Objective: To evaluate the efficacy and prognosis of loop cutaneous ureterostomy (LCU) in the treatment of primary obstructive megaureter (POM) with severe hydroureteronephrosis (HUN) in infants under 1 year of age，so as to provide reference for infants unsuitable for stage-Ⅰ ureteral reimplantation. Methods: A retrospective analysis was conducted on 12 infants with POM and severe HUN treated with LCU in our hospital during Jan.2019 and Dec.2023.The clinical characteristics，surgical techniques，indications，postoperative complications，stage-Ⅱ surgical approaches，and follow-up outcomes were summarized. Results: All operations were successful，with an average operation time of (37.08±7.53) min (6 left-sided LCU and 6 right-sided LCU).During the mean follow-up of (10.12±2.70) months，all infants showed clinical improvement，with complete resolution or significant alleviation of hydronephrosis，reduced ureteral diameter，and increased renal cortical thickness.Complications included asymptomatic bacteriuria in 3 cases (25%) and urinary tract infection (UTI) in 1 case，all resolved with oral antibiotics.Four cases developed peristomal rashes，which improved with topical treatment.Eleven infants underwent stage-Ⅱ Cohen ureterovesical reimplantation at a mean age of (15.20±2.07) months.Notably，27.3%(3/11) required ureteral tailoring or plication during reimplantation，which reduced the risk of ischemic necrosis from excessive trimming.During the follow-up of (22.17±13.93) months，hydronephrosis and renal function improved，and no febrile UTI or bladder dysfunction occurred. Conclusion: LCU is a safe and effective method，which can provide adequate urinary drainage，relieve obstruction，stabilize renal function，and allow time for ureteral maturation and renal parenchymal recovery.LCU also facilitates subsequent stage-Ⅱ surgery by reducing ureteral dilation.

Objective:To explore the relevancy between the uridine diphosphate-glucuronylgly-cosyltransferase 1A1 (UGT1A1) gene mutation and the phenotype of indirect hyperbilirubinemia in children.Methods:Sixteen cases with indirect hyperbilirubinemia who visited the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from July 2013 to November 2019 were retrospectively analyzed and were divided into Gilbert syndrome (GS), Crigler-Najjar syndrome type II (CNS-II), and indirect hyperbilirubinemia groups unexplained by UGT1A1 gene mutations. The differences in gene mutation site information and general clinical data were compared. The association between gene mutation spectrum and bilirubin level was explored by t-test analysis.Results:Ten of the sixteen cases with indirect hyperbilirubinemia had GS, three had CNS-II, and three had indirect hyperbilirubinemia unexplained by UGT1A1 gene mutations. A total of six mutation types were detected, of which c.211G?>?A accounted for 37.5% (6/16), c.1456T?>?G accounted for 62.5% (10/16), and TATA accounted for 37.5% (6/16), respectively. Compared with the GS group, the CNS group had early disease onset incidence, high serum total bilirubin ( t ?=?5.539, P ??0.05) and age of onset ( t ?=?0.3611, P ?>?0.05) between the two groups. There was no significant correlation between the number of UGT1A1 gene mutations and serum bilirubin levels. Children with c.1456T?>?G homozygous mutations had the highest serum bilirubin levels. Conclusion:The common pathogenic variants of the UGT1A1 gene sequence are c.1456T?>?G, c.211G?>?A, and TATA, indicating that these site mutations are related to the occurrence of indirect hyperbilirubinemia and have important guiding significance for the etiological analysis of indirect hyperbilirubinemia in children.

OBJECTIVE To evaluate the cost-effectiveness of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women， and provide reference for relevant decision-making. METHODS From the perspective of health system in China， Excel 2003 was used to establish Markov model， and cost-utility analysis was used to evaluate the cost- effectiveness of denosumab or teriparatide combined with Calcium carbonate D3 tablets in the treatment of postmenopausal osteoporosis in Chinese women. Pharmacotherapy effects were obtained with network meta-analysis， and cost and health utility value data were obtained from published literature. The model cycle was 1 year， and the simulation time limit was the patient’s lifetime. Univariate sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the effects of model parameter changes on the robustness of the results. Through scenario analysis， the cost-effectiveness of domestic drug cost used as drug cost of terlipatide group was discussed； the influence of residual effects of teriparatide on the results and the cost-effectiveness of sequential use of desumamab after terlipatide withdrawal were also discussed. RESULTS The effect of denosumab regimen was better than that of terlipatide regimen [13.24 quality-adjusted life years （QALYs） vs. 12.96 QALYs]， with lower cost （51 224.64 yuan vs. 167 102.67 yuan）， denosumab regimen was the absolutely superior regimen. The results of single factor sensitivity analysis showed that the cost and discount rate of Terlipatide injection had greater impact on the results. The results of probability sensitivity analysis showed that when three times of China’s per capita gross domestic product （GDP） in 2021 was used as the threshold of willingness to pay， the probability of cost-effectiveness of denosumab regimen was 93.5%. The results of scenario analysis showed that， whether the drug cost of terlipatide regimen which was replaced by domestic drugs， or the residual effect of terlipatide was considered， or desulmonab was used sequentially after two years of terlipide treatment， denosumab regimen was always the absolute advantage regimen. CONCLUSIONS Denosumab combined with Calcium carbonate D3 tablets is more cost-effective than teriparatide combined with Calcium carbonate D3 tablets in the treatment of postmenopausal osteoporosis in Chinese women.

OBJECTIVE To sort out and analyze the expression and provisions of drug standards in the text of the newly revised Drug Administration Law ，and to explore the connotation and legal positioning of drug registration standards so as to provide reference for the rational application and interpretation of relevant provisions of drug standards in Drug Administration Law . METHODS Through the review of the evolution of drug standard management in China ，the legal provisions of drug standard in the Drug Administration Law were analyzed. Comparative study and literature research methods were used to analyze the legal expression and connotation of drug standards. RESULTS & CONCLUSIONS There were different expressions about “national drug standards ”“drug standards ”and“quality standards ”in the current provisions of the newly revised Drug Administration Law ； the legal position of the provincial-level standard for the preparation of Chinese herbal pieces was not clear ，and there may be insufficient legal regulation in the enforcement of drug administration. It is necessary to make an administrative interpretation for the content of relevant drug standards and provisions ，and further clarify the legal attributes of drug standards in the processing of provincial Chinese herbal pieces in order to promote the standardized management of Chinese herbal pieces.

OBJECTIVE: To analyze the effects of hand-transmitted vibration operation on nailfold capillaroscopy( NFC) in fine sanding workers. METHODS: A total of 57 fine sanding workers of one golf ball production enterprise in Guangdong Province were selected as vibration exposure group and 30 workers without exposure to hand-transmitted vibration as control group by a judgement sampling method. NFC examination was carried out in workers of these two groups. RESULTS: The capillary haemorrhage detection rates,percentage of abnormal capillary loops and total capillary width in the vibration exposure group were higher than that in the control group [43. 9% vs 13. 3%,( 56. 6 ± 20. 9) % vs( 41. 2 ± 14. 5) %,( 44. 7 ± 4. 9) vs( 42. 4 ± 4. 9) μm,P < 0. 05]. The capillary density,capillary length and branch diameter in the vibration exposure group were lower than that in the control group [( 7. 7 ± 1. 0) vs( 8. 8 ± 1. 0) per mm,( 185. 1 ± 33. 9) vs( 205. 6 ± 23. 2) μm,( 18. 3 ± 1. 9) vs( 19. 6 ± 2. 6) μm,P < 0. 05]. No significant difference was found in the diameter of apical part and branch of capillaries between the two groups( P > 0. 05). In the vibration exposure group,the percentage of abnormal capillary loops in the left hand was lower than that in the right hand [( 53. 1 ± 20. 6) % vs( 61. 5 ±24. 2) %,P < 0. 01],the capillary length in the left hand of vibration exposure group was longer than that in the right hand [( 187. 2 ± 33. 5) vs( 179. 4 ± 35. 4) μm,P < 0. 05]. No significant difference was found in the capillary density,total capillary width,apical part diameter,output branch diameter and input branch diameter between two hands in the vibration exposure group( P > 0. 05). CONCLUSION: The hand-transmitted vibration can lower the nailfold capillary density,shorten and widen capillary loops, increase percentage of abnormal capillary loops and induce capillary haemorrhage. NFC could be used to assist early detection of microvascular damage induced by hand-transmitted vibration.

Purpose To explore the diagnostic value of quantitative measurements of magnetic resonance images (MRI) in transverse and coronary sections in patients with ischiofemoral impingement (IFI) syndrome.Materials and Methods The data of 70 patients (127 hips) in the Affiliated Hospital of Chengde Medical College from 2013 June to 2016 April who were performed hip MRI examination was analyzed retrospectively.39 patients (67 hips) with clinical diagnosis of IFI syndrome were selected as case group,while the other 31 patients (58 hips) with clinical exclusion of IFI syndrome were selected as control group.Ischiofemoral space (IFS),quadratusfemoris space (QFS),ischial angle,femoral neck angle (FNA) and lesser trochanter angle (LTA) were measured on axial MR image with PDWI FS sequence.The cervicodiaphyseal angle (CCD) was measured on coronary section MR image with T2WI TIRM sequence.The above measurements of two groups were analyzed.Results IFS,QFS and LTA in patients of case group were 12.2 (10.2-13.9) mm,8.5 (6.9-10.4) mm and (13.8±0.7) °,while these measurements were 26.3 (22.9-30.4) mm,21.6 (19.5-25.4) mm and (19.9± 1.0) ° in patients of control group.Compared with control group,these measurements were significantly lower in case group (P＜0.01).Ischial angel,FNA were significantly higher in case group compared with control group [(131.2±0.4) ° vs.(127.1±0.6) °,29.2 (22.8-34.1) ° vs.22.7 (19-28.3) °,P＜0.01].CCD showed no significant difference between the two groups (P＞0.05).QFS,LTA have positive correlation with IFS in case group (r=0.870 and 0.653,P＜0.05),while FNA,ischial angel have significant negative correlation with IFS in case group (r=-0.623 and-0.655,P＜0.05).The cut-offvalues ofQFS,FNA,ischial angel and LTA were ≤ 12.7 mm,≥ 21.75 °,≥ 131.65 °,≤ 9.3°,respectively.Conclusion The reduction ofIFS and QFS is the main imaging signs of IFI syndrome.

Objective To observe the effects and safety of oxycodone hydrochloride combined with parecoxib sodium in preventing postoperative hyperalgesia induced by remifentanil. Methods Eighty-eight ASA Ⅰ or Ⅱ patients undergoing elective laparoscopic myomectomy surgery were randomly divided into four groups (C,O,P,PO) with 22 cases in each group. Patients in group C,O,P,PO were given with 10 mL saline, 0.1 mg?kg-1 oxycodone hydrochloride, 40 mg parecoxib sodium, 0.1 mg?kg-1 oxycodone hydrochloride and 40 mg parecoxib sodium 30 min before the end of the surgery, respectively. The VAS scores were recorded at the end of surgery 30 min, 1 h, 2 h, 4 h, 8 h, and the cases of agitation, rigor, vomiting and increasing of analgesics were recorded. Results Compared with group C, the VAS scores in group O, P,PO were significantly lower(P<0.05). The VAS scores in group PO were lower than those in group O,P(P<0.05). The cases of agitation and rigor in group PO (0.0%, 5.0%) were less than those in group C (45.0%,23.0%) (P<0.05). The increased doses of analgesics in group PO(0) were less than those in groups C (12), group P (5), and group O (5)(P<0.05). Conclusion Oxycodone hydrochloride combined with parecoxib sodium can effectively prevent postoperative hyperalgesia induced by remifentanil, and reduce the incidence of postoperative agitation.

OBJECTIVE:To establish a method for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteolo-side and isochlorogenic acid A in Xiaoer ganmao granule. METHODS:HPLC was performed on the column of Hedera C18 with mo-bile phase of acetonitrile-0.1% formic acid aqueous at a flow rate of 1.0 ml/min,the detection wavelength was 254 nm,330 nm and 370 nm,column temperature was 40 ℃,and the injection volume was 5 μl,RESULTS:The linear range was 6.6-105 μg/ml for (R,S)-goitrin (r=0.999 9),9-140 μg/ml for chlorogenic acid (r=0.999 9),9-144 μg/ml for luteoloside (r=0.999 8) and 9-138 μg/ml for isochlorogenic acid A(r=0.999 6);the limits of quantitation were 330 ng,450 ng,450 ng and 450 ng,limits of detection were 66 ng,90 ng,90 ng and 90 ng,respectively;RSDs of precision,stability and reproducibility tests were lower than 3%;recoveries were 95.01%-98.77%(RSD=1.48%,n=6),95.14%-98.91%(RSD=1.52%,n=6),95.11%-97.54%(RSD=0.93%,n=6) and 95.58%-99.63%(RSD=1.73%,n=6). CONCLUSIONS:The method is simple and accurate,and suitable for the simultaneous determination of(R,S)-goitrin,chlorogenic acid,luteoloside and isochlorogenic acid A in Xiaoer ganmao granule.

Objective To discuss the value of MRI in diagnosis of complications related to pregnancy.Methods MRI were per-formed in 22 cases of late pregnancy,7 cases of postpartum with vagina bleeding,and 1 case with eight weeks of gestation following irregular vagina bleeding,respectively.The position of placenta and umbilical cord were observed in the cases of late pregnancy.The shape and signal features of embryo were evaluated in the case of eight weeks gestation following irregular vagina bleeding.Residual placenta and its relationship with the wall of uterus were analyzed in the cases of postpartum with vagina bleeding.Results Among the 22 cases of late pregnancy,normal position of placenta were in 4 cases,placenta previa were in 18 cases,umbilical cord winding around fetal neck in 8 cases.9 cases of placenta previa complicated with placenta accreta were comfirmed by cesarean delivery,how-ever,only 6 cases of placenta accreta were detected on MRI.The residual placenta with placenta accreta was found in all 7 cases of postpartum patients.Hydatidiform mole was proved by pathology in the case of eight weeks gestation following irregular vagina bleeding,and it was showed as a mass with hypointensity on T1 WI and hyperintensity on T2 WI in uterine cavity.Conclusion The complications related to pregnancy such as placenta previa,umbilical cord winding around fetal neck,residual placenta,placenta ac-creta could be correctly displayed on MRI.Hydatidiform mole also could be diagnosed by combining the clinical symptoms with MR images.