Objective To investigate if distribution of stone composition and onset age in the upper urinary tract changed during the past 12 years in China.Methods There were 1 878 urolithiasis patients of the upper urinary tract in our hospital from 2003 to 2014 enrolled in present cross-sectional study.There were 1 300 male and 578 female patients with a median onset age of 46 (6-95) years.Stone composition was measured by infrared spectrophotometry.All the patients were divided into 3 groups according to the onset year:Year 2003-2006,Year 2007-2010 and Year 2011-2014.The distributions of stone types were compared among the 3 groups.Age and gender were included as potential confounders.Chi square test,P trend test,Kruskal-Wallis test and logistic regression were employed in the statistical analysis.Results Calcium oxalate was the most common type with a dominant proportion of 78.1％ (1 466/1 878),while uric acid had a small proportion of 4.8％ (91/1 878).The proportions of uric acid in the 3 groups were 2.7％ (12/441),5.1％ (39/758) and 5.9％ (40/679),showing an increasing trend (P ＜0.05).Multivariate analysis showed that year group was independently correlated with the proportion of uric acid,with an OR of 1.385 (95％ CI,1.027-1.867).From 2003 to 2014,the proportion of uric acid calculus increased by 0.42％ (95％ CI,0.25％-0.59％) annually.The median ages of disease onset were 43,46 and 49 years respectively in those three groups,also showing an increasing trend with time (P ＜0.01).Conclusion From 2003 to 2014,the proportion of uric acid and onset age in patients of upper urinary tract calculi were increased in the present cohort.

Objective To investigate the proportion , risk factors and tendency of change of stone composition in recurrent urolithiasis .Methods Eighty-five recurrent urolithiasis patients from 2002 to 2014 were enrolled in this retrospective cohort study .There were 61 male and 24 female patients with a median age of 51 (21-89) years at initial events.Among those patients, 70 had two events, 12 had three events, and 3 had more than 3 events.Compositions of initial and recurrent stones were measured by infrared spectrophotometry.Stone type, recurrence interval and recurrence frequency were studied as potential risk factors for composition change . Chi square test and logistic regression analysis were employed in the statistical analysis.Results Stone composition changed during recurrence in 26 patients ( 30.6%) . Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1-5 years was 0.518 (95%CI, 0.277-0.967, P<0.05) when compared with those of less than 1 year or more than 5 years.Logistic regression analysis showed the odds ratio of recurrence interval of 1-5 years was 0.231 (95%CI, 0.075-0.707, P=0.010).The mutual conversion between calcium oxalate and infection stones was mostly observed when stone composition changed during recurrence .Twenty percent of calcium oxalate stones changed to infection stones and 29.2% of infection stones changed to calcium oxalate .
Conclusions Stone composition changes in about one third patients of recurrent urolithiasis .The mutual conversion between calcium oxalate and infection stones is the most common change .Recurrence interval is an independent risk factor to predict composition change .Repeated stone analysis should be suggested to patients with recurrent interval of less than 1 year or more than 5 years.

Objective To explore the clinical value of early fluid resuscitation guided by passive leg-raising test (PLR) combined with transthoracic echocardiography (TTE) in patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Seventy-four patients with septic shock admitted to China-Japan Friendship Hospital from January 2017 to October 2018 were enrolled. The patients were randomly divided into control group and experimental group with 37 patients in each group. Both groups of patients were treated with broad-spectrum antibiotics empirically, while received fluid resuscitation via the subclavian vein catheter. The patients of control group were given rapid fluid replacement, and those of experimental group received fluid replacement according to result of PLR combined with TTE. The stroke volume (SV) was measured by TTE before and after PLR, volumetric response of patients was judged by stroke volume variation (SVV). If the SVV≥15%, it was considered that there was a volume responsiveness, and fluid loading was given. If SVV﹤15%, it was considered that there was no volume shortage, and the restrictive fluid replacement was given. The goal of fluid resuscitation in both groups were to simultaneously meet the central venous pressure (CVP) of 8-12 mmHg (1 mmHg = 0.133 kPa), mean arterial pressure (MAP) ≥65 mmHg, urine volume ≥ 0.5 mL·kg-1·h-1, and central venous blood oxygen saturation (ScvO2) ≥ 0.70 within 6 hours. Vasoactive drugs were used when the patients could not achieve the treatment goals. The MAP, lactic acid (Lac), oxygenation index (PaO2/FiO2) and ScvO2 of the patients were determined at 6 hours of treatment, and serum C-reactive protein (CRP) and chest CT were reviewed at 48 hours of treatment, and compared with those before treatment. The total hospital stay and the mortality were recorded. Results There was no significant difference in gender, age, body weight and etiological structure between the two groups, which indicated that the baseline data were generally balanced. There was no statistical difference in MAP, Lac, PaO2/FiO2, ScvO2 and CRP before infusion between the two groups. After 6 hours of treatment, the MAP, Lac, PaO2/FiO2 and ScvO2 of the two groups were all better than those before infusion. Except for the difference in MAP between the experimental group and the control group (mmHg: 78.76±5.22 vs. 76.35±6.66, P > 0.05), the other three parameters in the experimental group were significantly better than those in the control group [Lac (mmol/L): 2.52±1.15 vs. 3.89±1.42, PaO2/FiO2 (mmHg):338.14±27.47 vs. 303.35±22.52, ScvO2: 0.70±0.04 vs. 0.63±0.05, all P < 0.01]. After 48 hours of treatment, CRP levels of both groups were lower than those before infusion, and the experimental group was better than the control group (mg/L: 110.12±39.80 vs. 137.98±31.23, P < 0.01). Chest CT showed that the incidence of pulmonary edema in the experimental group was significantly lower than that in the control group [13.5% (5/37) vs. 37.8% (14/37), P < 0.01]. The hospital stay of the experimental group was shorter than that of the control group (days: 21.47±5.58 vs. 28.33±4.93, P < 0.01), but no significant difference in mortality was found between the two groups [18.9% (7/37) vs. 18.9% (7/37), P > 0.05]. Conclusion Compared with the traditional rapid fluid replacement, early fluid resuscitation treatment strategies guided by the PLR combined with TTE, could better improve perfusion and oxygenation level of tissues and organs, avoid pulmonary edema caused by rapid fluid replacement, shorten the hospital stay in patients with septic shock, but had no significant effect on hospital mortality.

Objective:To investigate the mechanism of dexmetomidine (DEX) in improving lung injury in septic mice.Methods:Male C57BL/6 mice were randomly assigned to the blank group (NC), sham operation group (sham), cecal ligation and puncture group (CLP), and Dex treatment group (CLP+DEX), 36 mice per group. Mice in the CLP group were intraperitoneally injected with 1 mL sterile saline 15 min before CLP, and mice in the CLP + DEX group were intraperitoneally injected with 50 μg/kg DEX 15 min before CLP. The survival rate was recorded within 24 h after CLP. The mice were sacrificed at 0, 3, 6, 12, and 24 h after CLP, and lung tissues were collected. The expression levels of cytokines (IL-6, IL-1β, TNF-α) and lncRNA-HOTAIR in the lung of mice were detected by qPCR. RAW264.7 cell were cultured in vitro, LPS (100 ng/mL) and DEX (1 μ mol/L) were used to establish a cell model for studying the mechanism of Dex, and the expression of cytokines (IL-6, IL-1β, TNF-α) and lncRNA-HOTAIR in RAW264.7 cell model were detected by qPCR. In addition, the effect of lncRNA-HOTAIR on sepsis was explored in vivo and in vitro by knockdown or overexpression of HOTAIR.Results:The survival rate of the CLP+DEX group was higher than that of the CLP group within 24 h after surgery, and the levels of IL-6, IL-1β, and TNF-α in the lungs were significantly lower than those in the CLP group at 6, 12, and 24 h after surgery ( P<0.05). In addition, the level of lncRNA HOTAIR showed that the expression level of lncRNA HOTAIR in the lungs of mice were decreased after Dex treatment, and were decreased 1.1 times ( P<0.05), 4.0 times ( P<0.01) and 3.8 times ( P<0.01) at 6, 12, and 24 h, respectively. Compared with the NC group, knockdown of HOTAIR significantly decreased the levels of IL-1β, IL-6, and TNF-α in septic mice ( P<0.05), and overexpression of HOTAIR significantly increased the levels of IL-1β, IL-6, and TNF-α in septic mice ( P<0.01). Conclusions:DEX can reduce the production of inflammatory factors in the lungs of septic mice and improve the survival rate of septic mice. The mechanism may be related to the inhibition of HOTAIR expression.

Objective To evaluate theclinical efficacy and safety of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE),and analyze the advantages of ACOE compared to the traditionally anterior cervical surgery.Methods The clinical datawith more than one year follow-up of 96 patients suffered from cervical ossification of the posterior longitudinal ligament(OPLL) from April 2010 to March 2017 was retrospectively analyzed,including 57 males and 39 females,aged 32-69 years,average 54.6±8.7 years.There were 29 cases of nodular type (30.2％),48 cases of segmental type (50.0％),5 cases of continuous type(5.2％),and 14 cases of mixed type (14.6％).The neurological function assessments before and after operation were performed using the Japanese Orthopaedic Association (JOA) scoring system and the visual analogue scale (VAS) scoring system.The effect of ossified mass resection was observed by three-dimensional reconstruction CT scan.The spinal cord decompression was evaluated by MRI.The cervical curvature was compared before and after surgery by cervical lateral radiograph.The operation time,intraoperative blood loss,recovery rates of the JOA scores and complication rates of this group were compared with the cases of anterior cervical ossified posterior longitudinal ligament piecemeal resection (ACOP) reported by the recent literature to analyze the clinical efficacy,safety and advantages of ACOE.Results All the surgeries of 96 cases were successfully performed,including 57 cases (59.4％) with subtotal resectionof single vertebra,31 cases (32.3％) with subtotal resectionof doublevertebras,1 case (1.0％) with expanded intervertebral decompression,4 cases (4.2％) with "vertebra + semi-vertebra" subtotal resection,1 case (1.0％) with "semi-vertebra + vertebra + semi-vertebra" subtotal resection,2 cases with "double vertebras + semi-vertebra" subtotal resection (2.1％).Ninty-six cases were followed up for 12 to 78 months,with an average of 28.0±9.3 months.The preoperative JOA score with (11.38±2.80) scores was increased to 15.32± 1.62 scores at the last follow-up,and the recovery rate of JOA score was 74.63％±13.18％.The preoperative VAS score with 6.00±1.41 scores was reduced to 2.35±1.11 scores at the last follow-up.The cervical curvature increased from 10.4°±9.0° before surgery to 15.8°±8.1° at the last follow-up.CT showed that the ossified masses of the surgical segments were completely excised without residue;MRI showed that the compressionsof spinal cords and dural sacs were completely relieved,with nice morphology recovery.There was no neurological deterioration in this group.There were 6cases of cerebrospinal fluid leakage (CSFL),3 cases of C5 nerve palsy,1 case of Hornersyndrome,2 cases of dysphagia and hoarseness,1 case of titanium mesh subsidence with screw loosing.At the final followups,except one case of occasional throat foreign body sensation,the above complications were all remittedat different followup periods.Compared with the cases of ACOP reported by the recent meta-analysis,the operation time,the intraoperative blood loss,the complication rate of dysphagia with hoarseness and neurological deterioration were lower than those reported in the literature.The recovery rate of JOA scorewas higher than which reported in the literature.Conclusion ACOE is safe and effective for the treatment of cervical OPLL,which may be superior to traditional anterior cervical surgery in terms of surgical safe-ty,controllability of cerebrospinal fluid leakage and improvement of neurological function.