Objective To discuss the feasibility of percutaneous nephrolithotomy (PCNL) for treating upper urinary calculi under local anesthesia.Methods One thousand three hundred and sixty-three patients who suffered with upper urinary calculi were treated with PCNL, the puncture and tracts were created using local anesthesia and guided through ultrasound.Of the 1363 patients, 475 patients had complicated renal caluli, 520 patients had kidney pelvic calculi and 368 had upper uretere calculi.Results All of the patients successfully received PCNL under the local anesthesia.Of the 1363 patients five tracts were used in two patients, four tracts were used in four patients, three tracts were used in nine patients, double tracts were used in 25 patents and one tract was used in the remaining patients.The stone-free rate was 96.0% in the kidney pelvic calculi patients, 100.0% in the upper uretere calculi patients, and 90.1% in the complicated renal caluli patients.90.0% patients were find well throught the operation, 10.0% patients find a little pain and solved by another more 5 - 10 ml lidocaine local injection or 50 - 75 mg pethidine hydrochloride intramuscular injection.No case stop operation because of pain or position changed.All without any severe complications such as damaged of liver, spleen, thorax and intestine.Conclusion The PCNL handled under local anesthesia was simple safe and effective, deserved clinical popularizing use.

Objective To explore the inhibitory effect of tetramethylpyrazine (TMP) on ultraviolet A-induced senescence as well as matrix metalloproteinase-1 (MMP-1) and-3 (MMP-3) mRNA expressions in human dermal fibroblasts (HDFs).Methods HDFs were isolated from the prepuce by enzymatic digestion, and subjected to primary culture.Cultured HDFs were randomly divided into several groups: control group cultured in high-glucose DMEM medium and receiving no treatment, three TMP groups treated with 20, 50 and 100 mg/L TMP respectively, UVA group receiving UVA radiation alone, UVA + TMP groups pretreated with 20, 50 and 100 mg/L TMP respectively for different durations followed by UVA radiation.UVA radiation was given once daily for 5 consecutive days.The 55th passage HDFs served as the P55 group (senescence control group).Subsequently, CCK-8 assay was performed to evaluate the proliferative activity of HDFs in vitro, optical microscopy to observe the morphologic changes of HDFs after UVA radiation, β-galactosidase staining to estimate the senescence in HDFs, and real-time fluorescence-based quantitative PCR to quantify the mRNA expressions of MMP-1 and MMP-3 in HDFs.Statistical analysis was carried out by one-way analysis of variance (ANOVA) followed by least significant difference (LSD)-t test or Dunnett's T3 test.Results Compared with the control group, the proliferation of HDFs was significantly but transiently inhibited in vitro after the treatment with 100 mg/L TMP for 48 hours (P ＜ 0.05), but showed no significant changes after the treatment with 20 or 50 mg/L TMP for 24, 48 or 72 hours or after the treatment with 100 mg/L TMP for 24 or 72 hours (all P ＜ 0.05).The pretreatments with TMP of 20, 50 and 100 mg/L for 24, 48 and 72 hours all promoted the proliferation of HDFs to a certain degree in the UVA + TMP groups compared with the UVA group, with significant differences in cellular proliferative activity among the UVA group, UVA + TMP groups and control group at 24, 48 and 72 hours (F =17.451,15.231, 23.535, all P ＜ 0.01).Compared with the UVA group, the proliferative activity of HDFs was significantly increased in UVA + 100-mg/L TMP group at 24, 48, 72 hours, UVA + 50-mg/L TMP group at 24 and 72 hours and UVA + 20-mg/L TMP group at 72 hours.After repetitive UVA radiation, HDFs in the UVA group experienced an increase in cell volume, granule acount, and β-galactosidase expression, which was similar to the changes in the P55 group, while the pretreatments with 20, 50 and 100 mg/L TMP for 24 hours suppressed these UVA-induced changes in HDFs.The percentage of β-galactosidase-positive HDFs was 68.417％ ± 1.181％ in the UVA group, 58.167％ ± 5.620％ in the UVA + 20-mg/L TMP group, 45.167％ ± 5.502％ in the UVA + 50-mg/L TMP group, 43.000％ ± 2.000％ in the UVA + 100-mg/L TMP group, 33.667％ ± 5.865％ in the control group, and 76.000％ ± 6.557％ in the P55 group, with significant differences among these groups (F =45.918, P ＜ 0.01).Furthermore, the UVA group significantly differed from the UVA + TMP groups and control group in the percentage of β-galactosidase-positive HDFs and mRNA expressions of MMP-1 and MMP-3 (all P ＜ 0.05).Conclusion TMP can protect HDFs against senescence induced by repetitive UVA radiation, and down-regulate the mRNA expressions of MMP-1 and MMP-3 during senescence.

Objective To explore the effects of transitional nursing on the quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 118 patients in the stable phase of COPD, who were discharged from the Affiliated Hospital of Xuzhou Medical University during March 2015 to June 2016 were selected by convenience sampling method and divided into observation group (n=60) and control group (n=58) according to the random number table. The patients in the control group were treated with routine nursing mode, while the patients in the observation group were given transitional care after discharged on the basis of routine nursing. The effects of the transitional care and patients' quality of life were evaluated with Care Transitions Measure (CTM) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) at three time points, before intervention, three and six months after the intervention. Results There was no statistical difference in the score of CTM between the two groups before intervention (P>0.05). After intervention for 3 and 6 months, the CTM score of the observation group patients were significantly higher than that of the control group, and the differences were statistically significant (P<0.05). Before intervention and 3 months after intervention, patients' CAT score had no statistical difference between the two groups (P> 0.05). The CAT score of the patients in the observation group was lower than that in the control group after intervention for 6 months, and the difference was statistically significant (P<0.05). Conclusions Transitional nursing mode can improve the cognition of patients in COPD stable phase, promote healthy lifestyle and behavior, and improve patients' quality of life.

OBJECTIVE[corrected] To evaluate the method and technique of single-port laparoscopic radical nephrectomy.

METHODSForm January 2009 to September 2011, 22 patients with renal carcinoma were treated with single-port laparoscopic radical nephrectomy. An incision about 5 cm in length was made through the umbilicus or in the postaxillary line under the 12th rib to establish the peritoneal or retroperitoneal working space. A single-port cannulation was deployed and the operation was carried out using standard and crooked laparoscopic equipment.

RESULTSThe operations were completed successfully in all the 22 cases without conversion to open surgery, but additional trocar was needed in 5 cases. The mean operative time of radical nephrectomy was 150 min (90-240 min). The mean postoperative hospital stay was 7.6 days (3-15 days). The operation left a roughly 5-cm-long scar in all the cases.

CONCLUSIONSingle-port laparoscopic radical nephrectomy is safe and feasible with good cosmetic effect and shows much potential in radical resection of renal carcinoma.

Adult ; Aged ; Female ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Young Adult

Objective:To investigate the experience of moderate hypothermia(28℃) using in Stanford A aortic dissection.Methods:A retrospective analysis of 100 patients with Stanford A aortic dissection from January 2012 to March 2014, including 50 cases with deep(25℃) hypothermic circulatory surgery and 50 moderate(28℃) hypothermic circulatory surgery. The operation was performed with ascending aortic replacement, inclusiong aortic arch angioplasty, and stent implantation with descending aorta stent. The difference between the 2 groups during and after the operation was compared.Results:2 cases died in the hypothermia group, and 3 cases died in the deep hypothermia group. There were significant differences( P<0.05) between the middle and low temperature groups in the cooling time, the time of stopping circulation, the time of rewarming, the time of cardiopulmonary bypass, the time of operation, the time of operation, the time of conscious, the time of mechanical ventilation and the first day after the operation( P<0.05), but there was no significant difference between the creatinine and the bilirubin( P>0.05). Conclusion:Under the condition of sufficient cerebral perfusion and spinal cord protection, moderate hypothermia is safe, and it can reduce the operation time and postoperative complications. It has certain clinical significance.

Objective To evaluate the effects of the application of high-flow nasal cannula (HFNC)for the respiratory failure following radical resection of pulmonary carcinoma. Methods A total of 48 patients with radicalsurgeryofpulmonarycarcinoma effect postoperative failure from February 2015 to August 2016 were randomly divided into observation group(24 cases) and control group(24 cases) with digital table method.The observation group was received with HFNC,and the control group with oxygen atomization mask 8-10 L/min.The heart rate,respiratory rate,PaO2,PaCO2and oxygenation index(PaO2/FiO2)changes were evaluated before treatment,treatment for 1,6,24 h and at the end of the treatment in both groups, at the same time, noninvasive positive pressure ventilation (NPPV) rate, again intubation mechanical ventilation rate, incidence of ventilator associated pneumonia (VAP), ICU confusion assessment (CAM-ICU) positive rates and ICU stay time were compared in the course of treatment of difference. Results Through two different methods of treatment, the heart rate, respiratory rate, PaO2, PaCO2,PaO2/FiO2were(78.88±12.03)times/min,(18.96±7.53)times/min,(140.2±18.37)mmHg(1 mmHg=0.133 kPa),(37.04±7.67)mmHg,(242.83±27.13)mmHg in the observation group,respectively,compared with(88.83±16.48)times/min,(25.46±9.51)times/min,(86.08±20.83)mmHg,(45.71±10.37)mmHg and(210.71±36.34)mmHg in the control group,which had significant differences(t=-3.922-3.415,P<0.05). The ICU stay time in the observation group was( 68.71 ± 32.38) h, respectively, which was much shorter than that in the contorl group(107.67±66.15) h, the difference was statistically significant (t=2.416, P<0.05). The occurrence rates of NPPV and the positive rates of CAM-ICU were16.7%(4/24),4.2%(1/24)in the observation group,respectively,compared with 45.8%(11/24),33.3%(8/24)in the control group,which had significant differences(x2=4.752,4.923,P<0.05). Conclusions HFNC is a new and effective way of oxygen therapy that can better improve circulation oxygenation,reduce PaCO2,reduce the rate of line of NPPV and CAM-positive rate in the ICU,and can shorten the patient's ICU stay time in the treatment of lung cancer patients with postoperative respiratory failure.