Lean management,when introduced to optimize emergency operations,may improve medical service.It has been proved in practice that ideas and methodology of lean management guarantee emergency services by ensuring safety and quality of emergency operation process.In addition,it minimizes costs and enhances the business and social efficiency of the hospital.

Objective To study the microsatellite instability (MSD) of D310 and D16184 located in mitochondrial D-loop region in acute leukemia (AL). Methods The HV-1 and HV-2 regions in D-loop region of 100 persons with the untreated and treated acute leukemia was amplificated and screened by PCR-SSCP,then the abnormal samples was amplificated and sequenced directly and compared with revised Cambridge reference sequence (rCRS) and mtDB. The mutation rates of D310 and D16184 was measured by SPSS11.5 statistics software, x2-test. Results The total mutation rate of D310 was found in 49.0 % (49/100) of our patients. Its mutation rates in untreated group and treated group were 32.5 % (13/40) and 60.0 % (36/60)respectively. The mutation rate of treated group is higher than that in untreated group (P ＜ 0.05). The total mutation rate of D16184 was found in 32.0 % (32/100) of our patients. Its mutation rates in untreated group and treated group were 20.0 % (8/40) and 40.0 % (24/60) respectively. The mutation rate of treated group is higher than that in untreated group (P ＜ 0.05). Conclusion There was a high mutation rate with various types of mutations of microsatellite D310 and D16184 located in mitochondrial D-loop region in AL, which led to a doughty MSI. Chemotherapy could cause a more doughty MSI.

Objective To explore the safety and effectiveness of Mini-percutaneous nephrolithotomy (MPCNL)in the treatment of upper urinary stones in uygur children.Methods Retrospectively analyzed the date 158 cases of upper urinary stones in children treated by MPCNL in xinjiang hotan people's hospital from March to December 2016,117 cases of males and 41 cases of females,aged from 5 months to 14 years (average:2.59 years),including 112 cases of 5 months to 3 years old and 46 cases of 3 to 14 years old.There were 69 cases on the left,67 cases on the right and 22 cases on both sides.The average stone size was 2.3 cm × 1.8 cm.According to the size of the calculi,the percutaneous renal channel was selected between 12-18 F,the energy was selected for holmium laser lithotripsy,no perfusion pump was used and the hydrostatic pressure was controlled at 50 to 70 cm water column.Double J tube and renal fistula were placed postoperatively in 139 children;15 cases were not treated with renal fistula and 4 cases were completely free of tubulization.To observe the number and proportion of children with fever before and after operation.For multiple stones,use the accumulative maximum diameter calculation.To observe the changes of blood routine indexes before and after surgery,as well as operation time,puncture site,channel size and number,length of hospital stay,stone removal rate,stone composition and other postoperative complications.Counting data was expressed as a rate (％),and comparison between groups was performed by chi-square test.Results A total of 180 cases were successfully operated on kidney MPCNL.No complications above ClavienⅡ occurred.Two cases were treated with 1 unit of postoperative erythrocyte transfusion.The time of unilateral operation was 15 to 85 minutes with an average of 35 minutes.The first-stage stone clearance rate was 88.6％ (140/158) and the total stone clearance rate was 92.4％ (146/158).Postoperative hospitalization ranged from 3 to 8 days with an average of 6.2 days.Condusion MPCNL was used to treat upper urinary stones with high efficiency and safety and little damage for children with large stones or combined with water accumulation.Some appropriate children can be free of renal fistula or complete absence of tubulization to facilitate the recovery of children.

【Objective】 To compare the safety, efficacy, and patient satisfaction of conventional percutaneous nephrolithotomy (PCNL) and PCNL with integrated ureteric renal catheter in the treatment of kidney stones, so as to provide reference for the clinical application of this method. 【Methods】 A retrospective analysis were conducted on 154 patients with kidney stones (stone diameter 1.5—3.5 cm) admitted to our hospital during Apr.2022 and May 2023.Based on the method of placing the double-J stent and nephrostomy tube after stone fragmentation, the patients were divided into the integrated group (using PCNL with integrated ureteric renal catheter,n=77) and the standard group (conventional PCNL technique,n=77).The general characteristics, preoperative, postoperative, and follow-up data were compared between the two groups. 【Results】 There were no significant differences in postoperative hospital stay \[ (5.78±2.50) d vs. (5.29±2.18) d, P=0.193] , postoperative pain score \[ (2.22±0.42) vs. (2.30±0.46) , P=0.273\], preoperative-postoperative change in hemoglobin \[ (-4.13±10.11) g/L vs. (-2.96±9.39) g/L, P=0.459\], hospitalization costs \[ (17 088.14±2 876.94) yuan vs. (16 389.74±2 427.37) yuan, P=0.105\], and stone clearance rate \[65 (84.4.6%) vs.66 (85.7%) , P=0.821\] between the two groups (P>0.05).The integrated group had significantly lower incidence of post-discharge discomfort symptoms than the standard group \[36.4% (28/77) vs. 90.9% (70/77), P=0.001\].The integrated group reported higher satisfaction (77 satisfied vs. 64 satisfied plus 13 basically satisfied).No postoperative sepsis, septic shock, or transfer to the intensive care unit occurred. 【Conclusion】 PCNL with integrated ureteric renal catheter and conventional PCNL demonstrate comparable safety and efficacy, but the integrated method yields higher satisfaction, suggesting its worthiness for clinical promotion and application under appropriate indications.