Objective To evaluate the application value of ureteroscopy in the diagnosis and treatment of ureteral obstruction.Methods Clinical data of 52 cases of non-calculous ureteral obstruction treated by ureteroscopy were analyzed retrospectively.Results Of 35 cases of ureteral stricture,19 cases of routine dilatation,13 cases of balloon dilatation,and 3 cases of ureteroplasty were accomplished under ureteroscope.Holmium laser resection was employed in 13 cases of ureteral polyps.Conversions to open surgery were required in 3 cases of ureteral cancer,and an ureteroplasty was carried out in 1 case of retrocaval ureter.Complications included 2 cases of ruptured mucous membrane or urethral false passage and 1 case of ureteral perforation.Conclusions Ureteroscopy can clarify the etiology of ureteral obstruction and offer corresponding treatment.

OBJECTIVE:To study the general pattern and characteristics of the ADRs associated with Houttuynia cordata injection(HCI).METHODS:An analysis was conducted on55cases of ADRs induced by HCI reported in domestic medical jou_ rnals in recent years.RESULTS:The ADRs of HCI were not related to the dosage given.The onset of ADRs was commonly within30min during infusion.The ADRs mostly occurred in groups of patients under age20and from30to59years of age.The ADRs could involve multiple organs and systems,and the clinical manifestations were varying,of which allergic reaction was the commonest one including anaphylactic shock.CONCLUSION:The mechanism of allergic reaction induced by HCI remains to be further studied.Clinical physicians,nurses and pharmacists should pay more attention to the ADRs of HCI.

OBJECTIVE:To systematically review the efficacy and safety of insulin glargine versus premixed insulin in treat-ment of type 2 diabetes,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,CJFD, Wanfang Database and VIP Database,the randomized controlled trials(RCT)about the efficacy and safety of premixed insulin ver-sus insulin glargine in the treatment of type 2 diabetes were collected. Meta-analysis was performed by using Rev Man 5.0 statistics software after extracting data and evaluating quality by modified Jadad. RESULTS:A total of 10 RCTs were enrolled,involving 1 655 patients. Results of Meta-analysis showed that insulin glargine was better than premixed insulin on reducing glycated hemoglobin [M=-0.41,95% CI(-0.64,-0.18),P<0.001] and fasting blood glucose [MD=-0.51,95% CI(-0.99,-0.02),P=0.04], there were significantly differences between 2 groups,and there were no significantly differences in reducing 2 h postprandial blood glucose [MD=-0.56,95% CI(-1.21,0.09),P=0.09] and body mass index [MD=-0.52,95% CI(-1.52,0.48),P=0.31];the incidence of hypoglycemia in insulin glargine group was significantly lower than premixed insulin,there were significantly differ-ences between 2 groups [RR=0.65,95%CI(0.46,0.90),P=0.01]. CONCLUSIONS:The efficacy and safety of insulin glargine are better than premixed insulin in the treatment of type 2 diabetes.

OBJECTIVE:To screen Gongshisong's active sites for anti-sports fatigue. METHODS:Gongshisong extract was prepared with 80% ethanol extraction technology,and extracted with petroleum ether,chloroform,ethyl acetate and n-butyl alco-hol after dispersed with water to obtain the extract. 70 mice were randomly divided into blank control group(1% sodium carboxy-methylcellulose,CMC-Na),positive control group [Rhodiola wallichiana capsules,590 mg/(kg·d)],petroleum ether,chloro-form,ethyl acetate and n-butyl alcohol extracts and aqueous layer of Gongshisong groups(TS,TL,TY,TZ,TW groups). Gong-shisong extracts groups was given relevant medicine 2.5 g(crude drug)/(kg·d),ig,for consecutive 7 days. Exhaustion time of bur-den swimming test was detected. 70 mice were grouped according to above method,and the contents of liver glycogen,muscle gly-cogen and the coefficient of liver were tested in mice. 80 mice were grouped according to above method,and model group was es-tablished additionally(1% CMC-Na). The contents of lactic acid(LA),creatine kinase(CK)and urea nitrogen(BUN)in serum of mice were determined after 90 minutes of unburden swimming. RESULTS:Compared with blank control group,exhaustion time of burden swimming mice in TS,TY and TZ groups prolonged;the content of liver glycogen increased in TY,TZ and TW groups;the content of muscle glycogen increased in TS and TW groups;the contents of BUN,LA and CK in mice increased in model group (P<0.05 or P<0.01). Compared with model group,the serum content of BUN in mice decreased in TS and TY groups;that of LA in mice decreased in TZ and TW groups;that of CK in mice decreased in TS group (P<0.05 or P<0.01). CONCLUSIONS:The petroleum ether and n-butanol extract site and water layer of Gongshisong are good anti-fatigue active sites.

Objective:To investigate the clinical characteristics, treatments and prognosis of pulmonary arteriovenous fistula (PAVF) related ischemic stroke, as well as summarize the diagnosis and treatment process to screen and confirm PAVF related ischemic stroke.Methods:The clinical data of six PAVF related ischemic stroke patients in the First Affiliated Hospital of Fujian Medical University from January 2015 to January 2019, including clinical manifestations, brain magnetic resonance imaging, risk of paradoxical embolism (RoPE) score, contrast-enhanced transcranial Doppler (cTCD), contrast transesophageal echocardiography (cTEE), chest CT and pulmonary arteriography, were analyzed. PAVF patients were treated with interventional catheter embolization or conservative medication. All patients were followed up for 1.5 to 5.5 years.Results:All the six PAVF related ischemic stroke patients were young and middle-aged. The ratio of men to women was 1∶2. RoPE scores ranged from 6 to 7 points. Recurrent stroke was seen in five patients, and only one patient had primary stroke. Both anterior and posterior cerebral circulation could be involved. Hereditary hemorrhagic telangiectasia (HHT) was common in PAVF patients. Of the six patients, two had definite HHT with PAVF, two had suspicious HHT with PAVF, and the other two had sporadic PAVF. In all the six cases, a grade Ⅳright-to-left shunt (RLS) was observed on cTCD, and a mass of delayed microbubbles in the left atrium appeared on cTEE. One patient was diagnosed with patent foramen ovale (PFO). Lung enhanced CT was applied in all the patients. In three cases, PAVF was found located in left lower lobe. And in other three cases, lesions were located in left upper lobe, right lower lobe and right middle lung, separately. All cases were confirmed with simple type PAVF. Transcatheter embolization was performed to resolve PAVF in five patients. Of five post-operative patients, four cases showed no sign of RLS on cTCD. One patient combined with PFO still remained a small amount of potential RLS after embolization. One patient chose aspirin for conservative medication. All patients had no recurrence of ischemic stroke during the 1.5 to 5.5-year follow-up.Conclusions:PAVF related ischemic stroke patients have a high recurrence rate of ischemic stroke. PAVF related ischemic stroke has no specific brain imaging characteristics. cTCD is recommended for cryptogenic stroke patients with a high RoPE score (≥ 6 points) to detect RLS. If a patient turns out to be positive for RLS, cTEE could help differentiate intracardiac shunt from extracardiac shunt. For patients with cTEE suggesting extracardiac shunt, lung enhanced CT scan is necessary to confirm PAVF diagnosis. Patients who are diagnosed as PAVF can choose transcatheter embolization or surgical resection. cTCD could be used to evaluate the treatment effect.

With the roaring development of bioscience and its application in medicine, molecular diagnosis specially gene diagnosis shows striking advantages in disease diagnosis, treatment and prognostic assessment.Mo-lecular diagnosis mainly includes prenatal genes diagnosis the children of gene diagnosis and adult genetic diagno-sis.Molecular diagnosis is expounded from the aspects of medical practice in the field of medical ethics problem and how to correct the medical practice of molecular diagnosis of work, designed to guide all the medical workers to form the correct ethics in the field of molecular diagnostics.

BACKGROUND:In perioperative period of total knee replacement in elderly patients, it is crucial to maintain the normal function of blood coagulation. However, many factors may influence coagulation function of patients in perioperative period. Of them, anesthesia is an important factor. Different anesthesia methods wil produce different effects on blood coagulation. Appropriate anesthesia methods should be selected in the clinic to maintain the stability of coagulation function. OBJECTIVE:To explore the effect of application of general anesthesia and epidural anesthesia in elderly knee replacement and the effects on the function of blood coagulation. METHODS:A retrospective analysis was performed on clinical data of 135 elderly patients after total knee replacement in Dongying Hospital of Shandong Provincial Hospital Group from September 2012 to September 2013. Al patients were divided into control group (67 cases;general anesthesia) and observation group (68 cases;epidural anesthesia) according to the mode of anesthesia. Coagulation indexes and D-dimer levels were observed before anesthesia, 6 hours after anesthesia, and 1 day after replacement in both groups. The incidence of deep venous thrombosis was measured and compared between the two groups in 12-month fol ow-up.
RESULTS AND CONCLUSION:Through the statistics and comparison, no significant difference was detected in blood coagulation indexes at different time points in the two groups (al P>0.05). However, significant differences in D-dimer levels were detectable between the two groups at 6 hours after anesthesia and in the morning at 1 day after replacement. D-dimer levels were significantly lower in the observation group than in the control group (al P<0.05). The incidences of deep venous thrombosis were 3%and 21%in the observation and control groups, respectively, showing significant differences (P<0.05). These results suggest that epidural anesthesia during elderly totak knee replacement obtained good effects, and could maintain stable coagulation function.

Objective: To optimize the extraction process of total flavonoids from Oxytropis falcata bunge.Methods: With the content of total flavonoids as the index,and based on the results of single factor tests, central composite design-response surface methodology was adopted to optimize the extraction technology with the solvent amount, ethanol concentration and extraction time as the factors.Results: The optimal extraction conditions were as follows: extracted twice with 20-fold amount of 66% ethanol, and 84 minute per time.Under the above conditions, the extraction rate of total flavonoids was up to 23.21 mg·g-1.Conclusion: The central composite design-response surface methodology is convenient and highly predictive for the extraction optimization of total flavonoids from oxytropis falcata bunge.

Objective To evaluate the outcome of lung volume reduction surgery (LVRS)under video-assisted thoracoscopy in patients with severe chronic obstructive pulmonary emphysema.Methods The follow-up date of 68 patients with severe emphysema underweut LVRS by video-assisted thoracoscopy were analyzed retrospectively betweeu June 2002 to June 2012.Mean FEV1.0 、FCV 、RV、PO2 、PCO2 、mean 6MWT were assessed before their surgery and 6 months,1-year and 2-years after their surgery respectively.Results Compared with their preoperative results,Lung function,arterial blood gasanalysis and 6-minute walk distance (6-MWD) increased outstanging.Conclusion LVRS by VATS provides significant clinical and physiological improvement for the majority of patients with severe chronic obstructive pulmonary emphysema.

ObjectiveTo investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia. MethodsSixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device. ResultsAfter treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R² > 0.804, P < 0.001). ConclusionThe combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.