Flexible ureteroscopy techniques have experienced great developments in the past decade, as well as their expanding indications.However, this surgical procedure encountered some discouragement in clinical application for its long learning curve, poor ergonomics, high cost and attrition rate.In recent years, there were a group of advancements in flexible ureteroscopy, including robot-assisted ureteroscopy, dual working channels flexible ureteroscopy, disposable flexible ureteroscopy, rigid ureteroscopy with a deflectable tip and a series of accessory instruments development, which could all make surgery procedures more easily to be done and lower the expenses at the same time.These technical evolutions bring flexible ureteroscopy into a new level in urologic surgeries.

Objective To observe any therapeutic effect of pulsed electromagnetic fields (PEMFs) on bone loss in spinal cord injury (SCI) patients.Methods Fifty-five patients with SCI were divided into two groups randomly.The twenty-six patients in the control group (group B) were given only routine rehabilitation treatment; the twenty-six patients in the treatment group (group A) received PEMF therapy in addition.Results After 12 weeks of treatment,the average bone mineral density (BMD) of the proximal femur (including total,neck,Wards,inter,troch) in group A was significantly higher than in group B.The levels of bone-gamma-carboxyglutamic acid containing protein (BGP) and 1,25 (OH)2D3 in group A increased significantly,while they decreased in group B.Urine-pyridinium/crealinine (U-Pyd/Cr) levels in group A decreased significantly,while in group B they were higher than before.There were statistically significant differences between the two groups.Conclusion PEMF treatment can effectively retard bone loss in SCI patients.It has good preventive and curative effects on osteoporosis after SCI.

Objective:To analyze effect on the CD154-CD40 signaling pathway and Th1/Th2 polariza-tion by deficient inducible co-stimulator ( ICOS)-ICOS ligand ( ICOSL) signaling in mice infected with Schistosoma japonicum. Methods:ICOSL knockout ( ICOSL-KO) mice and wild-type C57BL/6J mice were used as experimental Schistosomiasis model infected with Schistosoma japonicum. The expressions of CD154 and CD40 on splenocytes and on inflammatory cells around granulomatous infiltration of liver in mice infected with Schistosoma japonicum were analyzed by flow cytometry,immunohistochemical staining, respectively, on the day before infection (0 week) and at the end of 4, 7, 12, 16 and 20 weeks post-infection. The splenocytes of the mice were stimulated with soluble egg antigen( SEA) for 72 hours, then the concentrations of interferon gamma(IFN-γ) and interleukin-4 (IL-4) in the culture supernatants were measured by sandwich enzyme-linked immunosorbent assay ( ELISA) kits. The levels of SEA-specific an-tibodies of IgG and IgG1 and IgG2a were measured in the mice sera by ELISA. The granulomatous pa-thology in the mice liver was dynamically observed by hematoxylin and eosin ( HE ) staining. Results:Compared with the wild-type C57BL/6J mice, the expressions of CD154 on CD4 + T splenocytes [(18. 62 ± 4. 76)% vs. (27. 91 ± 3. 94)%, (22. 44 ± 4. 67)% vs. (40. 86 ± 5. 21)%, (25. 50 ± 6. 81)% vs. (43. 81 ± 8. 41)%, (20. 22 ± 5. 28)% vs. (40. 95 ± 7. 34)%, (17. 87 ± 4. 59)% vs. (33. 16 ± 6. 31)%, all P <0. 01] and of CD40 on CD19 + B splenocytes [(19. 43 ± 3. 26)% vs. (24.37 ±3.59)%, (23. 00 ± 4. 47)% vs. (31. 80 ± 5. 86)%, (24. 46 ± 5. 01)% vs. (35. 85 ± 5. 32)%, (23. 42 ± 4. 69)% vs. (33. 30 ± 6. 14)%, (22. 85 ± 3. 78)% vs. (30. 88 ± 5. 94)%, all P<0 . 05 ] in the ICOSL-KO mice significantly decreased at the end of 4 , 7 , 12 , 16 and 20 weeks post-infection. Moreover, the expressions of CD154[(0. 319 ± 0. 066) vs. (0. 488 ± 0. 086), (0. 389 ± 0. 067) vs.(0.596±0.082),(0.378±0.064) vs.(0.543±0.072),(0.348±0.069) vs.(0.523±0.076), all P<0. 01] and CD40[ (0. 398 ± 0. 066) vs. (0. 546 ± 0. 079), (0. 461 ± 0. 085) vs. (0. 618 ± 0. 076), (0. 453 ± 0. 087) vs. (0. 587 ± 0. 074), (0. 449 ± 0. 065) vs. (0. 565 ± 0. 082), all P <0 . 05 ] on inflammatory cells around granulomatous infiltration in liver from the ICOSL-KO mice were sig-nificantly lower than those of the wild-type C57 BL/6 J mice at the end of 7 , 12 , 16 and 20 weeks post-in-fection. The levels of IFN-γ of the ICOSL-KO mice were significantly higher than those of the wild-type C57BL/6J mice at the end of 4, 7, 12, 16 and 20 weeks post-infection (P <0. 05). However, the levels of IL-4 of the ICOSL-KO mice were significantly lower than those of the wild-type mice ( P <0. 05). Compared with the wild-type C57BL/6J mice, the levels of SEA-specific antibodies of IgG and IgG1 and IgG2a in the sera of the ICOSL-KO mice significantly decreased (P<0. 01). Moreover, The Th2 differentiation index of the ICOSL-KO mice was significantly lower than that of the wild-type mice in post-infection (P<0. 01). Also, the ratio of IgG1/IgG2a of the ICOSL-KO mice were significantly lower than that of the wild-type mice at the end of 7 , 12 and 16 weeks post-infection ( P<0 . 05 ) . And the vo-lume of liver egg granulomas of the ICOSL-KO mice was significantly smaller than that of the wild-type mice ( P <0 . 01 ) . Conclusion: These findings suggest that there is obvious down-regulation in the expressions of CD154 and CD40 and impairment of Th2 immune response in the ICOSL-KO mice infected with Schistosoma japonicum, accompanying with notedly reduced hepatic granulomatous pathology. The ICOS-ICOSL signaling has a regulatory effect on CD154-CD40 signaling pathway, and may play an impor-tant role in the hepatic egg granuloma formation of Schistosomiasis.

Objective To analyze the effect of inducible costmulator (ICOS)/inducible costmulator ligand (ICOSL) signaling pathway on hepatic fibrosis in mice infected with Schistosoma japonicum.Methods Seventy-eight ICOSL knockout (ICOSL-KO) mice and 77 wild type C57BL/6J mice were used as experimental schistosomiasis model infected with Schistosoma japonicum.The sera of mice were collected on the day before infection (0 week),and at 4,7,12,16 and 20 weeks post infection.Then,the concentrations of hyaluronic acid (HA) and hydroxyproline (HYP) in mice sera were measured by sandwich enzyme linked immunosorbent assay (ELISA) kits.The expressions of transforming growth factor β1 (TGF-β1),α-smooth muscle actin (a-SMA) and Collagen-Ⅰ in livers from ICOSL-KO/wild type mice were assessed by immunohistochemical staining.The granulomatous pathology and fibrosis level in mice liver were dynamically observed by hematoxylin and eosin (HE) staining and Masson's staining,respectively.The difference between groups was detected by t test or x2 test when appropriate.Results After infection with Schistosoma japonicum,the levels of HA and HYP were gradually increased.In ICOSL-KO mice,the levels of HA at 7,12,16 and 20 weeks post infection were all significantly lower than those in wild type mice [(161.32±15.44) vs (186.01±21.24) ng/mL,t=2.528 2,P＜0.05; (166.73±18.18) vs (231.39±20.12) ng/mL,t=4.342 4,P＜0.05; (193.58±21.06) vs (252.51±25.29) ng/mL,t=4.003 9,P＜0.05; (253.98±24.53) vs (310.88±23.86) ng/mL,t=3.718 0,P＜0.05].Similarly,HYP levels in ICOSL-KO mice at 12,16 and 20 weeks post infection were all significantly lower than those in wild type mice (all P＜0.05).Immunohistochemical staining showed that TGF-β1,α-SMA and Collagen-Ⅰ expressions in liver of ICOSL-KO mice from 7 to 20 weeks post infection were all significantly lower than those of wild type mice (all P＜0.05).HE staining showed,the volume of liver egg granulomas of ICOSL-KO mice was significantly smaller than that of wild type C57BL/6J mice (P＜0.01).Furthermore,Masson's staining showed that the level of hepatic fibrosis in ICOSL-KO mice was lower than that in wild type mice and the fibrosis scores were statistically different between two groups (all P＜0.05).The mortality rate of the wilde type C57BL/6J mice was higher than that of ICOSL-KO mice.After 20 weeks of infection,the difference was statistically significant (55.84 ％ vs 37.18 ％,x2 =5.427,P＜0.05).Conclusions The degree of hepatic fibrosis and related indicators are obviously down-regulated in ICOSL-KO mice infected with Schistosoma japonicum.These findings suggest that ICOS/ICOSL signaling pathway has an important impact on the process of hepatic fibrosis caused by Schistosoma japonicum.

Objective To investigated the significance of serum B7-H3 in differential diagnosis of patients with benign and malignant obstructive jaundice.Methods The B7-H3 levels in 60 patients with obstructive jaundice who were divided into benign (32 patients) and malignant (28 patients) obstructive jaundice group were tested by enzyme-linked immunosorbent assay before and after operation.Results The serum B7-H3 levels of malignant obstructive jaundice group were significantly higher than that of benign group (9334.57 ± 1009.57) pg/mL vs (4450.81 ± 406.92) pg/mL,(P ＜ 0.01).The B7-H3 levels of benign and malignant obstructive jaundice group after operation were significantly lower than those before operation (2531.03 ± 415.64) pg/mL vs (4450.81 ±406.92) pg/mL,(5833.00 ± 2190.87) pg/mL vs (9334.57±1009.57) pg/mL,(P＜0.01).Conclusion B7-H3 participate in the inflammatory immune and tumor immune response,The serum B7-H3 can be used as differential diagnosis index of benign and malignant obstructive jaundice.

Objective To describe the work experience and needs of enterostomal therapist in Shanghai.Methods Phenomenological methodology was adopted in this study.In-depth interview was conducted on 9 enterostomal therapists.Data were analyzed by inductive codes and coding methods.Results Five themes were extracted,including responsibility and mission,pride,accomplishment,helplessness,and satisfaction.When they began their new jobs,they confronted many challenges,but they conquered them with responsibility and mission.Finally,they felt growing up and harvested a lot during this time.Conclusions Hospital managers should pay attention to problems they encountered in their work and provide necessary supports for their training,work and development.

Objective: To standardize the bill management, protect the economic order of public institutions. Methods: According to the current status of bill management in public health institutions, the corrective measurements comparing to national stipulation were proposed. Results: It is an important measure to manage the economic environment. Conclusion: It needs to follow the National Law of Negotiable Instrument, so as to ensure the right of party. Implement the law of bill to ensunre the right of party.

Objective To perform APACHEⅡand SOFA in assessmentof EICU patients with sepsis ,and analyze the risk factors. Methods A retrospective analysis from January 2014 to October 2015 in EICU of our hos-pital ,a total of 83 patients suffered from sepsis ,including sepsis group(30 cases)and septic shock(53 cases). PCT,PT,APTT,lactic acid,mechanical ventilation time and APACHE Ⅱ and SOFA score were collected, through the receiver-operating characteristic curve(ROC)index to predict the prognosis of patients with sepsis.Re-sults The mortality of the patients in the septic shock group,PT,APTT,APACHEⅡ,SOFA score,mechanical ventilation time and PCT were significantly higher than thosein the sepsis group(P<0.001). APTT,APACHEⅡ, SOFA score and mechanical ventilation time had significant difference (P ≤ 0.001) between survival and dead. The lactic acid level of the dead group was significantly higher than that in the survival group(P=0.038). The ar-ea under curve(AUC=0.806)of APACHEⅡscore was better than the SOFA score(AUC=0.765).The outcome of sepsis had correlation with APACHEⅡ,SOFA score,lactic acid,and mechanical ventilation time(P<0.05). Conclusion APACHE II and SOFA scores can accurately predict mortalityoutcome in emergency intensive care units patients with sepsis,especially the APACHEⅡscore.We can measure blood coagulation function,APACHEⅡ,SOFA score,PCT,lactic acid and mechanical ventilation time to assess the severity of patients with sepsis.

Objective To investigate the change and effect of operation on TK1,CEA, SCC-Ag and CYFRA21-1 level in non-small cell lung cancer patients. Methods From January 2013 to August 2013, 55 patients with NSCLC and 29 patients with benign lesions were recruited. The tumor indexes including TK1,CEA, SCC-Ag and CYFRA21-1 were measured by electrical chemiluminescence assay. Results ① Serum TK1, CEA, SCC-Ag and CYFRA21-1 level and the positive rates in NSCLC patients during preoperative period were higher than the benign disease control group ( P<0. 05 ) . ② Serum TK1 level changes in NSCLC patients preoperative and postoperative one week and one month showed a trend of hump-shaped curve, there was no obvious statistically significant differ-ence ( P>0. 05 ) . Serum CEA , SCC-Ag and CYFRA21-1 level of postoperative one week and one month in NSCLC patients were significantly lower than the level before the operation ( P<0. 05 ) . Serum CEA and CYFRA21-1 level of postoperative one week and one month in NSCLC patients showed no significant difference compared with benign disease control group ( P>0. 05 ) , serum TK1 and SCC-Ag level of the postoperative one week showed statistically significant difference compared with benign disease control group ( P<0. 05 ) , the postoperative one month level of serum TK1 and SCC-Ag showed no significant difference compared with benign disease control group ( P>0. 05 ) .③The preoperative level of TK1 and CEA in adenocarcinoma were higher than that in squamous carcinoma ( P<0. 05 ) . ④ The preoperative level of serum TK1 and CYFRA21-1 in female NSCLC patients were higher than male patients, the difference was statistically significant ( P <0. 05 ) , preoperative serum CEA and SCC-Ag level of NSCLC patients showed no obvious statistical correlation with gender ( P>0. 05 ) . The preoperative level of serum TK1 in NSCLC patients negatively correlated with the degree of differentiation of lung cancer, the difference was statistically significant ( P<0. 05 ) . Conclusion The perioperative level of tumor markers in NSCLC may be useful in monitoring diagnosis and differential diagnosis of NSCLC, especially in analyzing the invisible tumor burden of NSCLC patients. The perioperative level of tumor markers in NSCLC is related with the surgical effect and tissue types, and serum TK1 and CEA are more suitable for the evaluation of patients with lung adenocarcinoma. There is some value in the clinical applications.

Objective To observe the effects of bone marrow mesenchymal stem cells(BMMSCs) conditioned-medium (B-CM) on apoptosis in cultured cortical neurons after hypoxia-reoxygenation in vitro in rats.Methods BMMSCs were isolated,cultured and expanded,the culture me-dium was substituted by new medium that contain no serum when cells grew to 90% confluence.After cultured for 24 hours,the medium was collected as B-CM.Cortical neurons of mouse cultured for 8 days were divided into three groups:normal control groups,hypoxic group,B-CM disposed groups.Cell viability were detected by 3-(4,5-dimethlthiazd-2-yl)-2,5-diphenyltetra-zoliu bromidel (MTT) methods and the apoptosis of neurons was examined by flow cytometry and telemicroscopy on hypoxia for 0,6 hours and hypoxia-reoxygenation for 24 hours,respectively.Results Compared with control group,hypoxia for 6 hours could decrease cell viability,hypoxia-reoxygenation for 24 hours increased the cell apoptosis ratio remarkably(P