Objective To study and evaluate frequency-doubled-double-pulse laser (FREDDY) lithotripsy of ureteral calculi. Methods The experience of 150 cases of ureteral calculi treated with FREDDY from April to December in 2001 was summarized.94 are male patients and 56 female with an average age of 42.There were 48 cases of upper,35 middle and 64 lower ureteral stone. Results Of 150 cases,136(90.6%) were successful on the first lithotripsy.Of which in 131 cases (96.8%) the stone fragment completely expelled in one week.The procedure failed in 9 cases of upper ureteral calculi.Among them,5 cases was due to up drift of calculi or incomplete lithotripsy and was then shifted to ESWL therapy.2 was due to angular twist of the ureter and changed to open operation,and another 2 was due to perforation of ureter during the procedure.Of the 5 failed cases with middle and lower ureteral calculi,1 was due to incomplete lithotripsy,nonfragmentation in 1 case and failure of ureteroscopy in 3(changed to open operation).Different degree of hematuria was seen in every case after operation.High fever or pyonephrosis after operation has not been observed.The average operation time was 32 minutes,and the average time for laser working was 3.3 minutes.The average hospitalization after operation was 2.5 days. Conclusions FREDDY is a kind of laser with the characteristics of single function,simple operation,safe,less damage to the soft tissue and high efficiency of lithotripsy.The procedure is indicated if ESWL failed or not indicated.

BACKGROUND: Insulin resistance and impaired insulin secretion are the key complications of polycystic ovary syndrome (PCOS). The incidences of insulin resistance syndrome (IRS), impaired glucose tolerance (IGT) and diabetes mellitus have been clearly shown to be race-related, thus the association between polycystic ovary syndrome and insulin resistance was race-related.OBJECTIVE: To analyze the correlation of insulin resistance with body mass index (BMI), blood lipids and plasma glucose in Tibetan patients with PCOS.DESIGN: A prospective study based on Tibetan population.SETTING: Department of Cardiology, General Hospital of Chinese PLA; Second Department of Internal Medicine,General Hospital of Tibetan Military Area Command of Chinese PLA.PARTICIPANTS: Thirty-six Tibetan PCOS patients, aged 25-42 years with a mean age of (32±5) years were selected from the Second Department of Internal Medicine and Department of Gynecology, General Hospital of Tibetan Military Area Command of Chinese PLA. Another 36 female inpatients were selected as the controls (control group), aged 24-35 years with a mean age of (30±5) years.METHODS: The disease histories were collected and general conditions were recorded. Oral glucose tolerance test (OGTT, 75 g) was conducted for all the subjects. All the subjects werefasted for 12 hours to collect venous blood samples to detect the levels of hormone, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Ovary was detected with echocardiography. The insulin resistance index was calculated by the homeostasis model assessment (HOMA-IR) was calculated by the formula:fasting insulin (mlU/L)×FPG (mmol/L)/22.5. The blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were compared between the PCOS group and control group.MAIN OUTCOME MEASURES: Blood pressure, BMI and levels of blood lipids, plasma glucose and insulin were observed in both groups.RESULTS: All the 36 PCOS patients and 36 controls were involved in the analysis of final results. ① The BMI, systolic blood pressure and diastolic blood pressure in the PCOS group were higher than those in the control group (t =3.426 5,2.448 4, 2.212 5, P ＜ 0.05-0.01). ② The levels of total cholesterol, triglyceride and LDL-C in the PCOS group were higher than those in the control group (t=2.104 9, t =2.304 7, 2.400 0, P＜ 0.05-0.01), whereas the level of HDL-C was lower that in the control group (t =4.800 0, P＜ 0.01). ③ The levels of fasting insulin and 2-hour plasma glucose and HOM in the PCOS group were higher than those in the control group (t =7.809 5, 12.365 0, 2.789 9, P＜ 0.01).CONCLUSION: Tibetan PCOS patients present a clustering of atherosclerotic risk factors, including obesity, adverse lipid profile, hypertension, hyperglycemia, etc.

BACKGROUND:Atlantoaxial fusion is currently the main surgical treatment of atlantoaxial dislocation, but the premise is at the expense of atlantoaxial range of motion, especial y the rotation motion. Restricted non-fusion fixation is a method that can maintain the atlantoaxial stability, while retain the atlantoaxial range of motion. Further research should be performed to compare the biomechanical characteristics between the two methods. OBJECTIVE:To develop a three-dimensional finite element model of atlantoaxial instability, compare and determine the biomechanical properties of posterior atlantoaxial restricted non-fusion fixation system and posterior atlantoaxial screw-rod fixation system. METHODS:A verified intact finite element upper cervical (C0-C3) model was established and analyzed by Simpleware 3.0, Geomagic 8.0, Hypermesh 10.0, Abaqus 6.9, and Rhino 4.0 softwares based on the CT data col ected from a 31-year-old healthy male volunteer. The moment couple of 1.5 N?m was loaded, which made the model movement in flexion-extension, lateral bending, and rotating direction, respectively. The range of motion was recorded and compared with the in vitro biomechanical experimental data to verify the effectiveness of the model. The ranges of motion of the posterior atlantoaxial restricted non-fusion fixation system model and the posterior atlantoaxial screw-rod fixation system model were analyzed using the finite element method under flexion, extension, lateral bending, and axial rotation;meanwhile, stress nephograms of the posterior atlantoaxial restricted non-fusion fixation system model were observed. RESULTS AND CONCLUSION:(1) There were 206 747 elements and 72 500 nodes in the intact model of upper cervical spine (C0-C3) in this experiment, and the range of motion of intact model validated with the reported cadaveric experimental data. (2) The range of motion of the posterior atlantoaxial restricted non-fusion fixation system group was similar to which of the posterior atlantoaxial screw-rod fixation system group in flexion-extension direction. (3) In lateral bending direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was obviously limited, respectively. The range of motion of the posterior atlantoaxial restricted non-fusion fixation system model was larger than that of the atlantoaxial dislocation model and basical y same as that of the normal atlantoaxial model. (4) As to the rotating direction, the range of motion of the posterior atlantoaxial restricted non-fusion fixation system mainly disappeared at the atlantoaxial segment;by contrast, a majority of rotating motion was stil retained in the posterior atlantoaxial restricted non-fusion fixation system group. (5) The stress concentration occurred in the contact part between the screw and the connecting rod in posterior atlantoaxial restricted non-fusion fixation system model. (6) Results suggest that posterior atlantoaxial restricted non-fusion fixation system is effective and useful for atlantoaxial fixation. It not only restricted atlantoaxial flexion-extension, but also preserved axial rotation and lateral bending at the atlantoaxial joint.

Objective To analyze the clinical and pathological characteristics of breast carcinoma in elderly female patients and to offer the standard clinical diagnosis and treatment for breast carcinoma.Methods A total of 178 patients admitted to Breast Center of Beijing Hospital from January to December 2011 were enrolled in this retrospective study.Patients were divided into non-elderly group and elderly group.Clinical features,imaging diagnosis,operation patterns and pathological diagnosis were recorded.The data were analyzed by using SAS 9.1 software.Results The patients diagnosed as breast carcinomas in BI-RAD 4-5 categories by mammography were much more in the elderly group than in the non-elderly group (82.1％ vs.63.0％,P＜0.05).The diagnostic accuracy rates of ultrasonography and mammography in the elderly group were comparable(P＞ 0.05),while in the non-elderly group,the diagnostic accuracy rate of ultrasonography was higher than that of mammography (P＜0.05).The incidence of concurrent diseases was higher in the elderly group than in the non-elderly group (P＜0.05).The patients undergoing breast resection operation were much more in the elderly group than in the non-elderly group (14 cases vs.3 cases,P＜0.05).The pathological diagnosis analysis showed that there were no significant differences in the number of ER-positive cells and PR-positive cells,tumor size,histological grade,pathological stage between the two groups (all P＞0.05).The incidence of lymph node metastasis was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of Ki-67 positive cells was lower in the elderly group than in the non-elderly group (P＜0.05).The percentage of CerbB-2 strongly positive (+++) cells was lower in the elderly group than in the non-elderly group (5.1 ％ vs.24％,P＜0.05).The invasive ductal carcinoma was the major histological type of breast cancer in both two groups,but there were more mixed type and other type carcinomas in the elderly group than in the non-elderly group (P＜0.05).Conclusions Ultrasonograpy and mammography have better sensitivity for breast cancer in elderly female patients.The surgical protocols are often influenced because more concurrent diseases have occurred in the elderly.There are significant differences in some prognostic factors between the two groups,which may imply a better prognosis in elderly patients.

Objective To investigate the expression and significance of TGF‐β receptor Ⅰ /TGF‐β receptor Ⅱ (TGF‐β Ⅰ /TGF‐β Ⅱ) in human skin malignant melanoma A375 cell line .Methods The reverse transcription‐real time polymerase chain reac‐tion (RT‐PCR) and Western blot were utilized to assess the expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ in A375 cell line and human normal melanocytes .Results The expressions of TGF‐βR Ⅰ /TGF‐‐βR Ⅱ mRNA and protein of A375 cells line were significantly lower than those of human normal melanocytes .Conclusion The down‐regulated expression of TGF‐βR in the TGF‐β/Smad signal pathway of human skin malignant melanoma may be one of the pathogenesis of skin malignant melanoma .

Objective:Reports about impact of lumbar posterolateral fusion on adjacent segment degeneration concentrated on biomechanics and imageology,lack experimental study. This study observes the impact of posterolateral arthrodesis on the adjacent intervertebral disc. To observe the impact of posterolateral arthrodesis on the adjacent intervertebral disc. Methods:Rabbit models of posterolateral arthrodesis were established and the transverse processes of the fourth,fifth and sixth lumbar vertebrae were exposed. Stainless-steel wire0.8 mm in diameter was used to interconnect the three transverse processes in a figure of 8. Methylmethacrylate was then applied to encircle the transverse processes and the wire. Changes in the adjacent disc were observed by light microscopy 3 and 6 months after the operation. Results:Disc degeneration was found at L3-4 at 3 months postoperatively,and further degeneration was noted at this level at 6 months. Conclusion:Posterolateral fusion may accelerate the degeneration of the adjacent intervertebral disc.

Objective To investigate the laboratory examination,diagnosis and treatment of 57 cases of Acute Promyelocytic Leukemia.Methods The clinical manifestation,laboratory morphology-immunology-cytogenetics-molecular (MICM) classification,treatment and follow-up were analyzed retrospectively among 57 newly diagnosed cases of acute pmmyelocytic leukemia (APL) patients from January 2011 to December 2013 in Xiangya Hospital,Central South University.Results In 57 patients,the first symptom was given priority to with bleeding (73.7％),fever (26.3％),and the organ infiltration accounted for 29.8％.The phenotype of CD13 + CD33 + CD34-HLD-RA-was 59.6％ in 57 patients,CD13 + CD33 +CD34 + HLD-RA + was 8.8％,and the remaining 18 cases were not classic phenotypes.The positive percentage of PML/RARa was 93.0％ by fluorescence in situ hybridization (FISH),and the remaining 4 cases were other rare abnormal.Except one case gave up the treatment,the other 56 cases of APL patients reached 100％ complete remission rate under early screening and diagnosis,relatively standardized and effective treatment.Conclusions Hemorrhage is the most common clinical symptoms of M3.MICM classification,especially the FISH technology,is the main laboratory basis for diagnosis of M3.After the treatment of early specifications currently,M3 can almost be cured.

Objective To compare the anesthetic effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA)for cesarean section,and their influence on the incidence rate of supine hypotension syndrome(SHS).Methods 200 patients with cesarean section surgery in our hospital from February 2016 to July 2016 were randomly divided into observation group and control group,all of cases were given CSEA.100 patients in the observation group(the group L)were given ropivacaine in spinal anesthesia,the other 100 patients in the control group(the group B)were given bupivacane in spinal anesthesia.Recorded the relevant indicators,compared the incidence rate of SHS,the effect of anesthesia and neonatal score.Results The incidence rate of SHS of the group L was lower than the group B(χ2 =9.261,P<0.01).The effect of anesthesia and Apgar score of two groups had no statistically significant differences(all P>0.05).Conclusion The application of ropivacaine in CSEA for cesarean section not only has exact anesthesia effect,but also can effectively prevent SHS without any side effects.

Diving ; Humans ; Otitis Externa ; prevention & control

BACKGROUND: The occurrence and severity of acute high-altitude disease(AHAD) are determined by the speed entering the highland, the altitude of highland and seasons. The association between obesity and AHAD has not been fully investigated.OBJECTIVE: To investigate the association between obesity and acute high-altitude in people exposed rapidly to the highland.DESIGN: Comparative observation.SETTING: Department of Cardiology, General Hospital of Chinese PLA and Department of Cardiology, Tibetan General Hospital of Chinese PLA.PARTICIPANTS: The experiment was conducted at the Department of Cardiology, General Hospital of Tibetan Military Area Command of Chinese PLA in August 2006. Totally 82 Henan subjects aged 28-45 years were selected from the male workers constructing the Qinghai-Tibet Railway and their managers with acute high-altitude exposure. They had never been to the highland before, and all agreed to the detection.METHODS: ①Every subject completed the AHAD self-report questionnaire at sea level and 12 hours and 24 hours after ascending high-altitude. The items in the questionnaire included symptoms of headache, gastrointestinal symptoms,fatigue or weakness, dizziness, and insomnia. Each symptom was graded from 0-3 with 0 as no symptoms, 1 as mild symptoms, 2 as moderate symptoms, and 3 as severe symptoms and a total score of 15. A score of 4 or more could by identified as AHAD. ②The height and body mass were measured to calculate the body mass (BMI). Those with BMI≥28 kg/m2 served as the obesity group [n =39, mean age (35±8) years], and those with BMI of 18.5-23.9 kg/m2 as the normal body mass group [n =43, mean age (35±8) years]. ③Arterial blood was taken to evaluate arterial oxygen saturation (SO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide pressure (PaCO2) at baseline and 24 hours after ascending high-altitude. ④The measurement data was compared by t test.MAIN OUTCOME MEASURES: BMI, vital capacity of lungs, SO2, PaO2 and PaCO2 levels of obese and normal people.RESULTS: Totally 39 obese people and 43 normal people were involved in the result analysis. ①AHAD score: No symptom was reported at sea level in all participants (scored 0), but the AHAD scores in the obesity group were significantly higher than those in normal group 12-hour and 24-hour after ascending high-altitude. ②Blood gas analysis:At sea level, there were no statistical differences in the levels of SO2, PaO2, and PaCO2 between two groups (P ＞ 0.05).But 24 hours after ascending high-altitude, SO2 and PaO2 of the obesity group were much lower than in the normal group (P＜ 0.01), and PaCO2 was significantly higher than in the normal group (P＜ 0.01).CONCLUSION: Obese men are more vulnerable to high-altitude hypoxia than people with normal body mass. Obesity is an important risk factor for the development of acute high-altitude disease.