Adrenergic alpha-1 Receptor Antagonists ; therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Calcium Channel Blockers ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Urinary Calculi ; drug therapy

Objective To summarize the experience of management of upper urinary tract calculi by Extracorporeal Shock Wave Lithotripsy (ESWL) in our department in order to improve the gravel success rate and decrease the incidence of complications.Methods 15 019 patients with upper urinary calculi from October 1988 to September 2011 treated by ESWL with X-ray localization were analyzed retrospectively.The maximum diameter of the stones ranged from 0.8 cm to 3.2 cm,with 1 3 794 cases with maximum stone diameter less than 2 cm (guoup A),and with 1225 cases with maximum stone diameter more than 2 cm (guoup B).All patients had normal or nearly normal renal function,and 56.0％ patients (8 410/15 019)had varying degrees of hydronephrosis.Results The effective rate of first ESWL was 84.5％ ( 12 691/15 019) and the effective rate of second ESWL was 12.0％ (1 802/15 019),and 313 cases need a third ESWL.The clearance rate in group A was 90.2％ ( 12 443/13 794 ),in group B was 50.9％ (623/1225),and the overall stone clearance rate within three months was 87.0％ ( 13 066/15 019).The majority of patients ( about 93％ ) had postoperative gross hematuria,which disappeared after drinking lots of water.46cases (0.3％) of patients had postoperative fever,which returned to normal after usage of antibiotics.There were no serious complications such as kidney hematoma,continuous high fever,continuous hematuria,ureteral stones jams.Conclusions ESWL.with X-ray localization had the advantage of low energy,minor injury,easy localization,uniform stone fragment,because of which it could reduce the complications such as continuity fever,ureter stone james,continuious hematuria.ESWL with X-ray localization could be preferred treatment for upper urinary calculi with diameters between 10 to 20 mm.

AIM: To discuss the clinical efficacy of fresh amniotic membrane ( AM ) during the microscopic adjustable suture surgery in children's intercommunity strabismus, in order to guide clinical treatment.
METHODS: With the clinical randomized control study (RCT), 60 (112 eyes) cases of patients in childhood who received microscopic strabismus surgery in our hospital were divided them into two different groups from Jan. 2010 to Oct. 2015. According to the application of AM on the basis of ophthalmology outpatient number, 30 cases (58 eyes) in group A were treated with rectus muscle recession surgery combined adjustable suture combined with AM. The other 30 cases (54 eyes) in group B were treated with rectus muscle recession surgery combined adjustable suture only. All patients in two groups were followed-up over 6mo after the strabismus surgery.
RESULTS:Twenty-seven cases ( 48 eyes ) of all the strabismus patients must be adjusted after strabismus surgery, and the eye position adjustment rate was 42.9%. At 1mo after surgery, eye position of 18 cases (29 eyes) can be adjusted in all patients, and 44. 8% (16 cases, 26 eyes ) in group A with the average of adjustment lengths was 2. 56±0. 64mm, and 5. 6% ( 2 cases, 3 eyes ) in group B, with the average of adjustment lengths was 0. 52±0. 28mm, the differences of the adjustment rate and the average of adjustment amount were both high statistically significant (χ2 =22.477, P<0. 01; t=16. 502, P<0. 01 ) between the two groups. Except of 3 cases who couldn't cooperate with eye position adjustment, they all received eye position adjustment in different degrees in one month after strabismus surgery,and after eye position adjustment, 27 cases (53 eyes) in group A got normal eye position, and the correction rate of eye position was 91. 4%, and 16 cases (28 eyes) in group B got normal eye position after eye position adjustment, the correction rate was 51. 9%, the differences of the correction rate were statistically significant (χ2=21. 827, P<0. 01) between the two groups.
CONCLUSION: The application of fresh AM in the microscopic adjustable suture strabismus surgery is exactly effective in treatment of children's intercommunity strabismus. It can significantly extend the adjustment time and increase the adjustment amount, and it also can statistically improve the controllability and achievement ratio for children's strabismus surgery.

OBJECTIVE:To provide reference for promoting the management of antibiotics in the hospitals. METHODS:Each 3 hospitals from county second grade class A general hospitals,municipal third grade class A general hospitals and provincial third grade hospitals(including 2 third grade class A general hospitals and one third grade special hospital)in Anhui province were select-ed and respectively included into group A,B,and C. By on-site survey mode,questionnaires were used to investigate and score the situation of antibiotics management in hospitals of 3 groups,and then analyzed statistically. RESULTS:Scoring rate (SR) of overall situation on antibiotics management were 65.33%,89.34% and 86.67% in group A,B and C respectively;group A was statistically significantly lower than group B and C (P<0.001). SR of basic situation indicator on antibiotics management were 90.46%,95.25% and 95.25% in group A,B and C,respectively and there was no statistically significant difference among 3 groups (P>0.05). SR of development indicator of antibiotics management were 58.33%,88.90% and 86.10%,respectively in group A,B and C;group A was significantly lower than group B and C (P<0.001). SR of information construction indicator of antibiotics management were 50.00%,83.33% and 77.79% respectively in group A,B and C;group A was significantly lower than group B and C (P≤0.001). SR of information construction indicator of antibiotics management in 3 groups were all signifi-cantly lower than SR of basic situation indicator(P<0.05). SR of development indicator of antibiotics management in group A and C were all significantly lower than SR of basic situation indicator(P<0.05). CONCLUSIONS:The antibiotics management of mu-nicipal third grade class A general hospital is equal to that of provincial third grade hospital,and that of county second grade class A general hospital is in relatively low level. Different levels of hospitals should further strengthen the related antibiotics manage-ment work and information construction,especially for county second grade class A general hospitals.

Objective To study the imaging characteristics of vesical leukoplakia under the cys-toscope imaging system. Methods The characteristics of vesical leukoplakia were observed under the cystoscope imaging system in 556 cases. After anti-infection treatment to these patients, the chan-ges of the characteristic under the cystoseope imaging system were re-observed and compared before and after treatment. SPSS 11.0 software package x2 teat for statistical analysis was used. Results Under the cystoscope imaging system, there were four different imaging manifestations in the 556 pa-tients. These were, from mild to severe, congestive type in 42 cases, spots type in 56 cases, thin macular type in 399 cases and thick macular type in 59 cases. One type could transform to another af-ter anti-infection treatment. When reexamination by the cystoscope, 131 cases got improved, 304 cases had no changes and 121 cases were aggravated. Statistical analysis showed the transformation among the 4 types had significant difference (x2 = 130.92, v=6, P<0.001). From congestive type to spots type, thin macular type and thick macular type, after anti-infection treatment, the ratio of improved cases decreased gradually, however the ratio of aggravated cases and cases without changes increased gradually. Conclusion Vesical leukoplakia could be classified into 4 types initially: congestive type,spots type, thin macular type, thick macular type. The different clinical treatments should be provid-ed.

HMGR and DXR are key enzymes of terpenoids biosynthesis pathway. This study was aimed to discuss the effects of overexpression of HMGR and DXR from A momum villosum Lour. on the biosynthesis of terpenoids in transgenic tobacco. The real-time fluorescence quantitative PCR (RT-qPCR) was used to analyze the expression level of AvHMGR and AvDXR. Then, enzyme activities of HMGR and DXR were determined by spectrometer using the substrate-specific method. Different terpenoids were detected by GC-MS. The results showed that individual overex-pression of HMGR/DXR can inhibit the enzyme activities of HMGR and DXR but promote the biosynthesis of men-thene, neophytediene, cembrenene and sterol. The co-overexpression of HMGR and DXR had different enzyme activ-ities and can promote the biosynthesis of sterol and phytol, but inhibit the biosynthesis of neophytadiene. It was con-cluded that the overexpression of HMGR and DXR had diverse effects when regulating the biosynthesis of different terpenoids. This study provided the basis for using A vHMGR and A vDXR to regulate the metabolism of terpenoids.

Phillyrin is an important lignans compound from Forsythia. It is not only found in the raw medicinal material with high content, but also shows a variety of pharmacological activities. In the paper, the recent advances in extraction methods, pharmacology-toxicology, pharmacokinetics and the other studies of phillyrin were reviewed in order to provide reference and suggestions for the fur-ther research.

Objective To assess the clinical safety and feasibility for ultrasound guided paravertebral block anesthesia of percutaneous nephrolithotomy.Methods Between December 2015 to June 2016,180 patients with renal or ureteral calculi were enrolled and evaluated with uhrasonography and CT scan.Of all the 180 patients,108 males and 82 females.Their mean age was 39 years (23-71 years).The clinical characteristics of the patients in each group,such as age,gender,BMI index,ASA status,mean arterial pressure and disease type had no significant differences (P ＞ 0.05).These patients were randomized into general anesthesia group (G group),combined spinal epidural anesthesia group (C group) and paravertebral nerve block anesthesia group (P group).G group:35 males and 25 females.Their mean age was (40.1 ± 11.8) years and BMI was (25.1 ± 3.8) kg/m2;Renal calculi 52 cases,ureteral calculi 8 cases,Average maximum stone diameter was (2.6 ± 0.8)cm.C group:38 males and 22 females.Their mean age was (39.7 ± 12.4) years and BMI was (24.6 ± 4.1) kg/m2;Renal calculi 54 cases,ureteral calculi 6 cases,Average maximum stone diameter was (2.4 ± 0.8) cm.P group:35 males and 25 females.Their mean age was (38.9 ± 12.7) years and BMI was (25.4 ± 4.0) kg/m2;Renal calculi 51 cases,ureteral calculi 9 cases,Average maximum stone diameter was (2.5 ± 0.7) cm.Periprocedural Vital signs,complications,the times of anal discharging gas and postoperative feeding,hospitalized day and expense in these three groups were evaluated.Results Major intraoperative or postoperative complications did not occur in all of the patients.Mean arterial pressure decreased during preoperative changing positions was observed in group G (mean decreased 8.8 mmHg)and group C (mean decreased 1.9 mmHg),with significant difference in intra-group (P ＜ 0.05).Postoperative nausea and vomiting was observed in 8 and 2 patients of group G and group P,respectively (P ＜ 0.05).Postoperative pain was observed in 2 and 7 patients of group C and group P,respectively (P ＞ 0.05).In addition,group P had early post operation feeding time [(6.4 ± 2.4) h],shorter hospitalized day [(4.5 ± 1.1) d] and lower hospitalized expense compared with other groups (P ＜ 0.05).Conclusions Ultrasound guided paravertebral block can provide safe and reliable surgical anesthesia for percutaneous nephrolithotomy.

Objective To discuss the outcomes of the clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy. Methods 75 patients (11％) with CIRF among 655 who underwent initial MPCNL from January 2008 to December 2010 were diagnosed by CT scan.Clinical data of 68 patients (39 male and 29 female) were analyzed retrospectively.Previous open surgery hadbeen performed in 13 and ESWL in 20 cases.The median residual fragment size was 1.8 mm.The anatomical distribution of CIRF was 9 at upper pole,14 at middle,34 at lower,9 at renal ureteropelvic junction and 2 at upper and lower pole.Stone analysis showed 40 cases of calcium oxalate calculi,15 of calcium oxalate calculi mixed with carbonate calculi,2 calcium oxalate calculi mixed with uric acid,3 calcium oxalate calculi mixed with struuvite stone,3 struuvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Mean follow up was 23 months (12-36).Follow-up consisted of physical examination,serum routine,urine routine and CT imaging. Results 14(21％) patients (3 upper pole,1 middle pole,4 lower pole and 6 ureteropelvic junction) had symptomatic episodes,including 9 hematuria,2 renal colic pain,5 lower urinary tract symptoms,12 with size of CIRF ＞ 4 rmm.8 patients required surgical procedures.5 patients (1 middle,2 upper pole and 2 renal pelvis) underwent ESWL.3 patients with ureteral CIRF were performed ureteroscopic lithotripsy.The CIRF were clear after surgeries.4 paticnts with CIRF ＞ 4 mm did not have symptoms.These patients were recommended to conservational treatments.2 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.27％ (3/11)CIRF located in upper pole had symptom,compared with 4％ (1/14) in middle pole,11％ (4/36) in lower pole and 67％ (6/9) in ureteropelvic junction. Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or SWL are more likely to get CIRF.Medium-term follow-up of CIRF revealed that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.

Objective To analyze hemolysin and virulence -related genes in incomplete hemolytic Staphylococcus aureus.Methods Fifty strains of incomplete hemolytic Staphylococcus aureus were isolated from patients admitted in the Second Affiliated Hospital of Soochow University during 2013 and 2014, and the isolates with complete hemolytic phenotype were also collected at the same period as the control strains . All the strains were inoculated and subcultured on four kinds of sheep blood agar plates supplied by different manufacturers to compare their hemolytic phenotype .The relative mRNA expressions of hemolysin genes (hla, hlb, hlc, hld) in standard strain, complete and incomplete hemolytic phenotype strains were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and valued by 2 -△△Ct method.t test was used to compare mRNA expressions of hemolysin genes .Western blot was performed to analyze the expression of α-hemolysin.Antibiotic susceptibility test of incomplete hemolytic strains was performed using broth microdilution method.Resistant gene mecA and virulence genes pvl, tst were detected by PCR.Results The steady and hereditary incomplete hemolysis was observed in 50 strains of incomplete hemolytic Staphylococcus aureus on the sheep blood agar plates from different suppliers .Taking mRNA expression of hla, hlb, hlc, hld in standard strain as 1, the relative mRNA expressions of hemolysin genes in incomplete hemolytic strains were 0.02, 7.51, 0.06 and 0.12 respectively, there were statistical differences between standard strain and incomplete hemolytic strains (t =8.46, -56.40, 8.12 and 7.61, all P <0.05).And the expression of α-hemolysin was decreased in incomplete hemolytic strains .All the strains were identified as methicillin resistant Staphylococcus aureus (MRSA).Three strains exhibited different minimum inhibitory concentrations of teicoplanin and linezolid after subcultured , but the differences had no impact on the final results of antibiotic susceptibility test .mecA, pvl and tst genes were positive in incomplete hemolytic strains . Conclusion Staphylococcus aureus with incomplete hemolytic phenotype is methicillin resistant with higher expression of β-hemolysin and lower expressions of α-hemolysin, γ-hemolysin and δ-hemolysin.It carries plv and tst virulence genes and is of high virulence .