Objective To explore the different operation modes for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.Method A retrospective analysis was performed on 48 cases of native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney,including 14 cases receiving open surgery (open surgery),22 cases receiving laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision (oblique incision group) and 12 cases receiving modified endoscope assisted Plunk technique (Plunk group).The operating time,amount of bleeding and blood transfusion during operation,recovery of intestinal function,time of indwelling drainage tube and wound suture,the total cost of hospitalization,the hospital stay and the incidence of complications were comparatively analyzed.Result The operating time in open group was shortest.Group of Pluck is better than other groups in the aspects of Time of wound suture and intestinal function time in shorter in Plunk group than the rest two group (P＜0.05),and amount of bleeding and incidence of complication in Plunk group were higher than oblique incision group (P＜0.05).The incidence of complications and amount of bleeding were decreased significantly as compared with the rest groups (P＜0.05).Conclusion The mode of the laparoscopic radical nephroureterectomy with bladder cuff resection through a lower abdomen oblique incision has the advantages of high security,minimal invasion and satisfactory treatment effect.It is especially suitable for treating native renal pelvic and ureteral neoplasms occurring at the same side of transplanted kidney.

Objective To evaluate the impacts of the essential medicine system in Jiangsu Province on rational drug use in community health service centers.Methods 7667 outpatient prescriptions from 6 community health service centers in Nantong were selected by cluster sampling from January 2009 to December 2011,the part of SDUIs(Selected Drug Use Indicators)developed by WHO and the self-design indicators were employed to analyze rational use of drugs.Results After implementation of the essential medicine system,the average types of drugs per prescription decreased from 3.02 to 2.74,the rate of antibiotic drugs usage dropped from 61.43％ to 51.2％,the rate of one antibiotic usage reduced from 33.94％to 28.58％,and two types from 20.43％to 15.8％,all with significant differences(P＜0.001).The average expenses in single prescription arose from RMB 69.70 to 87.28,the rate of essential medicine usage increased from 81.22％to 85.60％,the injection utilization decreased from 31.14％ to 14.13％,while TCM utilization ascended from 16.17％to 21.8％,all with significant differences(P＜0.001).Condusion The essential medicine systems has positive impacts on rational drug use,but the expenses of per prescription are higher,and irrational antibiotic drugs are still a serious problem.

Objective To explore the impact of calciotropic hormones,such as parathyroid hormone (PTH)and vitamin D,on bone mineral density(BMD)in the old men with type 2-Diabetes.Methods Sixty elderly men with type 2-Diabetes were submitted to dual-energy X-ray absorptiometry to evaluate the BMD at lumbar spine and hip.Fasting blood samples were collected to evaluate the indexes of bone metablism and blood glucose.PTH and 25-(OH)-Vitamin D3 were measured and analyzed for their correlation with BMD at different sites.Results In all patients,the percentage of osteoporosis and osteopenia accounted for 20.0％ and 53.3％ of the patients according to BMD at lumbar or hip.Compared with the patient group with normal BMD,serum PTH was significantly higher in the patient group with osteopenia or osteoporsis([44.87 ± 10.62]μg/L vs[36.96 ±12.36]μg/L,P ＜ 0.05 ;[50.24 ± 20.32]μg/L vs[36.96 ± 12.36]μg/L,P ＜ 0.05).But there was no difference in 25-(OH)-Vitamin D3 levels between all groups.PTH was correlated negatively with BMD at hip (r =-0.224,P ＜ 0.05),but not significantly correlated with BMD at lumbar(r =-0.187,P ＞ 0.05)Conclusions Serum PTH was correlated negatively with BMD at hip in elderly man with type 2-Diabetes.

Objective To investigate the clinical characteristics and treatmentof ureteral endometriosis.MethodsA retrospective analysis was made on the clinical data of 16 cases of ureteral endometriosis of the Department of Vrology,Beijing Friendship Hapital,Affiliated to Copital Medical Universty from January.1991 to Augest.2011.ResultsSixteen cases were pathologically confirmed endometriosis,including 11 cases of outer lumen type,5 cases of lumen type ; endomctriosis lesions were all located in the lower ureter.Ureteral stricture length was 1.0-4.0 cm.During 12 months to 20 years follow-up,hydronephrosis detected by ultrasonography in 15 patients was released significantly,and no recurrence occurred except one case who was found hydronephrosis 3 years later.Ureter anastomosis was undergone later.ConclusionsUreteral endometriosis onset is undetectable which could impact renal function.Renal ultrasonography can reduce misdiagnosis.The principle of treatment is to remove the obstruction and protect renal function,and well follow-up to prevent recurrence.

Objective To explore the efficacy and safety of Gemcitabine and Cisplatin combination chemotherapy in treatment of muscle-invasive urothelial cell carcinoma.Methods Analyse of 72 cases of patients with muscle-invasive urothelial cell carcinoma receiving chemotherapy from September 2010 to September 2012,including 47 male and 25 female,the avarage age was 65 (86-33).All patients were received GC chemotherapy (Gemcitabine 800-1 000 mg/m2,ivgtt,dl,d8,d15; Cisplatin 70 mg/m2,ivgtt,d2).Efficacy was reviewed after 1 cycle of chemotherapy.Results Fifty-one cases in all the patients completed two or more chemotherapy cycles and CR 10 cases,PR 27 cases,total effective rate was 51.39％ (37/72).The main toxic reactions included nausea,vomit,myelosuppression,and then damage of liver and renal function.Cconclusion GC regimen is a good choice for urothelial cell carcinoma.Close follow-up and the usage of adjuvant drugs can contribute to reduce the side effect of chemotherapy.

Objective:To investigate the role of adenosine diphosphate ribosylation factor 6 (Arf6) in the pathogenesis of endometriosis.Methods:Endometrial tissues were sampled from women who were hospitalized in the Affiliated Hospital of Medical School of Ningbo University and Ningbo Women and Children′s Hospital from November 2020 to May 2021 with endometriosis ( n=44, endometriosis group) and without endometriosis ( n=17, control group). The expression of Arf6 protein in the endometrial tissues was detected by western blot. Endometrial epithelial cells from both groups were primary cultured and the distribution of intracellular mitochondria was detected by immunofluorescence. The expression of Arf6 protein was down-regulated by small interference RNA (siRNA), the distribution of mitochondria in cells with decreased Arf6 protein expression was observed, and the expression of mitochondria-related proteins development and differentiation enhancing factor 1 (DDEF1, also called AMAP1), reactive oxygen species 1 (ROS1) and epithelial-mesenchymal transition (EMT)-related proteins E-cadherin, vimentin were detected. Transwell assay was used to detect the changes in the migration ability of the cells. Results:Compared with the control group, ectopic endometrial tissue of endometriosis group showed high expression of Arf6 protein (0.174±0.019 vs 0.423±0.033; t=29.630, P<0.01); and in ectopic endometrial epithelial cells, mitochondria were distributed near the edge of the cell membrane. While Arf6 expression was down-regulated by siRNA, the distribution of mitochondria in ectopic cells returned to natural, close to the control level. In addition, the expression levels of AMAP1 and ROS1 in ectopic cells after Arf6 protein knockdown were significantly decreased. Transwell assay results indicated that knockdown of Arf6 could reduce the migration ability of ectopic epithelial cells [migration cell count: (34.3±7.5) cells]; and immunofluorescence verified low expression of E-cadherin but high expression of vimentin in ectopic epithelial cells, whereas knockdown of Arf6 protein E-cadherin expression increased but vimentin expression decreased. Conclusions:High expression of Arf6 protein in ectopic endometrial epithelial cells leads to the distribution of mitochondria tending to membrane marginalization, while inducing EMT, which are involved in the mechanism of endoheterosis pathogenesis.

Objective To explore the clinical study of the treatment of Diabetic foot with wound negative pressure treatment(NPWT)combined with periosteal distraction.Methods 129 patients with Diabetic foot admitted to our hospital from June 2022 to April 2023 were randomly divided into a combination group(n=43),a negative pressure group(n=43),and a control group(n=43).The control group was treated with conventional treatment,the negative pressure group was treated with NPWT,and the combined group was combined with periosteal distraction technique on the basis of the negative pressure group.The treatment efficiency,inflammatory index level,peripheral blood picture level,visual pain(VAS)score,and foot related index level of the three groups were compared.Results After 4 weeks of treatment,the scores of pain scale(VAS),white blood cell count(WBC),Calcitonin(PCT),Interleukin 6(IL-6),and high-sensitivity C-reactive protein(hs CRP)in the combined group were lower than those in the other two groups(P＜0.05);The effective rate,foot temperature,toe blood oxygen,Ankle-brachial pressure index,vascular diameter,blood flow velocity,and perfusion index(PI)of the combined group were higher than those of the other two groups(P＜0.05).Conclusion The combination of wound negative pressure therapy and periosteal distraction surgery can effectively alleviate pain,improve foot blood supply,and alleviate inflammatory reactions.

Objective To investigate the change in mortality of congenital malformation in children aged ＜5 years in Beijing from 2006 to 2015.Methods Using the death surveillance data in children aged ＜5 years in Beijing from 2006 to 2015,which was collected from the real-time surveillance network,we calculated the area and age distributions of the mortality of congenital malformation in children aged ＜5 years in Beijing.Meanwhile,the variations of age,time and space in the causes of deaths were discussed.Results The mortality rate of congenital malformation in the children s decreased from 1.909‰ in 2006 to 0.703‰ in 2015,the decrease rate was 63.17％.The decrease rate was highest in neonates (71.50％) (x2=57.993,P＜0.01).Expect urban area (x2=3.384,P＞0.05),the mortality rates of congenital malformation in the children showed a downward trend in outer suburban area and suburban area (x2=40.637 and 50.646,P＜0.01).The proportion of the children died of congenital malformation decreased from 32.97％ in 2006 to 23.24％ in 2015,which mainly occurred in infancy and neonatal period (x2=9.395 and 4.354,P＜0.05).The constituent ratios of the children died of neural tube defects,respiratory system abnormalities and other abnormalities decreased significantly (x2=13.478,7.358,7.912 and 10.074,P＜0.01).The constituent ratios of children died of chromosomal abnormality,multiple malformations and digestive tract abnormality didn't decreased significantly (P＞0.05).In the leading causes of deaths from congenital malformation,the mortality of congenital heart disease,neural tube defects and digestive tract atresia decreased obviously (x2=70.868,18.431 and 9.225,P＜0.01),except biliary atresia (x2=1.407,P＞ 0.05).There was an obvious area specific difference between the deaths of congenital heart disease and the deaths of neural tube defects,the mortality was higher in outer suburbs than in suburban and urban area (x2=45.783 and 6.649,P＜0.05).Conclusion Although the mortality rate of children with congenital malformation in Beijing has declined year by year,it is still the main cause of deaths in children under 5 years old,and the prevention and control of related diseases should be strengthened.

Objective To investigate the prognostic factors of patients with upper urinary tract urothelial carcinoma (UTUC) treated with gemcitabine plus cisplatin (GC).Methods The clinical and follow-up data of 80 patients with UTUC admitted to Beijing Friendship Hospital,Capital Medical University from January 2013 to July 2018 were retrospectively analyzed.All patients underwent UTUC radical surgery.All patients were treated with GC regimen:1,8,and 15 days,Gemcitabine 800 mg/m2,intravenous infusion over 30 min;day 2 Cisplatin 70 mg/m2,protected from light 2 h intravenous drip;28 d for 1 cycle.Adjuvant treatments such as acid suppression,hydration,and antiemetic were given before and after chemotherapy.Patients completed 1 to 5 cycles with an average of 2 cycles.The patient's age,gender,presence or absence of water,primary tumor site,tumor stage and grade,lymphatic vascular infiltration,tumor recurrence,lymph node metastasis,organ metastasis,chemotherapy cycle,total Survival,etc.are used as indicators ofobservation.Univariate analysis of the patient's overall survival,screening for clinical variables associated with prognosis,and then using the COX proportional hazards model for multivariate prognostic analysis to determine independent influencing factors.Results Eighty patients with UTUC were followed up for 2 to 72 months with a median follow-up of 27 months.Sixteen patients (20％) died of UTUC recurrence or metastasis,and 64 (80％) patients survived.The 1-year cumulative survival rate was 78.26％ (18/23),and the 2-year cumulative survival rate was 54.18％ (9/13 ×78.26％),the 3-year cumulative survival rate was 39.41％ (8/1 1 × 54.18％),the 4-year cumulative survival rate was 31.53％ (12/15 × 39.41％),and the 5-year cumulative survival rate was 28.66％ (10/11 × 31.53％).Univariate analysis showed combined hydronephrosis (P =0.023),lymphatic vessel infiltration (LVI) (P =0.001),tumor TNM stage (P =0.002),tumor recurrence (P =0.008),simple lymph node metastasis (P =0.005),organ metastasis (P ＜ 0.001) was related to survival rate.COX model multivariate analysis showed that the independent risk factors associated with survival of patients with UTUC receiving chemotherapy with GC regimen were hydronephrosis (HR =4.355,95％CI:1.232-15.390,P=0.022),LVI (HR =0.133,95％ CI:0.035-0.509,P=0.003),TNM stage (HR=0.099,95％CI:0.010-0.929,P=0.043).Conclusion The presence or absence of hydronephrosis,LVI,and tumor TNM staging are independent factors influencing the prognosis of patients with UTUC who have adjuvant chemotherapy.

Objective:To systematically analyze the basic characteristics and contents of the current health standards for infectious disease, environmental health, school health and disinfection in the context of COVID-19 prevention and control, and provide support for the further optimization of epidemic prevention and control guidelines and reference for the revision and improvement of related health standards.Methods:Public health standards used in COVID-19 prevention and control were selected for a systematic comparison with "The Plan of COVID19 Prevention and Control (the 6 th Edition)" and other epidemic prevention and control guidelines from the perspectives of application scope and technical elements. Results:The current standards of public health are with scientificity, timeliness and feasibility. The application scope and technical elements of the current public health standards basically meet the needs of the prevention and control of COVID-19 epidemic, but the public health standardization system still needs improvement, and some public health standards need to be revised.Conclusions:The implementation of current public health standards can provide strong technical support for the prevention and control of COVID-19 epidemic. The experience obtained from COVID-19 epidemic prevention and control might promote the further improvement of the health standardization system.