Objective To investigate the clinical indicators which could be used to differentiate incarcerated stones from unincarcerated stones by comparing clinical characteristics of patients.Methods 96 patients who were diagnosed as ureteral stones treated by ureteroscopic lithotripsy (URSL) from June 2017 to November 2017 were selected in the study.Clinical characteristics of patients were collected.The total study consisted of 62 male and 34 female patients.The patients' age ranged from 24 to 78 years old and average age was (54.5 ± 12.7) years old.There were 35 patients were diagnosed as ureteral stones with hypertension,9 patients with diabetes,85 patients with hydronephrosis,respectively.The number of patients,whose stone located in upper ureters,middle ureters and lower ureters were 49,19,28,respectively.The average of maximum stone diameter,maximum cross-sectional area of the stone,stone volume,hounsfield units of stone and maximum ureteral wall thickness (UWTmax) at the stone site were (7.75 ± 2.68) mm,(36.12 ± 24.43) mm2,(304.06 ± 303.39) mm3,(755.75 ± 318.05) HU,and (3.18 ± 1.13) mm,respectively.Percussion tenderness over kidney region were positive in 11 cases,weak positive in 64 cases and negative in 21 cases,respectively.Stone-free rate after operation were 93.8％.Patients were divided into two groups,incarcerated or unincarcerated,and statistical differences between clinical characteristics of the two groups were analyzed by univariate analysis.The differences were further compared by multivariate logistic regression analysis to find independent predictors of impacted stones.The ROC curve was used to find the optimal UWT for diagnosis of impacted stone.The accuracy of this value was evaluated and patients were grouped by this value to compare the differences between groups.Results The operation and follow-up were successfully performed in all patients.Univariate analysis showed there were no statistical significance differences in gender [(24 males and 16 females)vs.(38 males and 18 females)],age [(53.4 ± 12.3) years vs.(48.7 ± 12.7) years],previous history of diabetes (4 cases vs.5 cases) and stone location [(19 upper stones,9 middle stones,12 lower stones) vs.(30 upper stones,10 middle stones,16 lower stones)],between the two groups (P ＞ 0.05).Among the clinical characteristics of patients in incarcerated and unincarcerated groups,UWTmax were (4.15 ± 0.94) mm and (2.58 ± 0.76) mm,previous history of hypertension were 20 cases and 15 cases,ipsilateral URSL history were 14 cases and 10 cases,hounsfield units of stone were (847.66 ± 282.39) HU and (698.65 ± 325.50) HU,hydronephrosis were 40 cases and 50 cases,maximum stone diameter were (8.67 ± 2.28)mm and (7.17 ± 2.75)mm,maximum cross-sectional area of the stone were (43.83 ± 23.65) mm2 and (31.14 ± 23.64) mm2,stone volume were (386.20 ± 296.60) mm3 and (253.04 ± 296.29) mm3,percussion tenderness over kidney region were positive in 8 cases(20.0％),weak positive in 27 cases,negative in 5 cases and positive in 3 cases,weak positive in 37 cases,negative in 16 cases,respectively.The difference was statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed UWTmax (OR =10.40,P ＜ 0.001) at the stone site was significantly correlated with impacted ureteral stones and it was an independent predictor of impacted stones.ROC curve analysis showed that the optimal cut-off value of UWTmax was 3.26 mm.The sensitivity of the value to predict impacted stone is 82.5％ and the specificity is 87.5％.Depending on the cut off value of 3.26 mm,cases were divided into two groups,40 cases were in high UWTmax (≥3.26 mm)group and 56 cases were in low UWTmax (＜ 3.26 mm)group.Higher UWTmax was accompanied with a higher incidence of ureteral edema[77.5％ (31/40) vs.32.1％ (18/56)],polyps [30.0％ (12/40) vs.7.1％ (4/56)],strictures[37.5％ (15/40)vs.12.5％ (7/56)] and a lower stone-free rate[87.5％ (35/40) vs.98.2％ (55/56)].The difference was statistically significant (P ＜ 0.05).Conclusions UWTmax can be used to differentiate impacted stones from unimpacted stones before surgery.The patients with Higher UWTmax (≥3.26 mm) was accompanied with a higher incidence of stone impacted,ureteral edema,polyps,and strictures,and a lower rate of stone clearance.

Infl uidfl owfi eld analysis, the common simulation method is 1-D simulation or 3-D simulation, In order to analyze bloodfl uid system more quickly and accurately and choose the appropriate sample tube at the beginning of design for the system, this paper adopts a recently emerging 1D-3D simulation method to make simulations offl ow chamber subsystem. Respectively using Flowmaster and ANSYS system modeling, use MpCCI connects the two parameter coupling, realize the sheathfl uid velocity of research. The software can meet the needs of design and analysis of the Hematology Analyzerfl uid system. In this paper, the method of co-simulation for medical apparatus and instruments of Hematology Analyzerfl uid system development provides a new method, has important signifi cance on the subsequent simulation.

Objective:To investigate the efficacy of programmed cell death-1 (PD-1) inhibitor combined with immunochemotherapy in the treatment of refractory primary mediastinal large B-cell lymphoma (PMBCL).Methods:The clinical data of 2 refractory PMBCL patients who were achieving remission after applying PD-1 inhibitor combined with immunochemotherapy in Qilu Hospital of Shandong University (Qingdao) in July 2019 and January 2020 were retrospectively analyzed, and the relevant literature was reviewed.Results:The two patients were initially treated with CDOPE and R-CDOPE regimens, respectively, but the disease did not reach remission state. Later, they were adjusted to PD-1 inhibitor combined with immunochemotherapy to achieve remission. Radiotherapy and autologous hematopoietic stem cell transplantation were used as consolidation treatment, and maintenance therapy with PD-1 inhibitors was effective and had a good safety profile.Conclusions:For refractory PMBCL patients, PD-1 inhibitor combined with immunochemotherapy may have good efficacy.

Objective:To investigated the strength of adenosine diphosphate ribosylation factor-like protein 14(ARL14)expression in colorectal cancer(CRC)and its relationship with major infiltrating cells in the tumor microenvironment.Methods:Data from the 607 CRC cases and 51 normal tissues in the TCGA-CRC dataset were analyzed.ARL14 mRNA expression levels were retrospectively collected and the relationship between ARL14 expression and CRC patient prognosis was analyzed.Transcription factors and miRNAs involved upstream in reg-ulating ARL14 expression were predicted.Bioinformatics methods were used to analyze the relationship between ARL14 expression and cell infiltration into the tumor microenvironment.Tumor and normal tissues from 45 CRC patients who underwent surgery in Tianjin Medical University Cancer Institute&Hospital from January 2020 to January 2021 were collected,and expression levels of ARL14,smooth muscle actin-α(α-SMA),and fibroblast-activated protein(FAP)were detected by immunohistochemical staining to verify the relationship between ARL14 expression and fibroblast activation.Results:Differential analysis showed that the ARL14 expression level was significantly lower in CRC tissues than in normal tissues(P<0.001).Patients with low ARL14 expression had worse prognosis than patients with high expression(Log-rank P=0.025).MCP-counter analysis showed that ARL14 expression correlated negatively with fibroblast infiltration(P<0.0001).Im-munohistochemical staining results showed that ARL14 expression was significantly lower in tumors than in normal tissues(P<0.01).ARL14 expression also correlated negatively with α-SMA and FAP expression levels in the interstitium.Conclusions:ARL14 may play a tumor sup-pressor role in CRC and inhibit fibroblast activation.