operation was replaced every 2 to 3 d,the outer dressing was demolished 6 -8 d after operation.Results All patients were followed up after surgery until March 20, 201 6,the follow -up time was 4 -26 months.In these 1 5 patients,the success rate of operation was 86.7%(1 3 /1 5 ca-ses),among them,3 cases were success and 1 case was failed in Onlay +TIP group,and 1 0 cases were success and 1 case was failed in Mathieu +TIP group.The patients with successful operation were with beautiful appearance of the pe-nis,normal position of the meatus urinarius and normal urination.No peristome of urethra,urethrovaginal fistula or ure-thral diverticulum was found after surgery.However,urethral cracking of the glans of penis appeared in 2 operation failed patients,and the orificium urethrae externum was low -set,and urethroplasty was needed 1 year postoperatively. Conclusions For some failure cases with hypospadias showing suitable anatomy conditions,Onlay +TIP or Mathieu +TIP combined with penile and scrotal flap may be a good choice for the completion of reoperation.

Objective To investigate the effects of playful training on home environment and development in children with cerebral palsy. Methods89 children with cerebral palsy were divided into observation group (45 cases) and control group (44 cases). All children were treated with normal strengthen rehabilitation in hospital. The observation group received the training playfully. They were assessed with the Home Observation for Measurement of the Environment (HOME) and Bayley Scale of Infant Development (BSID) before and 6 months after treatment. ResultsAfter treatment, The HOME scores in observation group was significantly better than those before treatment and in control group （P<0.01）. The Psychomotor Dvelpment Index (PDI) of BISD was improved in both groups （P<0.01） with significant different between them（P<0.05）. The Mental Development Index (MDI) of BISD in observation group was significantly better than those before training and in control group （P<0.01）. ConclusionPlayful training can improve the development and home environment in children with cerebral palsy.

The improvement of women and children health,along with the growth in health needs,brings forth new challenges to maternal and children health care institutions.The dual demands of quantity and quality in maternal and children health services compel the institutions to improve capabilities under the current conditions,and more importantly,to further clarify the functional orientation which is the key issue for its development.This article is based on the analysis of the historical development and current situation of the maternal and children health care institutions,which sets up the functional orientation according with the rules and characteristics of maternal and children health services.The paper proposed a series of suggestions on its development,such as the health service admission system,appropriate staffing standards and the institution-construction standards.

Introduction to the theories on improving coordination level of the new rural cooperative medical system,including the risk theory,great number rule,fair theory,demand theory and supply theory which are cornerstones of enhancing the NRCMS improving the pooling level.The paper also probed into the practices of improving the pooling level of the NRCMS,including the models of high level,middle level and low level pooling.These theories and practices can help the localities better design and manage the pooling level of the NRCMS.

ObjectiveThis paper aims to analyze the clinical characteristics and medication rationality of liver injury related to Epimedii Folium preparation （EP） and explore the possible risk factors of liver injury， so as to provide a reference for the safe clinical application of Epimedii Folium （EF）. MethodA retrospective analysis was conducted on liver injury cases related to EP from 2012 to 2016. ResultThe number of reported liver injury cases and the proportion of severe cases related to the use of EP show an increasing trend， indicating the objective existence of liver injury caused by EP. There are more cases of liver injury related to EP in women than in men， with an onset age range of 15-91 years old and a median onset age of 60 years old （median onset ages for men and women are 59 and 60 years old， respectively）. The time span from taking EP alone to the occurrence of liver injury is 1-386 days， with a median of 38 days. The time span from taking both EP and Western medicine to the occurrence of liver injury is 1-794 days， with a median of 34 days. EF-related liver injury preparations are mostly composed of traditional Chinese medicines that promote immunity and tonify the liver and kidney， indicating that immune stress in the body may be the mechanism of liver injury caused by the use of EP alone or in combination. There is no increasing trend of toxicity with time or dose in the liver injury caused by EP. By further exploring its risk factors， it is found that patients have unreasonable medication methods such as excessive dosage， repeated use， and multi-drug combination， which may also be one of the important risk factors for EF-related liver injury. ConclusionEP has a certain risk of liver injury and should be emphasized in clinical diagnosis and treatment. Immune stress may be the mechanism of liver injury caused by EP， and in clinical use， it is necessary to be vigilant about the risk of liver injury caused by unreasonable use and combined use with Western medicine.

Discordance, such as overlap, repetition and inconsistent, of standards is one of the major problems in current standardization affair in China. Therefore, improving the unity and authority of standards through reduction of overlap, repetition and inconsistency has become the main goal of deepening standardization reform in China. This paper summarizes the discordance in public health standards in China, analyzes the major reasons and provides specific strategic suggestions through case analysis of public health standards in the ways of comparisons of same kind standards of other deparments and standards in administration documents and guidelines or technical specifications of academic associations or societies.

Psoraleae Fructus (PF) is a well-known traditional herbal medicine in China, and it is widely used for osteoporosis, vitiligo, and other diseases in clinical settings. However, liver injury caused by PF and its preparations has been frequently reported in recent years. Our previous studies have demonstrated that PF could cause idiosyncratic drug-induced liver injury (IDILI), but the mechanism underlying its hepatotoxicity remains unclear. This paper reports that bavachin isolated from PF enhances the specific stimuli-induced activation of the NLRP3 inflammasome and leads to hepatotoxicity. Bavachin boosts the secretion of IL-1β and caspase-1 caused by ATP or nigericin but not those induced by poly(I:C), monosodium urate crystal, or intracellular lipopolysaccharide. Bavachin does not affect AIM2 or NLRC4 inflammasome activation. Mechanistically, bavachin specifically increases the production of nigericin-induced mitochondrial reactive oxygen species among the most important upstream events in the activation of the NLRP3 inflammasome. Bavachin increases the levels of aspartate transaminase and alanine aminotransferase in serum and hepatocyte injury accompanied by the secretion of IL-1β via a mouse model of lipopolysaccharide-mediated susceptibility to IDILI. These results suggest that bavachin specifically enhances the ATP- or nigericin-induced activation of the NLRP3 inflammasome. Bavachin also potentially contributes to PF-induced idiosyncratic hepatotoxicity. Moreover, bavachin and PF should be evaded among patients with diseases linked to the ATP- or nigericin-mediated activation of the NLRP3 inflammasome, which may be a dangerous factor for liver injury.
Adenosine Triphosphate ; Animals ; Chemical and Drug Induced Liver Injury/etiology* ; Flavonoids ; Humans ; Inflammasomes ; Mice ; NLR Family, Pyrin Domain-Containing 3 Protein ; Nigericin