Objective:To observe the reliability and clinical implement of flexible ureteroscope combined with extracorporeal shock wave lithotripsy to treat the kidney stones with a diameter of more than 2cm. Methods:The diagnosed 80 cases of kidney stones (all with a diameter of more than 2cm) patients in our hospital were chosen, randomly divided into two groups, URL group and PCNL group,each of them with 40 cases. Surgical curative effect, operation time, postoperative complications, hospitalization days and the change of NGAL levels and the change of urine levels Kim-1 preoperative and postoperative blood 3 days of two groups were observed and compared. Results: Comparing with the PCNL group, the surgical curative effect, operation time and postoperative complications of the URL group have no significant difference, but the hospitalization days between are significantly different(t=8.433, P<0.05);In terms of NGAL, Kim-1, the postoperative 1d of PCNL group is significantly higher than preoperative, NGAL postoperative 1d of URL group is significantly higher than preoperative (t=3.319, P<0.05). Conclusion:It was reliable that flexible ureteroscope combined with extracorporeal shock wave lithotripsy to treat the kidney stones with a diameter of more than 2cm, lower complication rate, worthy of clinical.

Objective To evaluate the application value of Microendoscopic Discectomy (MED) in the treatment of lumbar disc herniation and lumbar spinal stenosis. Methods 188 cases of lumbar disc herniation and lumbar spinal stenosis were treated by MED, 38 cases of them performed lateral recess decompression. Results The mean follow-up period was 6.9 months. excellent and good therapeutic result rate was 97.4% (Macnab's standard). Conclusions MED in the treatment of lumbar disc herniation and lumbar spinal stenosis has short-term satisfactory therapeutic efficacy.

Objective To detect the mutation of STK11 in a family with Peutz-Jeghers syndrome.Methods Genomic DNA was extracted from peripheral blood and harmatoma polypus of all the patients,and 9 exons and noncoding regions of STK11 were amplified by PCR.Cycle sequencing was used to analysis the DNA sequence,and western blot was used to detected the mutational STK11 protein in the harmatoma polypus.Results The 21th codon CAG in exon 5 of STK11 gene transformed to TAG in all the patients,which translated into a truncated STK11 protein.Conclusion This novel mutation is the pathogeny of PJS in this family,which could be an indicator for the diagnosis of PJS in this family.And it may lead to a higher risk of cancer in patients.

Objective To investigate the advantage of separate bolus injection technique in CT urography (CTU) improving the display of the whole urinary tract.Methods Sixty cases of CTU examination,were divided into observation group and control group by random digits table with 30 cases each,observation group used separate bolus injection technique and control group used single bolus injection technique.The scanning included routine scanning,cortical phase,medullary phase and lag phase.Reconstruction of lag phase displayed the whole urinary tract.Then the image quality was compared between two groups.Results The whole urinary tract showed excellent in 12 cases (40.0％,12/30),good in 17 cases (56.7％,17/30),normal in 1 case (3.3％,1/30) in control group,which showed excellent in 23 cases (76.7％,23/30),good in 7 cases (23.3％,7/30) in observation group,there was significant difference in excellent rate between two groups (P ＜ 0.01).The CT value of starting of ureter was (238.6 ± 82.5) HU,middle-lower ureter was (245.9 ± 112.3) HU in control group and (239.0 ± 93.8),(235.3 ± 74.6) HU in observation group,there was no significant difference between two groups (P ＞0.05).There was no difference in developing of urolithiasis between two bolus injection techniques.Conclusion The application of separate bolus injection technique in CTU examination can reduce the dose of the first contrast material and contrast material reaction,and receive high-quality image of the whole urinary tract.

Objective To investigate the effect-site concentration for 50% of maximal effect (EC50 )of propofol required for loss of consciousness and onset of burst suppression and to assess the effect of target-control infusion(TCI)of remifentanil on these EC50 of propofol.Methods Sixty patients undergoning general anesthesia for scheduled surgery were randomly divided into 2 groups (n=30):group R received TCI of remifentanil with a target concentraton of 4 ng/ml 10 minutes before TCI of propofol,which started at a target plasma concentration of 1μg/ml and then increased by 1μg/ml step every 1 minute until the burst suppression ratio reach to 15%.Group N received a mock TCI of saline instead of remifentanil and the other procedures were as same as group R.During this,all patients were assessed by modified Observ-er’s Assessment of Alertness/Sedation (OAA/S)scale,the loss of consciousness was definited by modified OAA/S values less than 2,the onset of burst suppression was definited by 15% of burst suppression ratio. Results The EC50 of effect-site concentration of propofol required for loss of consciousness and onset of burst suppression were 2.35 (95%CI 2.29-2.41)and 6.31 (95%CI 6.13-6.47)μg/ml respectively.The EC50 of propofol required for loss of consciousness was decreased to 1.73μg/ml by TCI of remifentanil,but the EC50 of propofol required for onset of burst suppression did not changed by TCI of remifentanil. Conclusion TCI of remifentanil could decrease the EC50 of propofol effect-site concentration required for loss of consciousness but has no effect on the EC50 of propofol required for onset of burst suppression.

Objective To retrospectively compare the image quality and radiation dose for coronary CT angiography obtained with a prospectively gated transverse (PGT) CT technique and a retrospectively gated helical (RGH) CT technique. Methods Coronary CT angiography obtained with 256-slice CT were retrospectively evaluated in 177 patients. The main branches of coronary arteries were divided into 9 segments. The image quality was evaluated with a four-point grading scale. The assessability of coronary artery segment, image quality score and radiation dose for prospective and retrospective CT angiography were compared with student t test. Results The PGT technique was used in 86 patients. The routine RGT technique was used in 91 patients. The percentage of assessable coronary artery segments was 98. 8% (765 of 774)with PGT technique versus 99. 6% (816 of 819) with RGH technique (t = 2. 51, P = 0. 01 ). In patients with heart rates under 75 beats per minute, the image quality of coronary artery branches was similar between PGT and RGH techniques (99. 8% versus 99. 7%, t = 1.90, P > 0. 05 ) . In patients with heart rates above 75 beats per minute, the image quality with RGH technique was better than that with PGT technique (99.0% versus 93. 6%, t = 3.57, P < 0. 05 ). Effective dose with prospective CT angiography was 60. 0% lower than that with retrospective CT angiography [ (4. 4 ± 0. 5 ) vs ( 10. 3 ± 1.5 ) mSv, t = 33.4,P <0. 05 ]. Conclusions Prospective CT angiography can reduce effective radiation dose obviously. The PGT technique offers the similar image quality with RGH technique in patients with heart rates under 75 beats per minute and RGH technique has better image quality in patients with heart rates above 75 beats per minute.

Objective To explore the effects of H2S on cerebral injury after cardiopulmonary resuscitation (CPR) and its mechanism.Methods Forty-five healthy Sprague-Dawley (SD) rats were randomly (random number) divided into shame-operated group ( group A,n =5 ),resuscitation group ( group B,further divided into four subgroups as per rats sacrificed 6 h,12 h,24 h,and 72 h after resuscitation,n =5),and NaHS pretreatment group ( group C,further divided into 4 subgroups as done in group B).The ratio of water content in brain tissue was calculated.The content of H2S in cerebral cortex of rats in all groups was determined by using universal microplate reader. Immunohistochemistry method was used to count the Nestin-positive cells. Results The content of H2S in hippocampus area of brain showed dramatic changes from rising up at first and then to lowering down to the minimum and finally returning to the original level in 72 h in B group.Compare to group B,brain water content was lesser ( P ＜0.05 or P ＜ 0.01 ) and the levels of Nestin in hippocampus increased in group C(P＜0.05 or P ＜0.01).The neurological deficit score (NDS) was improved (P ＜0.05 or P ＜0.01) and pathological changes in hippocampus of rat brain detected by using hemotoxylin - eosin staining were slighter in group C in comparison with group B.Conclusions Endogenous H2S may involve in the course of formation and progress of cerebral injury after CPR and small dose of NaHS (exogenous H2S) can improve NDS by decreasing cerebral edema and up-regulating Nestin level in hippocampus of brain,playing a protection role in cerebral injury after CPR.

OBJECTIVETo develop an intelligent adjustable leg raising system which could realize the quantification and visualization of lower limbs' elevation angle and frequency.

METHODSWe determined the pole adjustable length of thighs and cruses and the flexion angle range of hips and knees according to the requirements of clinical lower limb function rehabilitation, and made force analysis of hip's and knee's flexion motivation mechanism and clinical observation on its security and effectiveness.

RESULTSThis device was small and compact in overall appearance, which could adjust the angle of the hips and knees bending and ankles turning alone. The force analysis of the hips and knees flexion power element was consistent with the design requirements. The preliminary studies showed the device could relieve pain, improve the range of motion and promote the rehabilitation, which was superior to that of the Brown Ska (P < 0.05).

CONCLUSIONThe intelligent adjustable leg raising system meets the requirements of clinical usage, which is suitable for different heights, and the flexion angle ranges of hips and knees are wide and in high accuracy, which is worth of being improved and generalized.

Objective To develop an HPLC method for the measurement of fractional and molar esterification rate of serum HDL(FER HDL and MERHDL).Methods Blood samples were mixed with 5,5'-dithiobis-(2-nitrobenzoic acid)(DTNB)and the sera were separated.Serum HDL fractions were prepared by precipitation with Dextran sulfate and magnesium and the fractions were incubated at 37℃for 1 h in the presence and absence of 2-mercaptoethanol(ME).Free cholesterol levels of the HDL fractions were analyzed by HPLC and FERHDL and MERHDL were calculated.Results Under the selected conditions,serum free cholesterol could be stabilized by inhibition of LCAT with DTNB and the inhibition be reversed by ME. The total CVs for FERHDL and MERHDL were 1.59%-3.74% and 1.64%-2.88%,respectively.The averages of FERHDL and MERHDL in 70 apparently healthy subjects were 18.7%/h and 42.7 μmol·L-1·h-1 with standard deviations of 7.2%/h and 11.8 μmol·L-1·h-1·respectively,and the medians were 16.1%/h and 11.8 μmol·L-1·h-1.Close correlations of FERHDL.and MERHDL with other cardiovascular disease risk factors were observed.Conclusion A new method for the measurements of FERHDL and MERHDL by HPLC has been estabished. The method is safe, precise and simple and applications in the assessment of cardiovascular diseases risks are expected.

Objective To investigate the effects of maternal behaviors in the rats with neuropathic pain (NP) on emotions of offspring rats and the relationship with DNA methylation in the amygdala.Methods Forty-eight healthy adult Sprague-Dawley rats (24 males and 24 females),weighing 200-250 g,were used in the study.Twelve female and 12 male rats were randomly selected,and NP was induced by chronic constriction injury (CCI).Each female rat was mated with one male rat at 10 days after CCI.Fortyeight F1 generation rats of maternal rats with NP were randomly divided into 2 groups (n =24 each) using a random number table:NP1 group and NP2 group.Forty-eight F1 generation rats of normal maternal rats were randomly divided into 2 groups (n=24 each) using a random number table:S1 group and S2 group.The F1 generation rats were cross-fed immediately after birth between group NP2 and group S2,and fed by their own mother rats in NP1 and S1 groups.All the offspring rats were fed to 21 days after birth by the maternal rats selected,and separately fed to 30 days after birth,and then subjected to behavioral testing.Retrieving and licking pups were recorded after delivery in maternal rats to evaluate the maternal behaviors.The mechanical and thermal paw withdrawal thresholds were measured in the offspring rats.Elevated plus maze and open field tests were conducted to detect anxiety and depression behaviors in the offspring rats.At 1 day after completion of behavioral testing,the expression of DNA methyltransferase 1 (DNMT1) and DNA methyltransferase 3a and 3b in the amygdala was detected by Western blot analysis.Results Compared with S1 or S2 groups,the latency to lick pups,latency to retrieve pups,and total retrieval time were significantly prolonged,and the total time spent licking pups was significantly shortened in NP1 group or NP2 group (P＜0.05 or 0.01).There was no significant difference in the mechanical and thermal paw withdrawal thresholds in the offspring rats between the four groups (P＞0.05).Compared with group S1,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Compared with group NP2,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Conclusion Decreased maternal behaviors in the rats with NP results in negative emotions including anxiety and depression in the offspring rats,and the mechanism is related to increased DNA methylation in the amygdala of the offspring rats.