Flexible ureteral lithotripsy (FURL) under general anesthesia (GA) is the dominant method in the treatment of renal and upper ureteral calculi，but some patients cannot tolerate GA.In recent years，there has been a growing interest in the use of local anesthesia (LA) as a safe and effective alternative.And it is also an option for patients who have calculi ≤20 mm with high fragility，lower CT value and better compatibility.Before surgery，it is important to conduct relevant examinations，evaluate the status of patients，prevent infections，and indwell ureteral stents.During surgery，lithotomy position，scissors position，prone leg position and other positions should be selected according to the specific conditions of patients.LA drugs should be used to control physiological pain and relieve psychological anxiety.Patients' breathing state should be carefully monitored，and appropriate ureteroscope and lens sheath should be selected for the success and safety of the operation.In this paper，the perioperative management of FURL under LA is briefly summarized，so as to provide reference for clinical practice.

Objective:To explore the effects of Zhenfang Baiwanzi Decoction combined with alteplase injection on serum inflammatory factors and vascular endothelial active substances in patients with acute ischemic stroke (AIS).Methods:Randomized controlled trial. A total of 87 patients with AIS admitted to Mengcheng County Hospital of Traditional Chinese Medicine between June 2019 and July 2022 were selected as the observation subjects by prospective cohort study, and they were divided into treatment group (44 cases) and control group (43 cases) according to the last number of medical records. The control group was given thrombolytic therapy with alteplase injection on the basis of routine therapy, and the treatment group was given Zhenfang Baiwanzi Decoction on the basis of the control group. Both groups were treated for 2 weeks. TCM symptoms were scored before and after treatment, and National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit, and Activity of Daily Living Scale (ADL) was applied to evaluate the quality of life. The levels of serum IL-6, CRP, TNF-α, monocyte chemoattractant protein-1 (MCP-1), VEGF, NOS and endothelin-1 (ET-1) were detected by ELISA. The adverse reactions were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 93.18% (41/44) in treatment group and 76.74% (33/43) in control group ( χ2=4.62, P=0.032). After treatment, the scores of hemiparalysis, skin insensitivity, deviated mouth and eye, inhibited speech and headache and dizziness in treatment group were significantly lower than those in the control group ( t=3.38, 3.77, 2.69, 2.60, 2.36, P<0.01 or P<0.05). The NIHSS score was significantly lower than that of the control group ( t=7.53, P<0.01) while the ADL score was significantly higher than that of the control group ( t=2.99, P<0.01). After treatment, the levels of serum IL-6, CRP, TNF-α and MCP-1 in treatment group were significantly lower than those in the control group ( t=6.07, 5.70, 5.30, 3.36, P<0.01), and the levels of VEGF [(364.54±33.04)ng/L vs. (346.86±29.63)ng/L, t=2.63] was significantly lower than that of the control group ( P<0.05), NOS [(20.77±3.12) μmol/L vs. (29.46±5.36) μmol/L, t=9.27] and ET-1 [(85.41±7.09) ng/L vs. (94.11±9.38) ng/L, t=4.89] were significantly lower than those in the control group ( P<0.01). Conclusion:Zhenfang Baiwanzi Decoction combined with alteplase injection can improve the clinical symptoms, reduce levels of inflammatory factors, protect the vascular endothelial function, and enhance the efficacy of patients with AIS.

Objective To analyze the imaging findings and pathological basis of seminoma and improve the understanding and diagnostic accuracy.Methods The imaging findings of seminoma in 67 patients proved by histopathology were analyzed retrospectively.The tumor location,size,contour,periphery,density or signal and contrast enhancement patterns were evaluated,and these were compared with the pathological results.Results All of the 67 cases were male.46 cases were located in testicular,10 cases in the pelvic cavity,6 cases in the peritoneal and retroperitoneal,4 cases in the mediastinum,1 case in the brain.On non-enhanced CT,testicular lesions appeared to be nodular or lobular masses with clear margin.Some cases showed cystic-solid masses.And the solid component was located in the edge of the lesion,and the irregular necrosis areas of low density was located in the center.Fat and calcification component were not found in the mass.After contrast administration,the masses showed heterogeneous enhancement.The thickened and tortuous testicular arteries were seen in 11 cases in arterial phase,and thickened and twisted testicular veins were seen in 9 cases in the venous phase.The imaging findings of the mass at the other location were without features.Conclusion Testicular seminoma has significant characteristics,thickened testicular arteries and/or draining veins on enhanced CT can help the diagnosis.Imaging features of extragonadal primary seminoma are not characteristic.Combined with clinical history and signs,it is possible to improve the diagnostiic accuracy of seminoma.

Objective To study the CT and MRI features of benign ovarian cystic lesions (BOCL) and to improve the understanding of imaging features.Methods CT and MRI findings were retrospectively reviewed and analyzed in 48 patients with BOCL proved by surgical pathology.CT scan was performed in 35 cases, among which 20 cases were performed with CT enhancement scan;MRI scan was performed in 8 cases, among which 3 cases were performed with MRI enhancement scan and diffusion weighted imaging(DWI).Five cases were performed with both CT and MRI.Results There were 11 cysts (3 simple cysts, 3 corpus luteum cyst, and 5 endometriotic cyst), 10 serous cystadenomas with 13 lesions, 8 mucinous cystadenomas, 9 teratomas with 10 lesions, and 10 struma ovarii.The CT and MRI characteristics of the lesions in size, shape,thickness of cyst wall,wall nodule,density or signal intensity,and enhancement features were helpful in differential diagnosis of BOCL.Conclusion CT and MRI findings of BOCL have certain characteristics, which is significant in the diagnosis, preoperative evaluation and prognosis.

Objective To study the effect of type 2 diabetes mellitus (T2DM) on the surgical treatment of proximal humerus fractures in senile patients .Methods A respective analysis was made on the 83 senile patients with proximal humerus fractures (NEERⅡorⅢ), who received surgical treatment in our department from January , 2010 to January, 2015.The patients were divided into the diabetic group ( type 2 diabetes mellitus ) and the control group .Statistical analyses were made on the differences incurred by gender , the incidence of osteoporosis , the duration of perioperative period and Constant-Murley scores 1 year after surgery .Results Postoperative complications of the diabetes group were higher than those of the control group , bone mineral density was lower than that of the control group , the time taken for fracture healing was obviously prolonged , and the function scores were lower , when comparisons were made between the 2 groups.Conclusion The development of a reasonable T2DM treatment protocol was of great significance to the shortening of perioperative period , the prevention of complications , the achievement of good prognosis , and the reduction of medical costs in senile patients with proximal humerus fractures .

OBJECTIVEThis study aimed to induce carcinogenesis of lingual mucosa in C57BL/6 mice by feeding them 4-nitroquinoline 1-oxide (4NQO) solution.

METHODSA total of 85 C57BL/6 mice were randomly divided into distilled water control group (DD group, n=5), 1,2-propylene glycol control group (PG group, n=5), and experimental group (EP group, n= 75). The mice in the experimental group were medially fed in 15 cages. By contrast, the mice in DD, EP, and PG groups were watered with distilled water, 50 mg.L-1 4NQO solution, and 1,2-propylene glycol solution. The mice in EP group were executed every two weeks from week 0, and the mice in the control groups were sacrificed at the 28th week. The mice were weighed. Mucosal lesions were measured by macroscopic observation and histopathologic detection.

RESULTSOne mouse in EP group died of unknown reason. The weight of the mice in EP group presented weight loss compared with the mice in DD and PG groups after the 24th week. Seventy-nine macroscopic lesions were observed in the lingual mucosa, oral floor, and upper palatal and buccal mucosa. A total of 70 macroscopic lesions (88.6%) were located in the lingual mucosa. Mucosal lesions changed from simple hyperplasia to squamous cell carcinomas. Well-differentiated squamous cell carcinomas were observed in all mice of EP group by pathological section at the 28th week. No lesion was found in the mice of DD and PG groups.

CONCLUSIONThe animal model of lingual squamous cell carcinomas was successfully established. The periods from 12th to 16th week and 20th to 28th week were the ideal times for the research on pathogenesis of early and medial-advanced stage during carcinogenesis of squamous cell carcinomas.

4-Nitroquinoline-1-oxide ; Animals ; Cell Transformation, Neoplastic ; Disease Models, Animal ; Mice ; Mice, Inbred C57BL ; Mouth Mucosa ; Tongue

Objective This?study?aimed?to?induce?carcinogenesis?of?lingual?mucosa?in?C57BL/6?mice?by?feeding?them?4-nitroquinoline?1-oxide?(4NQO)?solution.?Methods???A?total?of?85?C57BL/6?mice?were?randomly?divided?into?distilled?water?control?group?(DD?group,?n=5),?1,2-propylene?glycol?control?group?(PG?group,?n=5),?and?experimental?group?(EP?group,?n=75).?The?mice?in?the?experimental?group?were?medially?fed?in?15?cages.?By?contrast,?the?mice?in?DD,?EP,?and?PG?groups?were?watered with distilled water, 50 mg·L-1?4NQO?solution,?and?1,2-propylene?glycol?solution.?The?mice?in?EP?group?were?executed?every?two?weeks?from?week?0,?and?the?mice?in?the?control?groups?were?sacrificed?at?the?28th?week.?The?mice?were?weighed.?Mucosal?lesions?were?measured?by?macroscopic?observation?and?histopathologic?detection.?Results???One?mouse?in?EP?group?died?of?unknown?reason.?The?weight?of?the?mice?in?EP?group?presented?weight?loss?compared?with?the?mice?in?DD?and?PG?groups?after?the?24th?week.?Seventy-nine?macroscopic?lesions?were?observed?in?the?lingual?mucosa,?oral?floor,?and?upper?palatal?and?buccal?mucosa.?A?total?of?70?macroscopic?lesions?(88.6%)?were?located?in?the?lingual?mucosa.?Mucosal?lesions?changed?from?simple?hyperplasia?to?squamous?cell?carcinomas.?Well-differentiated?squamous?cell?carcinomas?were?observed?in?all?mice?of?EP?group?by?pathological?section?at?the?28th?week.?No?lesion?was?found?in?the?mice?of?DD?and?PG?groups.?Conclusion?The?animal?model?of?lingual?squamous?cell?carcinomas?was?successfully?established.?The?periods?from?12th?to?16th?week?and?20th?to?28th?week?were?the?ideal?times?for?the?research?on?pathogenesis?of?early?and?medial-advanced?stage?during?carcinogenesis?of?squamous?cell?carcinomas.

OBJECTIVETo explore the relationship between socioeconomic status and the risk factors of cardiovascular diseases in retirees from a community in Shanghai.

METHODSObservational study involved 9 943 retirees aged 50 and over in Shanghai. Both single factor and multi-factor analyses methods were used to describe the correlation between factors as:educational level, marital status, annual household income and risk of hypertension, coronary heart disease, stroke etc. A new defined compound index was used to assess the relevance of socioeconomic status on the risk of cardiovascular diseases, based on logistic regression model.

RESULTSAfter adjusted for age, the risk of cardiovascular diseases in these retirees was influenced by socioeconomic status. In general, opponent correlations in education levels and prevalence of hypertension were found between female and male. Compared with those having received college or higher education, the risk of hypertension increased in females when the education level declined, with OR as 1.08 (95% CI:0.89-1.30). For those having had senior high school junior high school or elementary education, the risks of hypertension were 1.26 (95%CI:1.05-1.51), 1.34 (95%CI:1.08-1.65), 0.72 (95%CI:0.59-0.87),0.78 (95%CI:0.64-0.94), and 0.70 (95%CI:0.52-0.92) for males, respectively. The risk of cardiovascular diseases increased with annual household income. Compared with high level of socioeconomic status, lower socioeconomic status might decline the risk of cardiovascular diseases in males by approximately 30%, with OR for medium being 0.72 (95%CI:0.61-0.84) and for lower ones it was 0.70 (95% CI:0.57-0.87). However, similar correlations were not found in females. No significant relationship was found between marital status and the prevalence of cardiovascular diseases in this study.

CONCLUSIONThe risks of cardiovascular diseases varied with different socioeconomic status, indicating that tailored interventions should be conducted in different socioeconomic groups.

Adult ; Aged ; Cardiovascular Diseases ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Social Class ; Socioeconomic Factors

Objective To explore the relationship between socioeconomic status and the risk factors of cardiovascular diseases in retirees from a community in Shanghai. Methods Observational study involved 9 943 retirees aged 50 and over in Shanghai. Both single factor and multi-factor analyses methods were used to describe the correlation between factors as:educational level,marital status,annual household income and risk of hypertension,coronary heart disease,stroke etc. A new defined compound index was used to assess the relevance of socioeconomic status on the risk of cardiovascular diseases,based on logistic regression model. Results After adjusted for age,the risk of cardiovascular diseases in these retirees was influenced by socioeconomic status. In general, opponent correlations in education levels and prevalence of hypertension were found between female and male. Compared with those having received college or higher education,the risk of hypertension increased in females when the education level declined,with OR as 1.08(95%CI:0.89-1.30). For those having had senior high school junior high school or elementary education,the risks of hypertension were 1.26(95%CI:1.05-1.51),1.34(95%CI:1.08-1.65),0.72(95%CI:0.59-0.87),0.78 (95%CI:0.64-0.94),and 0.70(95%CI:0.52-0.92)for males,respectively. The risk of cardiovascular diseases increased with annual household income. Compared with high level of socioeconomic status, lower socioeconomic status might decline the risk of cardiovascular diseases in males by approximately 30%,with OR for medium being 0.72(95%CI:0.61-0.84)and for lower ones it was 0.70(95%CI:0.57-0.87). However,similar correlations were not found in females. No significant relationship was found between marital status and the prevalence of cardiovascular diseases in this study. Conclusion The risks of cardiovascular diseases varied with different socioeconomic status, indicating that tailored interventions should be conducted in different socioeconomic groups.

Objective To investigate the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF) and its associated mechanism during the wound healing. Methods The animal model with the full-thickness skin injury was used in the study. Fifty male mice were involved in the study and divided randomly into control group (n = 25) and GM-CSF group (n = 25). Each group had five time points (5 mice per time point). All the mice received full-thickness skin defect (1 cm × 1 cm) through the panniculus camosus on the midline of the back near the neck after anesthesia. Recombinant human granulocyte-macrophage colony stimulating factor (RhGM-CSF) gel (10 μg/cm2) were applied in the GM-CSF group and gel matrix without RhGM-CSF applied in the control group. The wound healing time and rate were observed at days 3, 5, 7, 10 and 14 after injury. The wound specimens were collected to detect the histopathological change. The microvessel density of the wound was counted based on the results of CD31 immunohistochemistry. RT-PCR was employed to detect the expression changes of GMCSF, platelet-derived growth factor (PDGF) , vascular endothelial growth factor ( VEGF) and stromal cell derived factor-1 (SDF-1). Results RT-PCR results showed that the gene expression of GM-CSF reached the peak at day 3 after injury (P＜0. 01) and kept the high level at days 3-10 after injury (P＜ 0. 05) , followed by a sharp decrease to a normal level at day 14 after wound. The wound healing time was average (2.4 ±0. 3) days earlier than the control mice after application of rhGM-CSF, with significant increase of the wound healing rate during 7-14 days after injury ( P ＜ 0. 05 ). In the GM-CSF group, the early histology of trauma wound showed a small number of neutrophils, obvious epithelial cell proliferation in the wound margin, marked hyperplasia of the granulation tissue, high cell density with quantity of spindle-shaped and oval-shaped cells and increased number of new blood vessels. The microvessel density was also increased significantly (P ＜ 0. 05) at days 7-14 after injury. The gene expressions of VEGF and SDF-1 were significantly increased at day 7 and day 10 respectively after injury (P＜0.05) and the gene expression of pro-healing factor PDGF was significantly increased in every time point (at days 5, 7 and 10,P＜0.05;at day 14,P＜0.01). Conclusion GM-CSF expresses highly in the early stage after injury and can promote the wound healing, when the mechanism may relate to the up-regulated expressions of pro-angiogenic factors and pro-healing growth factors.