Objective To evaluate the advantages and disadvantages of different puncture positions in percutaneous nephrolithotomy. Methods Three hundred fifty-six patients who underwent PCNL were analyzed from March 2012 to October 2015. The passage caliber was 16F-20F. There were 217 cases in prone position and 139 cases in supine position. Results The successful operation in PCNL was 354 cases , while the remaining 2 cases were performed by open surgery. The primary stone clearance rate was 75.5%. The additional PCNLs were performed in 23 cases, and 63 cases of residual calculi were treated by ESWL. 11 patients were treated due to infection or bleeding by the additional PCNLs. There were 3 cases with massive hemorrhage which were treated by Interventional embolization therapy , 12 cases in postoperative fever , no renal resection , no intestinal injury, no deaths. There was no significant difference in stone clearance rate and complication rate between the two groups. Conclusion The puncture position of PCNL can be optional based on the stone size , stone location, degree of hydronephrosis ,and patient′s cardiopulmonary condition individually.

BACKGROUND:Traumatic auricle defectsin upper 1/2 or lower 1/2,seriously involve theauricular cartilage and skin blood vessels. The autogenic rib cartilage graft and acelular dermal matrix have good histocompatibility, and expanded flapis a kind of thin and achromatic tissue for skin defect repair. OBJECTIVE:To explore theapplication ofacelular dermal matrix and expanded flap in half auricular reconstruction,and to find out the fine carving and anastomosis of autogenic rib cartilage graftas wel as its similarities with the ear and clinical significance. METHODS:Eight cases of half auricular defects were treated with expanded flap, autogenic rib cartilage graft, fine anastomosisofautogenic rib cartilage graft and residual earfor half auricular reconstruction,during which theacelular dermal matrixwas usedto promote residual ear docking and skul auricle angle formation. The reconstructionwasperformed in three stages:first,anexpander(volume, 80mL)wassubcutaneously implanted attheretro-auricular area;second, the auricular defects were reconstructed with fine rib cartilage graft, acelular dermal matrix and auriculoplasty;finaly, acelular dermal matrixwas usedto promote residual ear docking. Thenthehalf auricular reconstructionwas evaluatedby objective measurement and subjective rating. RESULTS AND CONCLUSION:Half auricular reconstruction was successful in al the eight caseswithout obvious complications, and the cartilage grafts were in good condition.During thefolow-up,thereconstructed auriclewasshapedwel andformed a good involution withtheresidualauricle. In addition, the flange was smooth withoutobviouscolor difference and edema, and its position, size and shape were consistent with those of thecontralateralone. Afterthefolow-up of 6 months, objective indicators showed that the affected side had no significant differencefromthe contralateralone(P> 0.05). In conclusion,theacelular dermal matrixcanobviously decrease the complications of the cartilage grafts andcontributeto agood shaped auricle;and half auricular reconstructionby expanded flap, autogenic rib cartilage graft,andfine anastomosis of autogenic rib cartilage graftcanachieve significant clinical effects.

BACKGROUND:At present, the common filing materials used to correct secondary unilateral cleft lip nasal deformity include conchae cartilage, costal cartilage, Medpor implants, expanded polytetrafluoroethylene (ePTFE), alogenic acelular dermal matrix. OBJECTIVE:To analyze the therapeutic effects of comprehensive procedures with alogenic acelular dermal matrix or ePTFE for secondary unilateral cleft lip nasal deformity. METHODS: Thirty-six patients with secondary unilateral cleft lip nasal deformity were enroled, including 19 males and 17 females, aged 15-32 years. Alogenic acelular dermal matrix (n=22) or ePTFE (n=14) was used to correct nasal base colapse deformities. Anthropometry method was employed to make measurements. Fixed-point measurement was performed based on patient's pictures before and after correction. Long-term effects of these two kinds of filing materials were analyzed and assessed objectively and quantitatively. RESULTS AND CONCLUSION: After the folow-up of 6 months, al the patients were satisfied with their results, and no infection and no exposure occurred. The treatment effect of the alogenic acelular dermal matrix group was excelent in 16 cases and good in 6 cases; there were 10 cases of excelent and 4 cases of good in the ePTFE group. The objective indicators in the two groups were al improved at 6 months after correction (P < 0.05), but there was no difference between the two groups (P > 0.05). These findings indicate that alogenic acelular dermal matrix or ePTFE is useful to correct secondary unilateral cleft lip nasal deformity.

OBJECTIVETo investigate the clinical characteristics of Segond fracture combined with injuries, and to explore the operative method and opportunity.

METHODSFrom June 2010 to December 2014, 10 patients with Segond fracture were treated. There were 10 males, ranging in age from 26 to 69 years old, with a mean of 42 years old. Under arthroscopy examination within 7 to 10 days after injury, 6 patients had compete rupture of anterior cruciate ligament and meniscus injury; 2 patients had tibial avulsion fractures of the ACL combined with meniscus injury. At 4 to 8 weeks after injury, 2 patients were performed with arthroscopy examination; 1 patient had complete rupture of anterior and posterior cruciate ligament combined with meniscus injury; and the other patient had complete rupture of anterior cruciate ligament alone. All the patients with cruciate ligament rupture were treated with reconstruction of cruciate ligament; 9 patients had meniscus injuries were treated with menisus plasty or suture; and 2 patients had tibial avulsion fractures of the ACL were treated with non-absorbable Ethicon suture fixation under arthroscopy. After operation, the Lysholm scoring system was used to evaluate clinical effects.

RESULTSEight patients were operated within 10 days after injury, the knee joints swelling was obvious at the 3rd day after operation, and blood oozing was found by joint puncture. These 8 patients did out-of-bed activity with assistance at 1 week postoperatively. Other 2 patients performed operation in 4 to 8 weeks after injury without knee joint obvious swelling at the 3rd day after operation, and no blood oozing was found by joint puncture. These 2 patients did out-of-bed activity with assistance after 3 days postoperatively. All the patients were followed up, and the duration ranged from 12 to 24 months, with an average of 18 months. Postoperative Lysholm score of all patients was higher than preoperative scor, and the results were satisfactory.

CONCLUSIONFor Segond fractures, firstly, it is important to gain early diagnosis for treatment. Secondly, it is often associated with the rupture of anterior cruciate ligament and meniscus injuries, and the best time of cruciate ligament rebuilding and meniscus repairing maybe between 4 to 8 weeks after injury. Thirdly, personalized treatment should be chosen according to different complications.

Adult ; Aged ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Humans ; Male ; Middle Aged ; Tibial Fractures ; complications ; diagnosis ; surgery ; Tibial Meniscus Injuries

Objective （ ） To explore the influence of perceived organizational support POS and psychological resilience on （ - ）Methods presenteeism behavior in medical staff in the prevention and control of coronavirus disease COVID 19 . Doctors - - and nurses engaged in the front line work of prevention and control in the four designated hospitals for the treatment of COVID ， 19 in Guangdong Province Hunan Province and Jiangsu Province were selected as the research subjects using a random cluster ， - - sampling method. The Survey of Perceived Organizational Support Scale the 10 item Connor Davidson Resilience Scale and - ， Results Standford Presenteeism Scale 6 were used to investigate their POS psychological resilience and presenteeism. The ， （ ），（ ） （ ）， total scores of POS psychological resilience and presenteeism were 44.9±7.6 31.2±5.7 and 18.5±3.7 respectively. （ Both POS and psychological resilience had negative effect on presenteeism standardized regression coefficient were −0.59 ， P ） ［ and −0.38 both <0.01 . Psychological resilience played a partial mediating role between POS and presenteeism 95% （ - ）， ］ Conclusion confidence interval −0.22 −0.09 the mediating effect ratio was 23.4% . Both POS and psychological - ， resilience can directly affect the presenteeism behavior of medical staff in COVID 19 prevention and control and POS can also indirectly affect their presenteeism by affecting psychological resilience.

Objective （ ） To explore the influence of perceived organizational support POS and psychological resilience on （ - ）Methods presenteeism behavior in medical staff in the prevention and control of coronavirus disease COVID 19 . Doctors - - and nurses engaged in the front line work of prevention and control in the four designated hospitals for the treatment of COVID ， 19 in Guangdong Province Hunan Province and Jiangsu Province were selected as the research subjects using a random cluster ， - - sampling method. The Survey of Perceived Organizational Support Scale the 10 item Connor Davidson Resilience Scale and - ， Results Standford Presenteeism Scale 6 were used to investigate their POS psychological resilience and presenteeism. The ， （ ），（ ） （ ）， total scores of POS psychological resilience and presenteeism were 44.9±7.6 31.2±5.7 and 18.5±3.7 respectively. （ Both POS and psychological resilience had negative effect on presenteeism standardized regression coefficient were −0.59 ， P ） ［ and −0.38 both <0.01 . Psychological resilience played a partial mediating role between POS and presenteeism 95% （ - ）， ］ Conclusion confidence interval −0.22 −0.09 the mediating effect ratio was 23.4% . Both POS and psychological - ， resilience can directly affect the presenteeism behavior of medical staff in COVID 19 prevention and control and POS can also indirectly affect their presenteeism by affecting psychological resilience.

Objective （ ） To explore the influence of perceived organizational support POS and psychological resilience on （ - ）Methods presenteeism behavior in medical staff in the prevention and control of coronavirus disease COVID 19 . Doctors - - and nurses engaged in the front line work of prevention and control in the four designated hospitals for the treatment of COVID ， 19 in Guangdong Province Hunan Province and Jiangsu Province were selected as the research subjects using a random cluster ， - - sampling method. The Survey of Perceived Organizational Support Scale the 10 item Connor Davidson Resilience Scale and - ， Results Standford Presenteeism Scale 6 were used to investigate their POS psychological resilience and presenteeism. The ， （ ），（ ） （ ）， total scores of POS psychological resilience and presenteeism were 44.9±7.6 31.2±5.7 and 18.5±3.7 respectively. （ Both POS and psychological resilience had negative effect on presenteeism standardized regression coefficient were −0.59 ， P ） ［ and −0.38 both <0.01 . Psychological resilience played a partial mediating role between POS and presenteeism 95% （ - ）， ］ Conclusion confidence interval −0.22 −0.09 the mediating effect ratio was 23.4% . Both POS and psychological - ， resilience can directly affect the presenteeism behavior of medical staff in COVID 19 prevention and control and POS can also indirectly affect their presenteeism by affecting psychological resilience.

0.05). After dividing the patients into early-onset and late-onset subgroups, there were significant differences of DRD4 genotype and allele frequency between early-onset patients and controls (P0.05). Conclusion The results suggested that the polymorphism of DRD4 receptor gene may be associated with early-onset OCD. The 3/4 genetype may be the risk factor of early-onset OCD. Early-onset and late-onset OCD may have different etiology.

Aristolochic Acids ; adverse effects ; Child ; Drugs, Chinese Herbal ; adverse effects ; Female ; Humans ; Male ; Nephrosis ; chemically induced

Aim To explore the inhibitory effect of Euonymus alatus on hepatic fibrosis induced by carbon tetrachloride (CCl4) in mice and its mechanism. Methods Eighty C57BL/6 male mice were randomly divided into eight groups: normal group, CCl4model group, Euonymus alatus(EA) ethanol extracts groups in early stage(EAE), EA ethanol extracts groups in later stage(EAL),two drug groups with low/medium/high dose(EAE-L/M/H, EAL-L/M/H), with 10 mice in each group. Fibrosis model was established by injecting CCl4in peritoneal cavity,and the study lasted for 30 days. Different doses of drugs were given from 1 st day to 15 th day in EAE while from 16 th day to 30 th day in EAL,then all mice were sacrificed to for the observation of the morphological changes and collage-nous fiber by HE and Masson staining. Liver index, ALT,AST and TNF-α were tested by ELISA. The ex-pressions of α-SMA and CollagenⅠwere measured by immunohistochemistry and Western blot. Results Compared to normal group, liver index, ALT, AST, TNF-α, α-SMA and CollagenⅠ in EA groups were lower than those in model group in a dose-dependent manner(P<0.01 or P<0.05). Liver morphology and collagenous fiber in EAE and EAL were better than those in model group in a dose-dependent manner. The effect of EAE were superior to that of the EAL in HE, Masson, α-SMA, Collagen Ⅰ indexes(P <0.05). Conclusions Euonymus alatus may inhibit the process of hepatic fibrosis in mice with dose-effect de-pendence, and drug treatment in early stage performs better,which may be related to the decrease of TNF-α that affects the expression of α-SMA and Collagen Ⅰ.