Objective To compare ureteroscopic hthotomy (URL)and minimally invasive percuta-neous nephrolithotomy (MPCNL) for the management of upper-ureteral calculi ≥ 1.5 cm. Methods Fifty-eight patients with upper-ureteral calculi ≥ 1.5 cm were selected in randomized for URL group (35patients)or MPCNL group (23 patients). Ultrasonography and intravenous X-ray were performed for all pa-tients before surgery. Results In the URL group, 13 cases (37.1%)were rendered stone-free, 8 stones mi-grated upward to the pelvis of kidney. In these cases,a double- J stent was inserted, and ESWL was per-formed,7 cases had ureteral distortion, 3 cases had ureteral stricture, 4 cases had bad field of vision, MPCNL or open operation was performed in these eases. The mean operative time was 38 minutes (range 25-48 min-utes). In the MPCNL group,21 eases (91.3%)were rendered stone-free. In the other 2 patients,ESWL was performed because the stone fragments migrated upward to the pelvis of kidney. The mean operative time was 34 minutes (range 20-58 minutes). Conclusion Compared with URL,MPCNL is a safe and effective procedure for treating upper-ureteral calculi ≥ 1.5 cm.

Objective Among the various components of metabolic syndrome(MS),this investigation attempt to find the most important one.Furthermore,to verify the feasibility of using waist circumference(WC)for assessing the diagnostic criteria for MS proposed by the CDS in 2004.Methods Among 163 cases recruited,80 patients met the criteria of MS and 83 cases were diagnosed as non-metabolic syndrome group(non-MS).Age,WC,body mass index(BMI),fasting plasma glucose,lipid profile,blood pressure were compared between patients of MS and non-MS.Logistic regression analysis and area under curve(AUC)of receiver-operating characteristic(ROC)were used to study the predictive value of WC.Results Patients with CDS-defined MS showed a significantly higher age,WC,SBP,DBP,fasting plasma glucose,triglycerides(TG),1/HDL-C when compared with non-MS group.After adjusting for age,the family history of diabetes and hypertension,smoke,multiple logistic regression analysis revealed WC was the most important predictive factor for MS group.ROC analysis showed that the AUC of WC was 0.92 in the males,the cut-off value is 89.5 cm,the sensitivity was 0.84,the specificity was 0.93;the AUC of WC was 0.93 in the females,the sensitivity was 0.97,the specificity was 0.81 when cut-off value is 80.8 cm.This investigation has shown that smoking was also a component of MS.The relative risk of MS in current smokers and sustained smoker was higher than that of abstinence(6.88 vs 1.00 and 3.96 vs 1.00).Conclusion Central obesity is the riskest indicator for the diagnostic criteria for MS proposed by the CDS,WC is verified to be the accuracy and satisfactory predictive indicators for MS.Smoking may be a novel component of MS.

Clinicians need to focus on various points in the diagnosis and treatment of insomnia.This article prescribed the treatment protocol based on the unique features,such as insomnia in the elderly,women experiencing specific physiologi-cal periods,children insomnia,insomnia in sleep-breathing disorder patients,insomnia in patients with chronic liver and kidney dysfunction.It pro-vides some reference for clinicians while they make decision on diagnosis,differentiation and treat-ment methods.

Objective: To understand the status quo and differences of the rights and interests of primary medical staff in a community, and to provide targeted suggestions for improving the rights of such staff. Methods: From October to November 2018, a questionnaire survey was conducted on all the medical staff of 8 community health service centers in a district of Shanghai, and 562 valid samples were obtained. Results: The primary medical staff had the highest demands for " pay rise" (4.783±0.598), " paid vacation" (4.569±0.873)and " additional reserve fund" (4.553±0.963); the lowest demands were placed on " education-based promotion" (3.797±1.382), " refresher training" (3.801±1.314), and " opinion feedback mechanism" (4.018±1.223). At the same time, the rights and interests of these staff in different occupational categories were significantly different(P<0.05)in " daily reimbursement" , " housing subsidy" , " refresher training" and " opinion feedback mechanism" . Conclusions The salary demands of the primary medical staff are the most obvious, and there are differences in the demands of medical staff in different occupational categories. It is suggested to establish a more reasonable salary system and pay attention to the differentiated appeals of different medical personnel.