Objective: To explore the causal relationship between gut microbiota and upper urinary tract stones using Mendelian randomization (MR) analysis，and to investigate the potential mediating role of plasma metabolites. Methods: Data on gut microbiota，plasma metabolites，and upper urinary tract stones were obtained from publicly available Genome-wide Association Studies (GWAS).Bidirectional MR analysis was performed to examine the causal relationship between gut microbiota and upper urinary tract stones.Subsequently，a two-step MR approach was employed to determine whether gut microbiota contribute to upper urinary tract stones through plasma metabolites，and the mediating effects and mediator ratio were calculated.The inverse variance weighted (IVW) method was used as the primary analytical tool，supplemented by Bayesian weighted Mendelian randomization (BWMR)，MR-Egger，and weighted median (WM) analyses.Horizontal pleiotropy and heterogeneity tests were conducted to ensure the robustness of the findings. Results: Bidirectional MR analysis identified causal associations between 7 gut microbial taxa and 6 microbial metabolic pathways with upper urinary tract stones，while the development of upper urinary tract stones affected 13 gut microbial taxa and 5 metabolic pathways.Additionally，43 plasma metabolites (including 27 identified metabolites，8 unidentified metabolites，and 8 metabolite ratios) were causally associated with upper urinary tract stones.The two-step MR analysis identified 11 potential causal pathways.After metabolic pathways and unidentified metabolites were excluded，a causal link mediated by Bacteroides faecis between galactarate and upper urinary tract stones was confirmed，with a mediation proportion of 16.99% (95%CI：5.76%-33.95%，P=0.0371). Conclusion: This study establishes a causal relationship between parabacteroides and upper urinary tract stones，and elucidates the mediating role of galactarate，offering new insights into the pathogenesis and prevention strategies for upper urinary tract stones.

Objective To understand the occurrence and main characteristics of medication errors (ME) in Xiamen Maternal and Child Health Hospital.Methods All the ME reports received by the ME submission system of Xiamen Maternal and Child Health Hospital from January 1,2015 to December 31,2017 were collected,and ME characteristics such as the time of occurrence,classification,grade,drugs involved,and triggering factors were analyzed.On the basis of the 9-level grading method (grade A-Ⅰ),ME were further divided into potential errors (including potential error problems and errors that happened but the drugs were not given to patients) and out-door errors (the wrong drugs had been given to patients).Results A total of 18 944 ME reports were collected,including 12 ME that occurred before the link of prescription and did not involve patients and 18 932 ME that occurred in the link of prescription and various links after the prescription.Of the 18 932 ME,231 were out-door errors,which accounted for 1.22％ of overall ME.A total of 3 553 074 patients (number of registrations)were prescribed in the study period in the hospital and the incidences of overall ME and out-door errors were 0.53％ (18 932/3 553 074) and 0.07‰ (231/3 553 074),respectively.The highest incidences of both the potential errors and out-door errors appeared from 13:00 to 13:59 [21.87‰(1 120/51 248);0.18％(9/51 248)].The top 3 ME classes in the 18 944 ME were prescription errors (77.37％,14 657 ME),dispensing and location errors (17.35％,3 286 ME),and omission and delivering errors (2.22％,421 ME).Of the 18 944 ME,6 (0.03％),18 821 (99.35％),111 (0.59％),and 6 (0.03％) ME were grading as A,B,C,and D,respectively,while none was grading as E-Ⅰ.Personnel factor took the first place [59.65％ (11 301/18 944)] in all the triggering factors of ME,followed by environmental factor [17.71％ (3 355/18 944)].Conclusions The incidence of overall ME in Xiamen Maternal and Child Health Hospital was 0.53％ and most of the ME were not serious,which were no harm to patients.The peak time of the ME occurrence lasted from 13:00 to 13:59.Prescription error was the main type of ME and the main trigger factor was personnel factor.Results of the study could help to develop targeted precautions to reduce the occurrence of ME.

Objective To understand the occurrence and main characteristics of medication errors (ME) in Xiamen Maternal and Child Health Hospital.Methods All the ME reports received by the ME submission system of Xiamen Maternal and Child Health Hospital from January 1,2015 to December 31,2017 were collected,and ME characteristics such as the time of occurrence,classification,grade,drugs involved,and triggering factors were analyzed.On the basis of the 9-level grading method (grade A-Ⅰ),ME were further divided into potential errors (including potential error problems and errors that happened but the drugs were not given to patients) and out-door errors (the wrong drugs had been given to patients).Results A total of 18 944 ME reports were collected,including 12 ME that occurred before the link of prescription and did not involve patients and 18 932 ME that occurred in the link of prescription and various links after the prescription.Of the 18 932 ME,231 were out-door errors,which accounted for 1.22％ of overall ME.A total of 3 553 074 patients (number of registrations)were prescribed in the study period in the hospital and the incidences of overall ME and out-door errors were 0.53％ (18 932/3 553 074) and 0.07‰ (231/3 553 074),respectively.The highest incidences of both the potential errors and out-door errors appeared from 13:00 to 13:59 [21.87‰(1 120/51 248);0.18％(9/51 248)].The top 3 ME classes in the 18 944 ME were prescription errors (77.37％,14 657 ME),dispensing and location errors (17.35％,3 286 ME),and omission and delivering errors (2.22％,421 ME).Of the 18 944 ME,6 (0.03％),18 821 (99.35％),111 (0.59％),and 6 (0.03％) ME were grading as A,B,C,and D,respectively,while none was grading as E-Ⅰ.Personnel factor took the first place [59.65％ (11 301/18 944)] in all the triggering factors of ME,followed by environmental factor [17.71％ (3 355/18 944)].Conclusions The incidence of overall ME in Xiamen Maternal and Child Health Hospital was 0.53％ and most of the ME were not serious,which were no harm to patients.The peak time of the ME occurrence lasted from 13:00 to 13:59.Prescription error was the main type of ME and the main trigger factor was personnel factor.Results of the study could help to develop targeted precautions to reduce the occurrence of ME.

Objective To investigate the clinical application value of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Methods Fifty-four cases of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney were reviewed,including 9 cases with nonfunctioning tuberculosis pyonephrosis,18 cases with infection nonfunctioning pyonephrosis and 27 cases of nonfunctioning hydronephrosis.Fifty-four cases were received retroperitoneal laparoscopic nephrectomy,tuberculous and infection pyonephrosis underwent laparoscopic resection surrounding adipose capsule,nonfunctioning hydronephrosis underwent laparoscopic resection by pumping water to increase the peritoneal space.Results The operation of 54 cases were perfomed successfully.None of the patient required conversion to open surgery.During the surgery,1 case showed mild extravasation of cheese-like pus induced by laceration of the kidney capsule;2 cases had injuried on the peritoneum.The mean operation time was 125 (95-230) min,the mean blood loss was 84 (50-420) ml.All patients showed primary healing of the wound,the patients were discharged from the hospital in 6 to 11 d (mean 7.5 d).After followed up for 5-27 months,none of them had long-term complication.Conclusions Retroperitoneal laparscopic nephrectomy for nonfunctioning kidney has advantages of minimal invasion,less blood loss and quicker recovery,so it is a fairly safe and effective procedure for nonfunctioning kidney.

Objective To investigate the effects of arsenic trioxide plus thalidomide on immune function of patients with myelodysplastic syndrome (MDS).Methods Fifty-seven MDS patients (Low risk,medium risk and high risk) and 30 healthy volunteers were selected as our subjects.Thirty-four cases with medium risk Ⅱ and high risk MDS patients were randomly divided into A and B groups.Seventeen MDS patients in A group were treated with arsenic trioxide plus thalidomide,and 17 MDS patients in B group were treated with low-dose cytarabine.Lymphocyte subsets in peripheral blood were examined by flow cytometry (FCM).The adverse effect of arsenic trioxide and thalidomide were recorded.Results Compared with control group,the number of T lymphocytes(CD3 +),B lymphocytes (CD3-CD19 +) and NK cell (CD3-(CD16 CD56) +) of patients with MDS were significantly lower,and the differences were statistically significant (t =2.157,2.349,2.958 ; P ＜ 0.05 or P ＜ 0.01).The helper CD3 + CD4 + T cell (Th) ratio decreased in MDS patients than that of control group (t =2.412,P ＜ 0.05).The inhibition CD3 + CD8 + T cells (Ts) ratio increased (t =2.749,P ＜ 0.01).Th/Ts ratio inversion was seen in MDS patients.As the progression of MDS increase,Ts cell expression gradually increased and NK cells ratio gradually decreased.However,there was no significant difference among three groups.Th cells and B lymphocytes in the risk group were lower than that in the low risk group,and the difference was statistically significant (F =4.896 and 4.516,P ＜0.05),but there was no significant difference in the terms of the number of T lymphocytes,Th cell,ratio of Th/Ts and B lymphocytes among MDS groups.Number of T lymphocytes,B lymphocytes and NK cell count in group A after treatment were increased than that before treatment (t =2.435,2.468,2.653,P ＜ 0.05).In group A,2 cases were complete remission,4 cases with partial remission,and 5 cases with hematologic improvement.The total effective rate was 64.71％ (11/17),and curative effect is obviously better than that of B group (x2 =4.253,P ＜ 0.05).Meanwhile adverse effect was mild.Conclusion The cellular and humoral immune function decreased in MDS patients.The treatment of arsenic trioxide plus thalidomide on MDS is proved safety and efficacy,which might work by improving immune function of MDS patients.