Objective To explore the safety and efficacy of ultrasound-guided minimally invasive percutaneous nephrolithotomy(mini-PCNL) for the patients with complicated upper ureteral calculus.Methods The clinical data of 28 patients with complicated upper ureteral calculus was retrospectively analyzed,all of the patients had undergone ultrasound-guided mini-PCNL.The parameters included operative time,the stone-free rate,theretention time of nephrostomy tube,the average postoperative hospital stay and the complications.Results In all the 28 case,the 16F nephrostomy tract was established and the calculus were cleared successfully in one stage.The average operative time was 40 minutes,the average estimmate intraoperative blood loss was 60ml.The stone-free rate was 100％ according to the ultrasonography or KUB after the surgery.There were no complications such as bleeding,the damage to pleura or intestines.Conclusion As the preferred treatment of complicated upper ureteral calculus,ultrasound-guided miniPCNL is a safe and effective procedure.

Objective To examine and assess the clinical effect of Er ∶ YAG 2940 nm fractional laser resurfacing for skin wrinkles.Methods A total of 16 patients with Fitzpatrick skin type Ⅳ and facial wrinkles,were treated with Er ∶ YAG 2940 nm fractional laser resurfacing and follow-up were given every week after treatment,four weeks in all.Response to treatment was evaluated by observers and patients themselves.Photos were analyzed by the photoshop 12.0 software.Results During the four-week follow-up,the skin of patients was more and more better than pretreatment,and a large part of wrinkles was disappeared.The assessment of observers for wrinkle amelioration rose from (6.50--2.33) ％ to (34.80±5.24) ％ and the scores of content of patients was up to 4.00±0.27(generally satisfied),whereas no one satisfied at beginning.Analyzed by photoshop 12.0 software,the data of average and middle values were on the trend of increasing in all these four weeks while SD was basically on the trend of decreasing.Conclusions Fractional ablative photothemolysis using Er ∶ YAG 2940 nm laser is a promising option for skin wrinkles.

Objectives: To compare the efficacy of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in postoperative analgesia after spinal fusion. Methods: The CNKI, Wanfang, CBM, Pubmed, Embase, Ovid, Cochrane library databases were searched by computer. The randomized controlled trails with patient-controlled epidural analgesia or patient-controlled intravenous analgesia after spinal fusion published from May 1985 to July 2013 were selected. All of them were assessed by the standard of Cochrane systematic review. Data of postoperative VAS and the rate of side effects after using the analgesic drugs were extracted into an electrical sheet, which was synthesized by a Meta-analysis with RevMan 5.2 software. Re-sult: Eight randomized controlled trails involving 482 patients met the inclusion criteria. And the quality grade of 3 literatures was A, 5 literatures was B. The result of meta-analysis showed that: ①Visual analogue score(VAS). The postoperative first day′s VAS[WMD=-0.47, 95%CI(-0.74, -0.20)], second day′s VAS[WMD=-0.66, 95%CI(-1.14, -0.19)] showed that the patient-controlled epidural analgesia had a good analgesic effect compared with the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). No dif-ference in the postoperative third day′s VAS[WMD=-0.58, 95%CI(-1.38, 0.21)] was observed between the two methods, and no statistic difference(P>0.05); ②The side effects. The patient-controlled epidural analgesia had a higher incidence of skin itch[RR=1.53, 95%CI(1.08, 2.16)], paresthesia[RR=3.34, 95%CI(1.12, 9.98)] after surgery than the patient-controlled intravenous analgesia, and both had statistic differences(P<0.05). While two groups had no a significant deviation about nausea [RR=1.05, 95%CI (0.79, 1.40)], vomiting [RR=0.80, 95%CI (0.48, 1.31)], and no statistic difference(P>0.05). Conclusions: The patient-controlled epidural analgesia has better analgesic effects on the postoperative first and second day after spinal fusion, but obviously has a high-er incidence of skin itch and paresthesia than the patient-controlled intravenous analgesia.

Objective To discuss nursing of patients with early severe acute pancreatitis undergoing laparoscopic treatment and in comparison with open surgery. Methods Totally 56 patients with early se-vere acute pancreatitis were admitted from October 2002 to October 2007,among which 30 cases (group A) received laparoscopic.treatment and the other 26 cases (group B) was given open surgery.The average time of hospital stay,incidence of complication and re-operation were compared between the two groups. Re-sults The average time of hospital stay,incidence of complication and re-operation of group A were lower than those of group B (P<0.05). Conclusions Treatment of severe acute pancreatitis with laparoscopy proved to be a desirable method in that it performs good effect with little trauma and low fatality.Other basic treatment,regulation of water and electrolyte balance and acid-base balance,enforcement of nutritional sup-port,fasting and gastrointestinal decompression should not be ignored.

Itis confirmed that the core part of traditional functions of gentian is consistent with the record in Pharmacopoeia by comparison the gentian function recorded in ancient literatures, prescription andPharmacopoeia. We found some functions and disease treatments by gentian were not recorded by Pharmacopoeia. These functions summarized by ancient literatures included heat-clearing and detoxifying, eliminate rickets, tranquilizing, cooling blood and hemostasis and chlordimeform. And inPuji Prescriptions database those disease treatments by gentian included sore, rickets, feeling uneasy, seizures and bleeding. By analyzing the literature and combination with the results of modern pharmacology and clinical medicine research, it is believed that the potential functions of gentian are heat-clearing and detoxifying, rickets eliminating, tranquilizing, blood cooling and hemostasis and chlordimeform.

A harmonious physician-patient relationship is the basis of high-quality medical service,and the ultimate goal of building up humanistic care in hospitals.Based on the proposal of "Three Alls" and combined with successful experiences in practice,this paper comes up with some effective means in constructing a harmonious physician-patient relationship in order to provide hospital managers with feasible ideas and suggestions.

Objective To observe the expression and localization of the islet amyloid polypeptide(IAPP) in the stomach of human fetus. Methods The localization of IAPP immunoreactive(IR) cells in 12 human fetal bodies of stomach from 11th to 20th week of gestation was investigated with immunohistochemical SABC method. Results At 11th week of human fetal age,the IAPP-IR cells had been found in the gastric mucosa.The IAPP-IR cells were dominantly concentrated in the fundic gland.The number of IAPP-IR cells increased gradually,and the immunostain of immunoreactive cells darkened gradually from 14th to 20th week of gestation.As compared with the adjacent sections which were stained by HE,some IAPP-IR cells were co-localization with parietal cells.Conclusion IAPP-IR cells exist in the human fetal body of stomach..

12 patients with inconsistent growth of twins were involved.The acoustic features were analyzed,inclu-ding 2D and Doppler images.The differential diagnosis was verified during follow-up exam in some patients.8 cases were diagnosed with sIUGR by ultrasonography,meanwhile 3 were diagnosed with TTTS.The rest 1 case could not be etiologically diagnosed due to the bad image conditions.We can differentiate the two diseases by evaluating the umbilical cord insertion,the amiotic fluid and the hemodynamics of the other twin.Ultrasonography is helpful in the differential diagnosis for TTTS and sIUGR.

Although anterior cervical fusion has been a conventional surgical treatment for cervical spondylosis, concerns for the possible accelerated degeneration of adjacent segments after fusion have been growing. Fusion can also lead to other drawbacks, such as alteration of spinal biomechanics, graft and hardware complications, and chronic pain at the harvest site. In addition, it must be realized that decompression, not fusion, is the primary goal of anterior cervical surgery. Since the artificial cervical disc replacement can preserve enough motion after neural decompression with adequate stability, it provides a new surgical therapy for cervical spondylosis. This paper summarizes the progress in the related research field and makes comments on the current developments and future prospects of cervical arthroplasty.

Objective To investigate the ontogeny of the islet amyloid polypeptide immunoreactive (IAPP IR)cells and 5 hydroxytryptamine(5 HT)immunoreactive cells(EC cells)in human fetal small intestine and the relation between IAPP and 5 HT. Methods The immunohistochemical technique was used. Results IAPP IR cells were only observed in the fetal duodenum.At 16 weeks,single IAPP IR cell occurred in the epithelium of duodenum;From 22 to 27 weeks,the number of IAPP IR cells was gradually increased,which were mainly located in the intestinal glands.EC cells were detected in each section of small intestine,with the growth of fetus,the density of EC cells in small intestine decreased in order of duodenum,jejunum and ileum respectively.At the week of 11,EC cells were found in the epithelium of intestinal villi and undifferentiated glands.The number of EC cells showed a peak from 17 to 21 weeks of gestation.EC cells were dominantly concentrated in the epithelium of root villi and glands.After 22 weeks,EC cells decreased.The co existence of IAPP and 5 HT was not detected in the same cell,as compared with adjacent sections.Conclusion\ The results indicated that IAPP and 5 HT were expressed in endocrine cells of human fetal small intestine.IAPP IR cells and EC cells varied with the development of the human fetus. [