Objective:To compare the clinical efficacy and safety of Shuo Tong ureteroscopy(ST-URS) and flexible ureteroscope(FURS)combined with holmium laser lithotripsy in the treatment of upper ureteral calculi with CT numerical value ≥ 1000 HU.Methods:A retrospective analysis of the clinical data of patients of upper ureteral calculi with CT numberical value≥1000 HU in the First Affiliated Hospital of Xiamen University was made from January 2018 to November 2020.There were 61 cases treated with ShuoTong ureteroscopy holmium laser lithotripsy (ST-URS group), including 45 males and 16 females, with 40 on the left and 21 on the right, age of(48.3±12.7) years, body mass index of(24.7±2.7)kg/m 2, the diameter of stone of(1.50±0.45)cm, and the CT numberical value of(1 288.8±179.0)(1 017-1 738)HU. There were 87 cases were treated with flexible ureteroscopy holmium laser lithotripsy (FURS group), including 58 males and 29 females, with 56 on the left and 31 on the right, age of(48.5±13.0) years, body mass index of(24.1±3.8)kg/m 2, the stone diameter of(1.45±0.40)cm, and the CT numberical value of(1 311.3±188.9)(1 009-1 817)HU. There were no significant differences in gender, age, body mass index, the location of stone, the diameter of stone and the CT numberical value of stone( P>0.05)between the two groups. For ST-URS group, a rigid ureteral channel sheath and standard mirror(F7.5/11.5)were placed under direct vision, exiting the standard mirror, leaving the channel sheath, inserting a lithotripsy mirror(F4.5/6.5)and a holmium laser[Power: 8-30 W(0.4-1.0 J/20-30 Hz)], and withdrawing the stone fragments after crushing the stone by "nibbling method" . For FURS group, a hard ureteroscope(F8/9.8)was used to explore the lesion side of the ureter, inserting a guide wire and placing a soft ureteral sheath, then inserting a flexible ureteroscope(F8)for holmium laser lithotripsy, and useing a stone basket to remove larger stone fragments. Ureteral stent was routinely indwelled after the operation. On the day 1 and 1 month after the operation, imaging examinations were performed to evaluate the stone-free rate. No residual stones or the diameter of stone was ≤0.4 cm and no urinary tract infection or any symptoms were defined as stone free. The operation time, blood loss, success rate of stage Ⅰ ureteral access sheath placement, incidence of postoperative complications, stone-free rate(SFR) at 1 day after operation, SFR at 1 month after operation, postoperative hospital stay and hospitalization costs were compared between the two groups. According to the size of calculi, the 2 groups were divided into 2 subgroups(≥1.5 cm and <1.5 cm)in order to make further analysis. The operation time, stone-free rate(SFR) at day 1 after operation and SFR at 1 month after operation were compared between the two groups. Results:The operation time of the ST-URS group was shorter than the FURS group(40.10 min vs. 49.43 min, P=0.020), and the incidence of postoperative complications was lower than the FURS group[3.28%(2/61)vs. 13.79%(12/87), P=0.031]. The SFR at day 1 after operation was significantly higher than the FURS group[60.7%(37/61)vs. 25.3%(22/87), P<0.01], and the hospitalization cost was lower than that of the FURS group(27 686 yuan vs. 32 281 yuan, P<0.010). There were no significant differences in the blood loss[(4.92±9.51)ml vs.(3.95±6.04)ml, P=0.452], success rate of stageⅠureteral access sheath placement[ 96.7%(59/61)vs. 96.6%(84/87), P=1.000], SFR at 1 month after operation[81.97%(50/61) vs. 75.86%(66/87), P=0.375] and postoperative hospital stay[(2.5±1.4)d vs.(2.4±0.8)d, P=0.543] between the two groups. When the size of calculi was ≥1.5cm, the operation time of the ST-URS group was shorter than the FURS group (43.67 min vs 55.00 min), the SFR at 1 day after operation was higher than the FURS group[40.00%(12/30)vs. 9.38%(3/32)], and the above differences are all statistically significant ( P<0.05). Conclusions:Compared with the FURS, for the treatment of upper ureteral calculi with CT numerical value ≥1000 HU, the ST-URS has shorter in operative time, lower in hospitalization cost and incidence of postoperative complications and higher SFR at day 1 after operation. The ST-URS is a safe and effective surgical technique, which is superior in the treatment of larger(≥1.5 cm) stones.

In recent years, the incidence of single-gene nephrolithiasis has been increasing year by year. With the application of whole-genome analysis and whole-exome sequencing technology, the etiology of single-gene mutations leading to the development of urinary calculi has been extensively verified. Therefore, this article reviews the research on urinary calculi-related genetic diseases at home and abroad, and introduces transport proteins and channels; ions, protons and amino acids. The role of urinary calculi in the majority of clinicians realizes the significance of genetic testing in such diseases, thereby increasing the understanding of genetically related urinary calculi and improving the level of clinical diagnosis and treatment.

BACKGROUND: Perioperative treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancelation of surgery, additional illness, and even death, and have therefore attracted much attention. The purpose of the clinical recommendations is to form a diagnosis and treatment plan suitable for the current domestic medical situation for the immune-related adverse event (irAE). METHODS: This recommendation is composed of experts in thoracic surgery, oncologists, thoracic medicine and irAE related departments (gastroenterology, respirology, cardiology, infectious medicine, hematology, endocrinology, rheumatology, neurology, dermatology, emergency section) to jointly complete the formulation. Experts make full reference to the irAE guidelines, large-scale clinical research data published by thoracic surgery, and the clinical experience of domestic doctors and publicly published cases, and repeated discussions in multiple disciplines to form this recommendation for perioperative irAE. RESULTS: This clinical recommendation covers the whole process of prevention, evaluation, examination, treatment and monitoring related to irAE, so as to guide the clinical work comprehensively and effectively. CONCLUSIONS Perioperative irAE management is an important part of immune perioperative treatment of lung cancer. With the continuous development of immune perioperative treatment, more research is needed in the future to optimize the diagnosis and treatment of perioperative irAE.

Objective To study the effect of itraconazole/IFN-gamma on IFN-? and IL-10 in nude mice and mice and clinical significance. Methods Systemic infection of animals that induced by abdominal injection of Candida albicans and Cryptococcus neoformans, Expression of IFN-? and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA).Results After treated with Itraconazole and IFN-gamma, the levels of IFN-gamma were increased and ones of IL-10 were decreased significantly. Conclusions Itraconazole and IFN-gamma may play key roles in the immune function of those animals.

Objective: To establish a curve of dosage gradient-liver signal intensity of superparamagnetic iron oxide (SPIO) in normal rats and to find an appropriate dose for enhancement. Methods: Seventy-two SD rats, 4 rats a group at random, underwent MR enhancement with 0, 2, 5, 8, 10, 12, 15, 20, 30, 40, 50, 60, 70, 80, 100, 140, 210, 280 μmol/kg SPIO respectively after plane examination. The signal-to-noise ratio of liver was measured and a curve of dosage gradient-liver signal intensity was made. Results: (1)With the increase of SPIO dose, the signal intensity of both T1 and T2 weighted images of liver declined. (2)T2 weighted images was more sensitive than T1 weighted images in small dose, the ED50 of T1 weighted was 8 μmol/kg, and the ED50 of T2 weighted was 5 μmol/kg. (3)When the dose was greater than 15 μmol/kg, the signal intensity of T1 weighted images declined more rapidly than T2 weighted, the effect of enhanced T1 weighted images resembled T2 weighted ones, and its images was with more fine resolution. (4)At the dose of 40 μmol/kg, the signal intensity of T1 weighted images approached the background noise, and at the dose of 15 μmol/kg, the signal intensity of T2 weighted images approached the background noise. Conclusion: Good effect of T1 and T2 enhanced MR imaging can be acquired at the dose of 20-10 μmol/kg SPIO respectively, the best contrast-to-noise ratio is found on T2 weighted enhanced MR image.

Objective: To investigate the pathological changes of human hepatocellular carcinoma (HCC) after continuous passaging in nude mice. Methods: The mice model of HCC SMMU-LTMN were continuously observed for 20 years (1987-2007) . The subcutaneously transplanted carcinoma had been passaged for 228 generations. The pathological data of abdominally transplanted HCC, orthotopically transplanted HCC in nude mice, and orthotopically transplanted HCC in NOD-SCID mice were recorded. The pathological studies were conducted by light microscope, electron microscope, image analysis, chromosomal analysis, and measurement of alpha-fetoprotein (AFP) in peripheral blood. Results: (1) The local invasion and metastasis of of tumors were present in all the above 4 models for a long time. The local invasion rate and the pulmonary metastasis rate of subcutaneously transplanted tumors were 59.70% (40/67) and 37.10% (23/62), respectively. The pulmonary metastasis rate of abdominally transplanted tumors was 59.02%(36/61). The intra-hepatic and pulmonary metastasis rate of the othotopically transplanted tumors were 18.18%(4/22) and 31.82% (7/22), respectively. The pulmonary metastasis rate of HCC in NOD-SCID mice was 53.85%. (2) The tissue structure and the differentiation of the 10th generation tumor cells was similar to those of primary HCC, with grade 2 differentiation and coarse trabecular pattern as the main characteristics. From the 11th generation to the 228th generation, the main characteristics of tumor cells were grade 3 differentiation and lump pattern. Electron microscope also showed worse differentiation. (3)The AFP level was 92 500 ?g/L in cells before the 32th generation; it decreased to 6 729?g/L from the 33th-130th generation cells; and the level of the 220th generation was 1 000-5 000 ?g/L.(4)The DNA contents had a wide distribution (from 2c to 6c) in abdominally transplanted tumors and the pulmonary metastatic tumors; the mean DNA index in the former tumors (2.60?0.20) was wider than the that in the latter (2.10?0.26) . (5)From the 55th generation to 206th generation, it was found that tumor cells had integrated into the chromosome of the nude mice. Conclusion: The subcutaneously transplanted HCC in nude mice can be stably expressed for 20 years, with no change in the local invasion and metastasis ability of HCC. The differentiation of the tumor cells worsenes and the AFP level is decreased in the blood; some chromosome of tumor cells integrate into the chromosome of nude mice, which may be related to the internal environment of nude mice and the multi-potential differentiation of the tumor cells.

Thirty one male Wistar rats weighing 130-150 g were continuously fed with aflatoxin B1 (AFB1) for 45 weeks.Each rat received 3.89mg of AFB1 crystals in total close.Three treated rats and one control ret were killed at the 8th, 9th, 11th, 12th, 13th, 14th and 1.3th month, respectively, and seven rats died naturaly after the 17th month.Histological sections of the liver were stained with hematoxylin-eosin.Morphological changes of 28 rats' liver tissues stained with enzyme-labelled immuno-fetoprotein, and ultrastructural chinges of the liver specimens from 15 rats were observed .Histologicall ', the main manifestations of liver cells included hydratoid degeneration, eosinophilic degeneration, basophilic change.adipose degeneration and focal necrosis.The answer reaction showed oval cell and bilbary proliferation, hepatocellular regeneration and inflammatory cell infiltration.All of the above changes were chronic non-specific toxic hepatitis. The ultrastructural changes showed nucleolar uniformation, nucleoid body formation, mitochondria swelling and matrix uniformation, and vesicle formation and focal necrosis. 85.71 % 24/28)of the alpha-fetoprotein positive hepatocytes were found in host liver tissues.The AFP positive material mostly distributed in all of the plasma of liver cells.AFP positive hepatocytes were dispersed or focal in the liver tissue. This result suggests that the liver cell atavism mav be the toxic effect of aflatoxin B1.

The results of the rat hepatocellular carcinoma (HCC) induced by purified afla-toxin B1 (AFB1)were as follows. (1) The precancerous lesions included hepatocytic dysplasia (58.6%), eosinocytic proliferative foci (51.61%) with most positive results by indirect immunoperoxidase-labelling technique for ?-fetoprotein (IIP-AFP), and basophilic proliferative foci with all negative results by IIP-AFP. (2) In 11 cases of HCC, there were 7 with multicentric origin and 4 with single origin, and 9 of 11 cases were in gradeⅠ differentiation and 2 in grade Ⅱ differentiation. (3) In 11 cases of HCC, 7 were of large cell type of HCC and 4 small cell type of HCC. (4) The specimens of 6 cases of HCC were examined by electronic microscopy, and it was found that the differentiation in the large cell type of HCC was better than that in the small cell type of HCC. The authors assume that there may exist multicentric and single origins in the histogenesis of HCC, and AFB1 is likely to be a carcinogen of human non-cirrhotic HCC.

Observations on 142 cases of noncirrhotic hepatocellular carcinoma (NCH) (135 surgical operating specimens, 8 autopic cases) were made. 50 cases of cirrhotic hepatocellular carcinoma (CH) (42 surgical operating specimens, 8 autopic cases) were taken as the control. The results were as follows:(1)In both groups, the hepatocellular carcinoma (HCC) had a similar background of liver diseases. 51.41% of the cases of hepatitis B and 48.59% of the cases of"orcein negative hepatitis" were associated with NCH,while 58.00% of the former and 42.00% of the latter were associated with CH. In both groups in the cases of HCC were included 5 cases of primary multiple carcinoma. We considered that pathogenesis of HCC were synthetic factors. It was assumed that NCH is due to weak carcinogen, hepatic parenchyma is lightly destroyed, and as the human body has hypersusceptibility to HCC, the precancerous stage is short and cancer occurs early.(2)In 80.99% of the NCH cases and 100% of the CH cases was found proliferation of oval cells. The difference between the two groups of HCC was statistically significant.The proliferation may be a repairing reaction. Owing to the action of car-cinosen, the poorly differentiated HCC may be derived from the disturbances of oval cells.(3)In 29.57% of the cases NCH and 70.00% of the cases CH was found hepar tocyte dysplasia, and the difference between the two groups of HCC statistically significant. It was indicated that dysplasia may be precancerous disoders.Oval cell proliferation and hepatocyte dysplasia of the NCH group are less than those of the CH group.It is suggested that liver tissues of the NCH group are slightly damaged, hence the incidence of NCH is lower than that of CH.

Observations on the histopathology of malignant granuloma in 5 cases were mace One of them was of the generalized type,with widespread pathological changes,confirmed by autopsy.The other 4 were of the localized type and treated by radiating.Two of them died and autopsy examinations were made whereas the clinical symptoms subsided in the other two cases.In one case there was exacerbation of symptoms after local injection of penicillin.One case revealed nodular reticulosis in the spleen.The histopathologic features of the disease are quite in accord with these of allergic,necrotizing and granulomatous vasculitis.They may occur locally on the nose,face and lungs and may also become widespread in the whole body.Some focal histological changes after radiotherapy are also discussed in the paper.