Objective To evaluate the therapeutic effect of ESWL combined with urinary stone decoction and ear acupoint pressure for the patients with renal and ureteral calculi.Methods A total of 110 patients with renal and ureteral calculi were randomly divided into the Chinese medicine (CM) and conventional groups, 55 in each group. Both groups were given ESWL treatment as basic treatment. Chinese medicine group were given the urinary stone decoction and auricular acupressure, and the conventional group used stone granules. Both groups were treated for 2 weeks. According to the photography of ultrasound, the changes of calculi, time of lithagogue, pain relief after operation and the effect rates of pain relief on abdomen and waist, of remission of haematuria, and of urinate pain. ResultsAfter treatment, the successful rates of operation in the CM group was 90.9% (50/55), and conventional group was 76.4% (42/55). There was significant difference between 2 groups (χ2=4.251,P=0.009). The time of stone removal in CM group was significantly shorter than that in the conventional group (7.3 ± 3.8 dvs. 11.2 ± 4.3 d,t=4.032,P<0.001). After 1st, 3rd, 5th, 7th days, the VAS pain scores in the CM group were significantly lower than those in the conventional group (4.1 ± 0.8vs. 5 ± 1.2,t=4.783;4.5 ± 0.9vs. 5.3 ± 1.3,t=4.492; 3.8 ± 0.8vs. 4.5 ± 0.8,t=4.503; 2.2 ± 0.8vs. 2.9 ± 0.9,t=3.691; allP<0.01). After 7th day, the rates of abdominal pain relief was 60% (33/55), pain relief was 79.1% (34/43), the remission of hematuria was 81% (17/21) in the CM group, and the control group were 40% (22/55), 59.6% (28/47), 52% (13/25). There were significant differences between 2 groups on these indices (χ2 values were 4.400, 3.982, 4.217,P values were 0.036, 0.046, 0.040).Conclusions The ESWL combined with urinary stone decoction and ear acupoint pressure could improve the symptoms of patients with kidney ureteral stones.

Objective To evaluate atrial septal defect (ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2 -3 cm incision was made in the fourth right intercostal space. Utilizing transesophageal or transthoracic echocardiography, the occluder was released using a monotube unit. Results All patients were occluded successfully. No patient required open surgery utilizing extracorporeal circulation. There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe, less invasive, and has excellent outcomes.

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) in peripheral blood for the outcomes in patients with acute intracerebral hemorrhage.Methods Consecutive inpatients with intracerebral hemorrhage diagnosed with the head CT were entolled.The modified Rankin Scale (mRS) was used to evaluate the functional outcomes at 90 d,0-2 wvas defined as good outcome,3-6 were defined as poor outcome,and 6 was defined as death.Univariate analysis was used to compare the demographic characteristics,baseline data,imaging,and laboratory findings between the groups.Multivariate logistic regression analysis was used to determine the independent correlation between NLR and the outcomes,and receiver operating characteristics (ROC) analysis was performed to assess the predictive value of NLR for the outcomes.Results A total of 205 patients with acute intracerebral hemorrhage were enrolled in the study,107 (52.2％) had poor outcome and 57 (27.8％) died.There were significant differences in age (P=0.038),Glasgow Coma Scale (GCS) scores (P=0.001),National Institutes of Health Stroke Scale (NIHSS) scores (P =0.001),neutrophil count (P =0.005),lymphocyte count (P =0.002),NLR (P =0.001),fasting blood glucose (P =0.012),hypersensitivity C-reactive protein (P=0.002),hematoma volume (P =0.005),and proportion of bleeding into the ventricles (P =0.002) between the poor outcome group and the good outcome group.There were significant differences in age (P =0.002),previous stroke (P =0.018),GCS scores (P =0.001),NIHSS scores (P =0.001),neutrophil count (P=0.008),lymphocyte count (P=0.001),NLR (P=0.001),fasting blood glucose (P=0.016),hematoma volume (P=0.001),and proportion of bleeding into ventricle (P=0.002) between the death group and the survival group.Multivariate logistic regression analysis showed that NLR was an independent predictive factor for poor outcome (odds ratio [OR] 2.405,95％ confidence interval [CI] 1.613-3.587;P=0.001) and death (OR 2.268,95％ CI 1.532-3.358;P =0.001) after adjusting for confounders.The ROC curve analysis showed that NLR had a higher predictive value for poor outcome at 90 d (area under the ROC curve 0.703,95％ CI 0.632-0.774;P ＜ 0.001).When the cutoff value was 2.3,the sensitivity and specificity were 61.7％ and 72.4％,respectively.NLR also had a predictive value for death within 90 d (area under the ROC curve 0.706,95％ CI 0.629-0.786;P =0.003).When the cutoff value was 2.2,the sensitivity and specificity were 63.2％ and 72.6％,respectively.Conclusion NLR may have certain predict value for outcomes in patients with acute intracerebral hemorrhage.

In view of the current teaching status of Traditional Rehabilitation Methodology for rehabilitation medicine specialty in higher medical colleges and universities,combining with the knowledge of some acupoints taught in this course,we put forward some suggestions for the teaching of this course.In teaching process of acupoints knowledge,while emphasizing the importance of its anatomical location,we should also attach importance to elaborating the name of acupoints and the rich cultural contents contained in the naming process.At the same time,paying attention to induction learning and finding memory rules,combining theoretical knowledge with classmates' hands-on practice,and encouraging students to participate early in clinical practice activities,we can develop students' practical work ability.

Extracellular vesicles(EVs)are membrane-derived lipid bilayers secreted by bacteria and eukaryotic cells.EVs se-creted by Gram-negative bacteria have been extensively studied for many years,but due to differences in cell wall structure,EVs in Gram-positive bacteria have been disregarded.However,the production of EVs in Gram-positive bacteria was confirmed in recent stud-ies.Components of EVs are diverse,including proteins,lipids,nucleic acids and metabolites,play important role in biofilm forma-tion,antibiotic resistance,horizontal gene transfer(HGT)and pathogenesis.EVs have potential applications and are involved in the fields of vaccine research and development,disease treatment and drug delivery.Here,we review the latest findings on the biogene-sis,components,applications and functions of EVs from Gram-positive bacteria,hoping to provide a reference for the research in the field of EVs in Gram-positive bacteria.

Background Essential and non-essential elements have an important impact on the development of the central nervous system during fetal development. Due to their less developed brain, preterm infants are more sensitive to element exposure, and are high-risk groups of neurodevelopmental abnormalities. However, it is not clear whether the effects of element exposure in utero on postpartum neurodevelopment are different between full-term infants and preterm infants. Objective To evaluate the effects of element exposure levels during pregnancy on neurodevelopment of children aged 6-24 months (of corrected age), and compare the effects between preterm and full-term children. Methods A prospective study design was adopted and this study was conducted based on the Maoming Birth Cohort Study (MBCS) in Maoming City, Guangdong Province. Twenty elements in cord blood of 197 preterm infants and 297 full-term infants were measured, including 11 essential trace elements [vanadium (V), chromium (Cr), manganese (Mn), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), selenium (Se), strontium (Sr), tin (Sn), and iron (Fe)], and 9 non-essential trace elements [aluminum (Al), arsenic (As), thallium (Tl), lead (Pb), uranium (U), cerium (Ce), antimony (Sb), cadmium (Cd), and yttrium (Y)]. The neurodevelopment of the children at 6, 12, and 24 months were evaluated by the Ages and Stages Questionnaires-the Third Edition (ASQ-3). A generalized estimating equation (GEE) model was adopted to evaluate the associations between elements and neurodevelopment in full-term and preterm children separately. Results The positive rates of 10 elements (Mn, Cu, Zn, Se, Sr, Fe, Sb, Tl, Pb, and As) in cord blood were greater than 80%. Among the preterm birth children, the results of GEE analysis showed that after adjusting for the covariates, for each increase of interquartile range (IQR) in ln-transformed concentration, As was associated with problems/delay in the communication and problem-solving sub-scales, with the adjusted odds ratios (OR) and 95% confidence intervals (CI) of 1.36 (1.03-1.80) and 1.55 (1.10-2.20), respectively; the adjusted OR (95%CI) of problems/delay in the fine motor and problem-solving sub-scales were 1.44 (1.00-2.07) and 1.76 (1.09-2.84) for Sb, respectively; the adjusted OR (95%CI) of problems/delay in the communication sub-scale was 1.37 (1.09-1.74) for Se. No statistically significant associations between umbilical cord blood element concentrations and neurodevelopment indicators were observed among full-term children. The results of stratified analysis by sex showed that the associations between umbilical cord blood element concentrations and neurodevelopment problems/delay were only significant among female preterm children. Conclusion Exposures to As, Se, and Sb during pregnancy may increase the risk of neurodevelopment problems/delay in preterm children aged 6-24 months, and female seem to be more vulnerable.

Objective: To establish a three-dimensional coordinate system that can accurately measure the recurrence rate after orthognathic surgery, and evaluate and analyze the degree of recurrence. Methods : Data from patients who underwent orthognathic surgery in a hospital were selected to reconstruct three-dimensional images with spiral CT. The two researchers used the multiplane assisted positioning method to fix the points three times and screened them using intra-andintreclass correlation coefficients (ICC). Reproducible and accurate landmark points were drawn to establish different coordinate systems and calculate the facial asymmetry index (AI) to determine the coordinate system with the best mid-sagittal plane symmetry. This coordinate system and lateral radiographs were used to separately measure the recurrence rate, and evaluate and analyze the three-dimensional recurrence degree of orthognathic surgery. Results : Ten landmark points that may be repeatedly fixed were obtained, including N (nasion), K (K point), ANS(anterior nasal spine), PNS (posterior nasal spine), Ptm(pterygomaxillary fissure), Gn (gnathion), IZ(IZ point), MZ (MZ point), Ms (mastoideale), Cor (coronion) and and Go (gonion). Three coordinate systems were established, and the most suitable coordinate system was the upper edge point of the left infraorbital foramen. The inner upper edge of the right infraorbital foramen and both sides of the midpoint of the ear points constituted the horizontal plane (HP), which passed through the outermost point of the left zygomatic frontal suture and the outermost point of the right zygomatic frontal suture and was perpendicular to the horizontal plane to constitute the coronal plane (CP). It was perpendicular to the two planes to form a sagittal plane (SP). Two-dimensional and three-dimensional measurements of recurrence were performed on 112 patients, and new three-dimensional recurrence evaluation results were obtained. Less than 40% had low recurrence, 40% to 61% had moderate recurrence, and greater than 61% had high recurrence. Conclusion This study established a three-dimensional coordinate system suitable for measuring the recurrence rate after orthognathic surgery, obtained a new three-dimensional recurrence evaluation result, and provided a clinical experimental basis for evaluating the effect of orthognathic surgery and improving stability.