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

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 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.

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 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 observe the effect of different analgesic methods including patient controlled epidural analgesia (PCEA) and patient controlled intravenous analgesia (PCIA) on stress response and anxiety in surgical patients with lower limb fracture. Methods A total of 120 surgical patients with lower limb fractures were employed and divided randomly into Groups PCEA, PCIA and C (40per group). All patients were anaesthetized by using combined spinal-epidural anesthesia. After operation, PCEA and PCIA were applied in the patients of Groups PCEA and PCIA, respectively. No analgesic method was employed in the Group C. The dynamic indices including mean blood press (MAP) and heart rate (HR), blood serum cortisol (COR) and blood sugar (BS) were measured at different time points,ie, T0 ( pre-anesthesia), T1 ( the end of the operation), T2 (24 hours after operation) and T3 (48 hours after operation). The visual analogue pain score was conducted at time points of T1, T2 and T3. The measurement of anxiety score was done at pre-operation and at days 1 and 7 after operation. Results There were no significant changes in HR and MAP of Groups PCEA and PCIA (P＞0.05, compared with T0) at every time point after operation. Whereas, HR and MAP of Group C were increased at time points of T1 and T2 (P ＜ 0.05, compared with T0 ), with statistical difference compared with Groups PCEA and PCIA at the same time points (P ＜ 0.05 ). VAS in Group PCEA was lower than that in Group PCIA at time points of T2 and T3 ( P ＜ 0.05). Meanwhile, VAS in Groups PCEA and PCIA was lower than that in Group C (P＜0. 05). COR and BS in Group PCEA were significant lower than those in group PCIA at time points of T2 and T3 (P ＜ 0. 05 ). Meanwhile, COR and BS in Groups PCEA and PCIA was lower than that in Group C (P＜0.05 or ＜0.01 ). Moreover, the changes were more significant in Group PCIA than that in Group PCEA (P ＜ 0. 05 ). The anxiety score in Groups PCEA and PCIA was lower than that in Group C (P ＜ 0.05). Conclusions Two analgesic methods of PCEA and PCIA can provide safe and effective postoperative analgesia and attenuate the stress response and anxiety in surgical patients with lower limb fracture. Meanwhile, PCEA takes more advantages than PCIA.

Objective To investigate the medication safety and relevant influence factors among the elderly with chronic diseases,to improve the safety of the elderly medication,and provide the theory basis for the rational use of drugs.Methods Questionnaire survey was conducted on 452 elderly outpatients with chronic diseases using self-designed questionnaire.Results 21.7％ (98/452) of the elderly took seven or more drugs.The incidence of adverse drug reactions was 38.4％ (174/452).The prevalence in the top three were cardiovascular disease [61.3％ (277/452)],diabetes [53.5％ (242/452)],and lung disease [42.0％ (190/452)].Old people had unsafe medication behaviors including missing medication,stopping medication on their own,increased or reduced dosages of medicine and taking overdue medication,and so on.Logistic regression analysis showed that the main influence factors of medication safety were age,previous occupation,educational level,monthly household income per capita,medication time,the source of drugs and whether received medication safety health education (P＜0.05).Conclusions Relative lack of safety knowledge,wrong cognition and behaviors exist in the elderly.It is worthy of paying attention to adverse drug reactions and hidden dangers of the elderly.

Objective To investigate the function of serum Interleukin-6 (IL-6) in the formation of cerebral edema after acute cerebral infarction through dynamic changes of serum IL-6 and MRI indicators.Methods One hundred and twenty-eight patients with cerebral edema after acute cerebral infarction and 30 healthy were selected as our subjects.The serum IL-6 were measured in at 1,5 and 14 d after acute cerebral infarction.MRI scans were performed in the corresponding time,and then processed synthesis of apparent diffusion coefficients (ADC) graph.Cerebral infarction volume,signal intensity ratio (SIR) of each sequence and relative apparent diffusion coefficient(rADC) were measured and calculated.Results The serum IL-6 in patients with acute cerebral infarction at 1 d after cerebral infarction was significantly higher than that in normal control group and reached the peak level at 5th D after cerebral infarction,significantly decreased at 14th d.The serum IL-6 of each time point were significantly higher than that of normal control group(P =0.000).There were liner positive correlation between the serum IL-6 and the volume of cerebral infarction and SIR of T2 weighted image and fluid attenuation inversion recovery (r =0.750,0.621,0.691 ; P =0.000).The serum of IL-6 and SIR of T1 weighted image was showed negative correlation (r =-0.404,P =0.000).The serum of IL-6 and SIR of diffusion-weighted imaging sequence at 1,5 d after cerebral infarction showed a positive correlation (r =0.678,P =0.000).There was liner negative correlation between the serum IL-6 and rADC at 1 d after cerebral infarction (r =-0.826,P =0.000).Conclusion The rise of serum IL-6 may promote the formation and development of ischemic cerebral edema.