Objective To evaluate the efficacy of retroperitoneal laparoscopic pyelo-ureterolithotomy. Methods Totally 52 cases of unilateral urinary calculi were treated with retroperitoneal laparoscopic pyelo-ureterolithotomy in our hospital. All the patients received placement of ureteral stent during the operation. Results All the operations were completed successfully without conversion to open surgery. The time of the operation varied from 50 to 200 minutes with a mean of 110 minutes. The patients were discharged from hospital in 5 to 14 days (mean,7.5 days). Eight weeks after the operation,the stent was withdrawn from the patients. Follow-up was achieved in all of the patients for six months. Ultrasonography showed that the hydronephrosis disappeared in 21 cases at 3 months,and in 32 patients at 6 months. None of the cases had recurrence. ECT showed an increased GFR in eight patients with severe hydronephrosis (increased from a mean of 16 ml/min before the operation to 25 ml/min). Conclusions Retroperitoneal laparoscopic pyelo-ureterolithotomy is effective,safe,and less invasive for the calculi in the renal pelvic and upper ureter.

Objective] To explore the nursing method and effect of traditional Chinese medicine wet compress for the treatment of the disease of the blood vessel. [Method]Selects the hospital March 2013 to January 2015 ,a total of 96 patients with confirmed thrombotic occlusion vasculitis with the first period and the second period of patients, who were randomly divided into treatment group and control group, 48 cases in each, two groups at the same time, the routine nursing and the context of Mailuoning 30ml IV drip, treatment group based on the Tougu Tongmai Recipe wet applied external treatment, combined with TCM syndrome nursing. Two groups for 1 month for a course of treatment, observation of cold pain in the limbs, gap of claudication, soreness and numbness symptoms and treatment of total efficiency; readmission after followed up to observe the recurrence(deterioration), statistical analysis of parallel. [Results] The total effective rates of treatment group and control group were 95.8% and 68.75% respectively, the difference was statistically significant(P<0.05); the difference between the two groups was statistically significant(P<0.05); the difference between the two groups was statistically significant(P<0.05). [Conclusion] Compared with Mailuoning injection in the treatment of, Speranskia through vein wet compress external treatment nursing can effectively improve the thrombus occlusive vasculitis in patients with limb peripheral blood circulation, also can better reduce the recurrence rate, slow the progression of the disease, so as to achieve the purpose of disease treatment.

Objective To simulate the solution drought stress conditions with polyethylene glycol (PEG) 6000 for study on the seed germination of Cassia occidentalis.Methods The seed of C.occidentalis was treated with 5% and 10% PEG 6000,respectively,then the germination rate,the activity of superoxide dismutase (SOD),peroxidase (POD),and content of malondialdehyde (MDA) were measured.Results Compared with the same period of the control,soaking with 5% PEG 6000 for 5 h could increase the activity of SOD and POD,decrease the content of MDA.PEG Pretreatment could decrease free radical accumulation and make cell membrane system less damaged in the course of absorbing water in seed.Conclusion Soaking with 5% PEG 6000 for 5 h could increase the seed germination rate of C.occidentalis.

So far, the major therapeutic drugs of diabetes are western medicine , but side effects of hypoglycemic western med-icine are large and not easy to take for a long time .In recent years , we found the side effects of some kind of hypoglycemic Chinese herbal medicine were small , much easier to be accepted by the patients .Thus, the clinical treatment of diabetes may have new meth-ods.According to the mechanisms of Traditional Chinese Medicine for protection of islet function , this review will discuss them from re-ducing oxidative stress , increasing the number of islet cells and promoting βcells to secrete, relieving insulin resistance , increasing in-sulin sensitivity and so on .All of these aspects reflect the unique role of Traditional Chinese Medicine in the treatment of diabetes and protection of islet function .

Objective To explore the effect of microRNAs 224 and 21 on human glioma stem cells survival and the possible molecular mechanisms.Methods qPCR was used to detect the dysregulated expression of microRNAs in malignant glioma samples, human GBM stem cells, artificially established GBM stem cell lines and human tissues.Caspase 3/7 assay, Annexin V apoptosis/fluorescence assay were performed to determine the effect of miR-21 or miR-224 mimics and inhibitor on cell apoptosis.Living cells count was used to assess miR-21 or miR-224 mimics and inhibitor on cell growth.TargetScan was used to explore potential targets of miR-21 and miR-224, and dual luciferase reporter assay was used to identify whether the 3’UTR of Caspase 3, Caspase 9 and Bim mRNA was a binding target of miR-21 or miR-224.Western blot was used to detect the expression of Caspase 3, Caspase 9 and Bim protein after transfection of miR-21 or miR-224 mimics or inhibitors.Results miR-21 and miR-224 are strongly upregulated in GSC samples, multiple GBM human tumor specimens, and GBM neurosphere stem cell lines ( P<0.05 ) .Caspase 3/7 assay and Annexin V apoptosis/fluorescence assay results showed that miR-224 and miR-21 regulated GSC apoptosis.Living cells count results demonstrated that miR-224 and miR-21 regulated GSC growth.miR-224 and miR-21 regulate pro-apoptotic gene expression by directly targeting Caspase 3, Caspase 9, and Bim 3’-UTRs. Conclusion These results indicate that miR-224 and miR-21 are important physiologic drivers of GSC resistance to apoptosis, providing new points of therapeutic leverage against these treatment-resistant cells.

Objective:Whether extralevator abdominoperineal excision (ELAPE) improves survival and safety remains controversial.Systematic review of all comparative studies to define the superiority of ELAPE to conventional abdominoperineal excision (APE).Methods:Corresponding data,with case-control studies or cohorts regarding intraoperative perforation rate,the local recurrence rate and postoperative complications in the ELAPE group and the APE group,were retrieved from PubMed,Embase,the Cochrane Library,Chinese Biomedical Literature (CMB),VIP,China National Knowledge Infrastructure (CNKI),and Wanfang Database.Meta-analysis was performed by using RenMan 5.2.Results:A total of 10 articles were included.Intraperative perforation rate (MD=0.54,95％ CI 0.31 to 1.39,P=0.03),local recurrence rate (MD=0.30,95％ CI 0.21 to 0.42,P＜0.001) in the ELAPE group was significantly lower than that in the APE group.The difference in positive margin rate between the 2 groups was not statistically significant (P=0.07).Conclusion:Through gap repair of episiotomy and individualized therapy can improve ELAPE postoperative quality of life.ELAPE shows certain advantages in treating lower rectal cancer comparing to APE,but it should pay attention to individualized treatment.More studies through large sample multi-center,medium and long term randomized design are necessary to determine the effect of surgery on tumor.

Objective:To investigate the effect of short-term intensive treatment with insulin on metabolic control,?-cell function and insulin resistance in newly diagnosed type 2 diabetic patients. Methods:Thirty-eight newly diagnosed type 2 diabetic patients were randomly divided into two groups and treated with continuous subcutaneous insulin infusion(CSII) or multiple daily insulin injection(MDI) for 1 month.Fasting blood glucose(FBG) and lipid profiles were measured,and oral glucose tolerance test(OGTT)was performed before and after the treatment.The second phase insulin and C peptide secretions were measured by calculating area under curve(AUC) in OGTT.HOMA model was used to evaluate ?-cell function((HOMA-?)) and insulin resistance. Results:Excellent control of FBG was achieved after 1 month intensive treatment.(HOMA-?) was improved significantly. Conclusion:The excellent metabolic control and ?-cell function improvement can be achieved by short-term intensive insulin therapies like CSII or MDI.

Objective To evaluate the clinical value of CT scan in the diagnosis of tracheoesophageal groove lymph node (TEGLN) metastasis of thoracic esophageal carcinoma. Methods Forty-six patients with thoracic esophageal carcinoma underwent esophagectomy with three-field dissection (3FD) of the cervical, mediastinal, and abdominal lymph nodes. CT findings of TEGLN were compared with that of pathological findings. Results Among the 46 patients who underwent esophagectomy with 3FD, 14 (30%) were found to have TEGLN metastases. Of the 277 TEGLNs excised by operation, 16 were found to have metastases. Primary sites of the thoracic esophageal carcinoma with TEGLN metastasis in upper, middle, or lower portion were 66.67%, 22.86%, and 40%, respectively. The difference between each portion was not statistically significant. The thoracic esophageal carcinoma with TEGLN metastasis in T 1, T 2, T 3 and T 4 staging were 50.00%, 25.00%, 28.57%, and 100.00%, respectively. There was no statistically significant difference between each T staging. 18 TEGLNs were found in CT scans. The average diameter of them was 1cm (0.3～2.5 cm). Sensitivity and specificity of CT examination were 87.50% and 98.47%, respectively. Positive predict value and negative predict value were 77.78% and 99.23%, respectively. Conclusion In patient with thoracic esophageal carcinoma, nodules appeared in tracheoesophageal groove could be diagnosed as lymph nodal metastases. Low cervical and mediastinal CT scan should be a conventional examination, and it was the basis of the radiation therapy plan. Dissection of TEGLN was very important for patient of thoracic esophageal carcinoma, but if bilateral tracheoesophageal grooves were negative in CT scans, and bilateral internal jugular chain and bilateral superclavicular lymph node were both negative in clinical examination. 3FD dissection, which could increase the rate of operative complication, was not conventionally used.

The construction of harmonious doctor-patient relationship is an important project in social medicine .The influen-cing factors about doctor-patient relationship are analyzed from three aspects which are responsibility ethics , bottom-line ethics and clin-ic ethics.Based on the discussion , certain countermeasures are proposed to reconstruct harmonious doctor -patient relationship .

The hospital grade assessment is an effective approach to measure the comprehensive strength and the overall level of a hospital, and it is also an effective carrier which can promote the standardized management , improve the quality of connotation and accelerate the development of the hospital .This article aims to expound the effective and concrete methods for preparation in the hospi -tal grade assessment by introducing the practice and experience of Jinling Hospital in grade assessement .It also points out that:defi-ning the purpose of the assessment is the fundation , having a thorough grasp of the assessment criteria is the basis , having a compre-hensive knowledge of the hospital is the premise , establishing and implementing the plan strictly is the crux .All these might be helpful to promote the hospital grade assessment .