Objectives: To evaluate the outcome of mini-PNL and standard PNL in horseshoe kidney. Methods: A total of 14 patients with horseshoe kidney were offered PCNL from January 2007 to December 2010 in our department. The male/female ratio was 2.5(10/4). The mean age was 38 years (range 29-55). All underwent color Doppler sonography, plain x-ray of kidney, ureter, and bladder, intravenous urography and CT. The left-to-right ratio was 1.8(9/5). All 14 patients had multiple stones or complex renal calculi, including 1 with staghorn stones. Mean stone size was 4.2cm(2-6.5cm). 10 patients had a history of failed extracorporeal shock wave lithotripsy. All percutaneous renal surgery was performed in one session under ultrasonography guidance. Among the treatments, 4 were mini-PNL, 10 were standard PNLs. Results: All surgery was successfully performed in one session under ultrasonography guidance by F18 tract or F24 tract. The stone-free rate after one-session operation was 78.6%(11/14). mini-PNL group was 75%(3/4), while PNL group was 80%(8/10). 3 cases received ESWL to remove the residual calculi, no second-session operation. 9 were performed in one tract and 5 in two tracts. 9 in upper calix, 7 in middle and 3 in lower. Mean operative time was 112.5±67.5min, mini-PNL operative time was longer than that of standard PNL (135±45min vs102.5±75min, respectively). Conversely, there was an advantage for miniperc over standard PNL in terms of a significantly reduced hematocrit drop (2.8±0.4g/dl VS 4.2±0.8g/dl, respectively). No mini-PNL patients required blood transfusions, whereas 3 did in the standard PNL group. Postoperative rate of surgery-related infection was 14.4%(2/14). No pleural or abdominal injury occurred. Conclusion: Both treatments have their own advantage. Mini-PNL and standard PNL are both effective and safe for calculi within horseshoe kidneys.

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Antirheumatic Agents ; therapeutic use ; Arthritis, Juvenile ; therapy ; Biological Products ; therapeutic use ; Child ; Humans

Background Diabetic retinopathy (DR) is one of the most important microvascular complications of diabetes,which has become one of the leading causes of blindness.Neovascularization is the main pathological manifestations of DR,but its mechanism is unknown.There is a clear need to investigate its pathogenesis which can offer potential therapeutic targets.Objective The aim of this study was to investigate the expression and distribution of visfatin and vascular endothelial growth factor (VEGF) in diabetic model rats.Methods This study was approved by Animal Ethic Committee of Inner Mongolia Medical University.Sixty SPF 8-week-old male SpragueDawley rats were randomized into the diabetic group and control group.The rats were housed under a condition that alternated between 12 hours of light and darkness,with free access to rat food and water.Diabetes was induced by intraperitoneal injection of 60 mg/kg (0.60 ml/100 g) of streptozotocin (STZ) and control rats received equivalent volume of buffer.The models were regarded as successful when blood glucose was ≥ 16.7 mmol/L.Rats were sacrificed 12 weeks after the injection of STZ and retinal specimens were prepared to detect the expression of visfatin and VEGF.Total retinal protein was isolated from the retinas of experimental and control eyes,and the expression of visfatin and VEGF was assessed by Western blot.Frozen cross sections of retinas of 5 μm thickness were used to perform double immunofluorescence staining with anti-visfatin and anti-VEGF antibodies.Results Mean body weight of the diabetic rats was (189.02±11.34) g and that of the control rats was (489.57 ± 14.48) g at 12 weeks post-injection,showing a significant difference between them (t =5.236,P =0.003).Mean blood glucose level was (29.25±3.86) mmol/L in the diabetic group and (5.32±1.01) mmol/L in the control group,demonstrating a significant difference (t =11.778,P =0.000).Double immunofluorescence staining showed reduced expression of visfatin and VEGF in the retinal nerve fibrous layer and glial cells in the control rats.A stronger staining for visfatin and VEGF was found in the various layers of the retina in the diabetic rats,with an expression level of visfatin (A value) of 346.26±41.23,which was considerably higher than that of the control group (102.07±65.01) (t =8.291,P =0.000) in 12 weeks after injection.Furthermore,the expression of VEGF in the retina was elevated in the diabetic group compared with the control group (A value) (415.88±92.15 vs.113.06±32.06) (t=10.067,P=0.000).Conclusions Visfatin might contribute to the pathologic progression of diabetic retinal,neovascularization and it might play a synergistic role with VEGF in the pathophysiology of DR.

Objective To study the protein components of the secretion of the proximal trunk of transected peripheral nerve and the effect of the secretion on the growth of motor neuron.Methods After the sciatic nerves of rats were transected, the proximal trunk secretion collecting compartment (P-SCC), distal trunk SCC (D-SCC) and (proximal) plus distal trunk SCC (PD-SCC) were set up. The protein components of the solution in the 3 types SCC were analyzed by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and mass spectrum. And the effect of 3 kinds solution on the growth of motor neuron was tested by the motor neuron culture respectively. (Results) All the P-SCC, D-SCC and PD-SCC were filled with light yellow, clear fluids. The protein (concentration) was (5.45?1.2)mg/ml,(3.87?0.7)mg/ml and (5.68?1.5)mg/ml in the solution of PD-SCC, P-SCC and D-SCC (respectively). The protein patterns of the 3 solution were similar, and the detected (protein) spots were 1098?34,985?47 and 1021?36 spots in the solution of P+D-SCC, P-SCC and D-SCC (respectively). Most of the protein spots (distributed) in the rangs of MV 25-90KD and PH 4-8. The results of motor neuron culture demonstrate that the number of survival cells, cell area, neurite length and OD value of experimental groups(including mix group, (proximal) group and distal group) are generally higher than control group. But there is no obvious difference between the three experimental groups. Conclusions (1)The proximal trunk of transected sciatic nerve had the similar secretive ability as the distal nerve trunk.(2)(Protein) image of the 3 kinds of SCC solution showed that proteins from the three SCC solution were homologous. (3)All the 3 kinds of SCC solution could promote the growth and activity of motor neuron, and there was no difference in function between P-SCC and D-SCC solution.

Objective To investigate the career decision-making self-efficacy as well as the psychological well-being of medical students and to discuss the correlation between them.Methods A cross-sectional survey with cluster random sampling was performed anonymously among 714 students of different majors and different grades in an medical University.The contents of the survey included the career decision making self-efficacy scale (CDMSE) as well as the self-reporting inventory(SCL-90).All data in the two groups were analyzed with t test; comparison of data between groups were analyzed with One-Way ANOVA; multiple comparison was analyzed with S-N-K; Pearson and Partial correlation analysis were used to analyzed the correlation between the career decision making self-efficacy and wellbeing.Results Totally 659 students completed the inventory,with response rate being92.3％.Average score of the participants' career decision-making self-efficacy was (124.72 ± 26.76)points,situating at the middle and lower level.There were differences in the scores of career decision making selfefficacy among different sexes,sources,grades and being student cadres or not (P =0.019,0.000,0.027,0.026) ; No differences was found among students of different majors and whether being the only child(P =0.243,0.223).Results of the SCL-90 inventory demonstrated that medical students had some psychological problems including obsessive-compulsive,interpersonal sensitivity and anxiety.Correlation analysis showed that psychological well-being and career decision-making self-efficacy was negatively correlated.Conclusions Measures should be taken to improve the medical students' career decision-making self-efficacy according to their psychological characteristics and to improve the medical students' psychological status by the improvement of career decision-making self-efficacy.

Objective To test and eva1uate the abi1ity of three potential chloroplast DNA (cpDNA) barcoding sequences;To find new methods to identify the species of gardenia. Methods Three cpDNA sequences were amplified and sequenced by universal primers of matK, rbcL and psbA. By comparing PCR amplification efficiency, length, intra-and inter-specific divergence, and barcoding gap, BLAST and DNA MAN were used to evaluate these loci. Results The amplification efficiency of 5 samples from 3 gardenia species was 100%. Analysis of the intra-and inter-specific divergence of matK among the sequences showed that barcoding gap was superior to psbA and rbcL, with higher identification efficiency. Conclusion Gardenia jasminoides Ellis can be better identified by matK sequence.

Objective To study the frequency of cystic fibrosis transmembrane conductance regulator(CFTR)mutations in patients with congenital bilateral absence of vas deferens(CBAVD).Methods Eighty-five CBAVD patients were collected from May 2007 to May 2009.The diagnosis of CBAVD included azoospermia,normal of 4 sex hormone items,absence of seminal vesicle,normal volume of testicular and epididymis dilated siltation.And 85 normal fertile men served as controls.Genomic DNA was isolated from peripheral blood.The mutations of CFTR exons 10,11 were detected by PCR-single strand conformation polymorphism,and direct sequencing was performed on 85 cases of CBAVD and the control males.Results Of the 85 CBAVD,10 cases(11.8％)exhibited an abnormal CFTR gene mutation,with 4 cases I556V,2 cases M469V,and 1 case of E527N,A F508,L558S,S485C.No mutations were detected in 85 controls.There was a significant difference between the 2 groups(x2 =8.606,P =0.003).Conclusions CBAVD might be caused by the CFTR mutations.The frequencies and the spectrum of CFTR mutations might be different from those Caucasian population in the west country.

Background With the development of phacoemulsification surgery,the minimization of the size of the incision in order to reduce the damaging of eye tissue and postoperative complications becomes a focus.Objective This study aimed to assess the clinical efficacy of coaxial phacoemulsification type cataract surgery through a 1.8 mm microincision with foldable intraocular lens (IOL) implantation in eyes with age-related cataract.Methods Informed consent was obtained from each patient at the beginning of this study.A serial case observation study was designed.Thirty-two eyes of 32 patients with age-related cataract were enrolled in the Inner Mongolia Autonomous Region People' s Hospital from April 2012 to May 2012,including 8 eyes of grade Ⅱ hard nucleus cataract,16 eyes of grade Ⅲ hard nucleus cataract and 8 eyes of grade Ⅳ hard nucleus cataract.Ocular axial length was measured by an A-mode ultrasonic apparatus,and IOL diopter was calculated using the SRK-Ⅱ formula.Under ocular surface anesthesia,a 1.8 mm clear corneal tunnel incision was made at the 10-11 o' clock position,and then an auxiliary incision was made at the 2 o' clock position.The opaque lens was extracted by routine phacoemulsification.An Akreos MI60 IOL was implanted through the 1.8 mm incision.The time and level of ultrasonic power required for phacoemulsification,postoperative visual acuity and incidence of postoperative complication were assessed.Postoperative examinations were scheduled at 1 day,1 week and 1 month after the surgery.Results All the operations proceeded smoothly.The mean phaco-time was (7.0±3.6) seconds and the mean ultrasonic power level was (15.3 ±6.1)％ among the different grades of cataract groups.The number of eyes presenting an uncorrected distance visual acuity of ≥ 0.5 was 18 (56.25％),28 (87.50％) and 30 (93.75％) 1 day,1 week and 1 month after surgery,respectively.The number of eyes with a best corrected distance visual acuity of ≥ 0.5 and 0.8 were 31(96.88％) and 26 (81.25％),respectively,1 month after surgery.Negligible changes were detected in the anterior chamber depths,and no thermal damage was found at the incision during the operation.Conclusions Coaxial phacoemulsification and IOL implantation through a 1.8 mm microincision is safe and effective.Thorough planning and precise execution are necessary.

OBJECTIVE:To observe clinical efficacy and safety of Tianqi jiangtang capsules combined with metformin in the treatment of elderly patients with type 2 diabetes mellitus complicated with cerebral microvascular lesions. METHODS:A total of 96 elderly patients with type 2 diabetes mellitus complicated with cerebral microvascular lesions were randomly divided into control group(48 cases)and observation group(48 cases). Control group was given Metformin hydrochloride tablets 0.5 g orally,3 times a day. Observation group was additionally given Tianqi jiangtang capsules 1.6 g orally,3 times a day,on the basis of control group. Both groups received treatment for 4 weeks. Clinical efficacies of 2 groups were observed as well as total score of TCM symptoms,the levels of blood glucose(FPG,2 hPG,HbA1c),blood lipid(TC,TG,HDL-C,LDL-C),hs-CRP,ET-1,blood rheology and oxidative stress indexes(MDA,SOD),the occurrence of ADR. RESULTS:The total response rate of observation group was significantly higher than that of control group(89.58% vs. 70.83%),with statistical significance(P<0.05). After treat-ment,total score of TCM symptoms,the levels of blood glucose,hs-CRP,ET-1,TC,TG,LDL-C,blood rheology indexes and MDA in 2 groups were significantly lower than before;total score of TCM symptoms,the levels of FPG,2 hPG,hs-CRP,ET-1, TC,TG,LDL-C,blood rheology indexes and MDA in observation group were significantly lower than control group;the level of SOD in 2 groups were significantly higher than before,and the observation group was significantly higher than control group,and the level of HDL-C in observation group was significantly higher than before treatment and control group,with statistical signifi-cance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Tianqi jiangtang capsules combined with metformin show significant therapeutic efficacy in the treatment of elderly patients with type 2 diabetes mellitus,and can re-duce the levels of blood glucose and lipid,improve blood rheology and oxidative stress reaction,with goud safety.