AIM: To investigate the changes of bladder volume , pressures and pelvic nerve firing induce by different speeds and ways of instillation .METHODS:Female SD rats (n=20) were randomly divided into 2 groups.The rats in group A was performed using 3-F polyethylene tubing inserted into the bladder through the urethra .The rats in group B were performed using 3-F tubing inserted into the dome of the bladder and secured by silk suture .The rats in both groups were infused with saline into the bladder at different speeds of 50, 100, 200 and 400μL/min.The changes of bladder vol-ume and pressure were recorded by urodynamic measuring devices .The changes of pelvic nerve firing during instillation were recorded by multi-channel physiologic recorder .RESULTS:In group A, the maximum firing frequency , bladder leak point pressure ( BLPP) and maximum voiding pressure ( MVP) were increased with the increase in the instillation speed . No significant difference of the maximum bladder capacity (MBC) at different speeds was observed .In group B, the maxi-mum firing frequency had no significant difference at different speeds .MBC was decreased with the increase in the instilla-tion speed , and exhibited significant decrease at 200 and 400 μL/min.No significant difference of BLPP and MVP at dif-ferent speeds was observed .Compared with group A , the maximum firing frequency and MBC in group B significantly de-creased at different speeds .However , BLPP and MVP in group B were higher than those in group A at the speeds of 50 and 100 μL/min.CONCLUSION:Different instillation speeds with the method of group A will not change the bladder volume but influence the pelvic nerve firing , so the process of method A may take various speeds according to different aims .How-ever, process of method B at the speed of over 200 μL/min may not be good to MBC, thus instillation under 200 μL/min is re-commended .

Objective To investigate the treatment of urinary tract obstruction after kidney transplantation, and to introduce the novel ‘antegrade percutaneous urinary tract throughout guidance technique’ with guide wire in selected patients. Methods 43 cases of renal transplantation patients due to urinary tract obstruction (ureteral stenosis and hydronephrosis in 24 cases, urinary calculi with or not ureteral stenosis in 19 cases) received endourological treatment. Retrograde pathway was tried firstly, if failed, antegrade pathway was adopted with‘antegrade percutaneous urinary tract throughout guidance technique’, 18 Fr percutaneous tract was established if necessary, endoscopy was needed in antegrade or combine with retrograde pathway. Results Of the 43 patients, 9 (20.9 %) patients were managed directly through the retrograde ureteroscopy, 28 (65.1 %) patients were managed with anterograde percutaneous technique in 18 Fr tract, 6 (14.0 %) patients were treated with ‘antegrade percutaneous urinary tract throughout guidance technique’. Operation time was (72.0 ± 16.0) (45 ~ 95) minutes. Postoperative stone clearance rate of 89.5 % (17/19). Of 32 cases with ureteral stricture, 6 (6/32, 18.8 %) cases were cured after one time of dilation and JJ stent indwelling for 2 months, 18 (56.3%) cases with stable hydronephrosis after 2-3 times of dilation and JJ stent indwelling, 5 cases (15.6 %) needed long-term repeated stent indwelling for drainage, 3 (9.4%) cases required nephrostomy tube drainage. Conclusion Minimally invasive treatment of urinary tract obstruction after renal transplantation is effective. Antegrade percutaneous urinary tract throughout guidance technique provided a powerful guarantee for retrograde operation and avoided the bleeding risk following percutaneous renal surgery, when combined with flexible ureteroscopy, urinary calculi in patients with kidney transplantation can be effectively managed with little trauma.

Objective To establish the HPLC fingerprint of Chuanxiong Chatiao San(CXCTS)and Chuanxiong Chatiao Granules(CXCTG),and to compare their quality difference by using HPLC fingerprint in combination with anti-platelet aggregation activity in vitro.This study explores the material basis of anti-platelet aggregation activity of CXCTS and CXCTG to provide a reference for the quality control and clinical application.Methods HPLC fingerprint for 20 batches of CXCTS and seven batches of CXCTG were established,and systematic clustering analysis was conducted using SPSS 27.00 statistical software.In addition,the in vitro anti-platelet aggregation activity was determined.The relationship between HPLC fingerprint spectrums and anti-platelet aggregation activity was analyzed by using SIMCA P-14.0 statistical software for partial least squares analysis(PLS).The markers of quality difference of CXCTS and CXCTG were screened.Results A total of 26 common peaks in the fingerprint and 16 components were identified.Systematic clustering analysis showed that CXCTS and CXCTG were clustered into two categories.There were significantly differences in HPLC fingerprint and anti-platelet aggregation activity between CXCTS and CXCTG.Combining correlation coefficient and VIP value,we confirmed 17 common peaks,which showed positive correlation with anti-platelet aggregation activity and the VIP values were greater than one.The effective fractions of anti-platelet aggregation activity were screened out.Among the above-mentioned fractions,hesperidin,rosmarinic acid,buddleoside,pulegone,coniferyl ferulate,(Z)-ligustilide,notopterol,imperatorin,isoimperatorin,peak 7,9,12,14,6,17,19,and 23 were picked out as the quality difference markers.Conclusion HPLC fingerprint spectrum of CXCTS and CXCTG was established in this study.The established method can detect multiple active components in both formulations.There was significant difference between CXCTS and CXCTG on the content of active ingredients and anti-platelet aggregation activity.The former is of higher quality than the latter.This study can provide reference for the quality control and clinical application of CXCTS and CXCTG.

Objective:To explore the suitability of mechanical insufflation-exsufflation combined with external diaphragm pacemaker in elderly patients with mechanical ventilation and its effect on the complications and prognosis of mechanical ventilation.Methods:Using the convenient sampling method, a total of 40 elderly patients undergoing mechanical ventilation through nasal tracheal intubation who were admitted to the Geriatric Ward of the PLA General Hospital from September 2018 to December 2019 were selected as the research objects. The patients were divided into the observation group and the control group by random number table method, with 20 cases in each group. The control group continued the traditional airway nursing technique and limb rehabilitation training, while the observation group added mechanical insufflation-exsufflation combined with external diaphragm pacemaker on the basis of the control group. The incidence of pulmonary infection, changes in sputum production at 1 h and 24 h, diaphragm thickening rate, weaning time, success rate of weaning and mortality rate were observed in the two groups before and after intervention.Results:After the intervention, the incidence of pulmonary infection in the observation group was lower than that of the control group, the sputum production and diaphragm thickening rate at 1 h and 24 h were higher than those in the control group, the weaning time was shorter than that of the control group, and the success rate of weaning was higher than that of the control group. All differences were statistically significant ( P<0.05) . There was no statistically significant difference in mortality rate between the two groups ( P>0.05) . Conclusions:Compared with traditional airway nursing techniques, mechanical insufflation-exsufflation combined with external diaphragm pacemaker can help elderly patients with mechanical ventilation achieve airway clearance and respiratory muscle exercise more safely and effectively, improve strength and endurance of diaphragmatic muscle and enhance the ability of spontaneous cough in elderly patients. In addition, the intervention method is mild and easy for patients to accept, and it is worthy of being widely used in elderly patients with mechanical ventilation.

Objective:To explore the prevalence and independent associated factors of vascular calcification (VC) in non-dialysis chronic kidney disease (CKD) patients of stage 3-5.Methods:It was a single-center cross-sectional observational study. Non-dialysis stage 3-5 CKD patients ≥18 years old who were admitted to the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University from May 1, 2022 to December 31, 2022 with VC evaluation were enrolled. The patients' general information, laboratory examination and imaging data were collected. Coronary artery calcification (CAC), thoracic aorta calcification (TAC), abdominal aorta calcification (AAC), carotid artery calcification and aortic valve calcification (AVC) were evaluated by cardiac-gated electron-beam CT (EBCT) scans, lateral lumbar x-ray, cervical macrovascular ultrasound and echocardiography, respectively. The differences in clinical data and the prevalence of VC at different sites of patients with different CKD stages were compared, and the prevalence of VC at different sites of patients in different age groups [youth group (18-44 years old), middle-aged group (45-64 years old) and elderly group (≥65 years old)] and patients with or without diabetes were compared. Multivariate logistic regression analysis was used to analyse the independent associated factors of VC for different areas.Results:A total of 206 patients aged (51±14) years were included, including 129 (62.6%) males. There were 44 patients with CKD stage 3 (21.4%), 51 patients with CKD stage 4 (24.8%), and 111 patients with CKD stage 5 (53.9%). CKD was caused by chronic glomerulonephritis [104 cases (50.5%)], diabetic kidney damage [35 cases (17.0%)], hypertensive kidney damage [29 cases (14.1%)] and others [38 cases (18.4%)]. Among 206 patients, 131 (63.6%) exhibited cardiovascular calcification, and the prevalence of CAC, TAC, AAC, carotid artery calcification, and AVC was 37.9%, 43.7%, 37.9%, 35.9% and 9.7%, respectively. The overall prevalence of VC in young, middle-aged and elderly patients was 24.6%, 73.6% and 97.4%, respectively. With the increase of age, the prevalence of VC in each site gradually increased, and the increasing trend was statistically significant (all P<0.001). The overall prevalence of VC in CKD patients with diabetes was 92.5% (62/67), and the prevalence of VC at each site in the patients with diabetes was significantly higher than that in the patients without diabetes (all P<0.001). Multivariate logistic regression analysis revealed that age (every 10 years increase, OR=2.51, 95% CI 1.77-3.56, P<0.001), hypertension ( OR=5.88, 95% CI 1.57-22.10, P=0.009), and diabetes ( OR=4.66, 95% CI 2.10-10.35, P<0.001) were independently correlated with CAC; Age (every 10 years increase, OR=6.43, 95% CI 3.64-11.36, P<0.001) and hypertension ( OR=6.09, 95% CI 1.33-27.84, P=0.020) were independently correlated with TAC; Female ( OR=0.23, 95% CI 0.07-0.72, P=0.011), age (every 10 years increase, OR=3.90, 95% CI 2.42-6.29, P<0.001), diabetes ( OR=5.37, 95% CI 2.19-13.19, P<0.001) and serum magnesium ( OR=0.01,95% CI 0-0.35, P=0.014) were independently correlated with AAC. Moreover, age and diabetes were independently correlated with carotid artery calcification, AVC and overall VC Conclusions:The prevalence of VC in non-dialysis CKD patients of stage 3-5 is 63.59%, of which CAC reaches 37.9%, TAC is the most common one (43.7%), while AVC is the least one (9.7%). Age and diabetes are the independent associated factors for VC of all sites except TAC, while hypertension is an independent associated factor for both CAC and TAC.