Percutaneous nephrolithotomy(PCNL)is important in the treatment of upper urinary tract stones,and tubeless day-time surgery is a promising approach.It can improve the patients'hospitalization experience and shorten hospitalization time,but it also faces risks such as difficulty in managing residual stones after surgery,urinary extravasation caused by poor ureteral drainage,and so on.Currently,there are insufficient guiding principles in this regard.Based on our experience and relevant literature,this paper will discuss the technical points of day-time tubeless PCNL and explore its feasibility.

Abstract Flood disasters are the common public health emergencies, mainly leading to environmental damage, water pollution, food pollution, vector breeding, infectious disease epidemic and other risk factors of sanitary and anti epidemic work. The guideline has been formulated with reference to the technical documents such as Guideline for Environmental Sanitation Disposal and Preventive Disinfection in Flooded Areas and Technical Proposal for Sanitary and Anti epidemic Measures after Flood Disasters, as well as the latest research progress at home and abroad. In order to guide the sanitary and anti epidemic measures in flooded areas, protect the health and safety of students and teachers and ensure the normal educational and teaching order, the guideline introduces the key measures that should be taken by schools, teachers and students in flood striken areas.

Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.

Objective:To analyze the clinical characteristics of adult Chinese patients with syncope.Methods:This is a cross-sectional survey study. Patients with preliminary diagnosis of syncope in the Emergency Department, Geriatrics and Cardiology Outpatient Department, or Syncope Unit of 37 hospitals in 19 provinces, autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study. The clinical features of these patients with syncope were analyzed.Results:A total of 4 950 consecutive patients with syncope were included in this study. The age was (56.3±16.8)years, and 2 604 cases (52.6%) were male. The most common type of syncope was neurally mediated syncope (2 345 (47.4%)), followed by cardiac syncope (1 085 (21.9%)), orthostatic hypotensive syncope (311 (6.3%)), and unexplained syncope accounted for nearly one third (1 155 (23.3%)). Predisposing syncope was more common in patients under 65 years of age(2 066(72.4%) vs. 786(27.6%),χ 2=136.5, P<0.001). Presyncope was more common in patients with neurally mediated syncope (1 972(79.0%) vs.1 908(73.9%), χ 2=17.756, P<0.001). Premonitory symptoms were more common in women(1 837(80.0%) vs. 1 863(73.0%),χ 2=33.432, P<0.001). Presyncope syndrome was more common in patients under 65 years of age (2 482(77.8%) vs. 1 218(73.4%),χ 2=17.523, P=0.001). Cyanosis was more common in ≥65 years old patients (271(18.2%) vs. 369(12.7%), χ 2=23.235, P<0.001). Urinary incontinence was more common in old patients aged ≥65 years(252(15.2%) vs. 345(10.8%), χ 2=19.313, P<0.001). Family history was more common in patients with cardiogenic syncope compared with other types of syncope (264(24.3%) vs. 754(19.5%), χ 2=11.899, P=0.001). Hypertention(1 480(30.5%)), coronary heart disease(1 057(21.4%)), atrial flutter and atrial fibrillation(359(7.2%)), second degree atrioventricular block(236(4.8%)) were common complications of syncope. The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%) vs. 640(16.6%), χ 2=241.376, P<0.001). Other common complications included cerebrovascular diseases (551 (11.1%)) and diabetes mellitus (632(12.8%)). Conclusions:Neurally mediated syncope is the most common syncope in adult Chinese population. Patients with predisposing conditions and premonitory conditions are younger. Presyncope is more common in women. The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.

Objective:To investigatethe maternal and infant adverse outcomes of group B streptococcus (GBS) colonization during the late pregnancy.Methods:A total of 567 pregnant women who underwent obstetrics and gynecology examination in Yuyao People′s Hospital from December 2018 to June 2019 were selected for the study. Internal vaginal secretions of all the pregnant women were extracted from the lower 1/3 of the vagina for bacterial culture, and GBS culture and screening were performed on pregnant women. According to the results of GBS screening, pregnant women were divided into GBS negative group (8 cases) and GBS positive group (559 cases). The general condition and pregnancy outcomes of pregnant women were compared between the two groups, and the correlation between pregnancy outcomes and streptococcus colonization was analyzed.Results:There were no statistically significant differences in age, gestational weeks, number of births, number of pregnancies, history of abortion, residence area and ethnicity between the two groups ( P>0.05). The incidence of premature rupture of membranes and fetal distress in GBS positive group were higher than those in GBS negative group:5/8 vs. 7.69%(43/559), 3/8 vs. 5.01%(28/559), and the differences were statistically significant ( P<0.05). Spearman single factor correlation analysis showed that GBS colonization in pregnant women were positively correlated with premature rupture of membranes and fetal distress ( r = 0.632, 0.573, P<0.05). Conclusions:GBS colonization in late pregnancy is closely related to pregnancy outcomes, and strengthening GBS screening has great significance to reduce adverse pregnancy outcomes.

Objective:To investigate the efficacy and safety of programmed death-1 (PD1) inhibitor combined with transcatheter arterial chemoembolization (TACE) in the treatment of huge primary liver cancer.Methods:From June 2016 to December 2019, the clinical data of 31 patients with huge primary liver cancer enrolled in the Central Hospital of Lishui were retrospectively collected and analyzed. The tumor size ranged from 10.1 to 18.8 cm, with an average of (14.2±2.3) cm. The patients were divided into TACE group (TACE treatment, 18 cases) and combined group (one week after TACE, patients receiving a dose of 200 mg PD1 inhibitor administration every 21 days, 13 cases), according to whether patients receiving PD1 inhibitors. The patients were followed up. The disease control rate (DCR) were compared between the two groups using Mann-Whitney U test. The median overall survival (OS) and progression free survival (PFS) were calculated by Kaplan-Meier method. Results:The DCR in combined group (53.8%, 7/13) was higher than that in TACE group (22.2%, 4/18), and the difference was statistically significant ( Z=-2.13, P=0.04). The median PFS (5.0 months) in combined group was longer than that in TACE group (3.0 months), the difference was statistically significant (χ2=4.39, P=0.04). The median OS (15 months) in combined group was longer than that in control group (9 months), and the difference was statistically significant (χ2=5.51, P=0.02). Conclusion:The combine PD1 inhibitors with TACE is an effective and safe therapy for huge primary liver cancer.

Objective:To understand and compare the differences between age, sex and liver diseases-related mortality risk in patients with hepatitis B virus-related liver cirrhosis.Methods:Based on the front-page inpatient medical record database and the death registration system of Beijing patients with hepatitis B-related liver cirrhosis from 2008 to 2015 were included. The survival information of all patients were traced up to the occurrence of liver disease-related mortality event or until December 31, 2019. Kaplan-Meier method was used to calculate the cumulative incidence of liver disease-related mortality in patients with liver cirrhosis. Cox regression model was used to analyze the effect of age-gender interaction on liver disease-related mortality risk.Results:A total of 16 738 patients with hepatitis B-related liver cirrhosis were included, of which 13 969 cases (83.46%) were in compensated stage and 2 769 cases (16.54%) were in decompensated stage. Liver cirrhosis complications mortality risk in patients with compensated stage cirrhosis at 3, 5, and 8 years were 10.84%, 12.70%, and 14.37%, respectively; while in decompensated stage patients, the mortality risk was 16.70%, 19.02%, and 20.73%, respectively. The 3, 5, and 8-year liver cancer mortality rates of patients with compensated stage liver cirrhosis were 5.24%, 7.49%, and 10.25%, respectively; while those with decompensated stage liver cancer mortality rates were 9.01%, 11.16%, and 13.50%, respectively. Liver disease-related mortality risk was increased with age in patients with liver cirrhosis. Liver cirrhosis complications mortality risk in female patients with liver cirrhosis at age < 60 years was lower than that of male patients. Liver cirrhosis complications mortality risk in male and female patients aged 60-69 years were similar. Liver cirrhosis complications mortality risk in female patients aged ≥70 years was higher than that of male patients. However, female patients had a lower risk of liver cancer mortality than male patients in utmost age groups.Conclusion:Age is positively correlated with liver diseases-related mortality risk in patients with hepatitis B-related liver cirrhosis. Female sex is a protective factor for liver cancer mortality in patients with liver cirrhosis, and the protective effect on liver cirrhosis complications mortality risk gradually disappears with age.

Objective To investigate the correlation between ipsilateral prominent posterior cerebral artery laterality (PCAL) and white matter hyperintensities (WMHs) in patients with severe internal carotid artery (ICA) stenosis. Methods From April 2016 to December 2017, patients with unilateral ICA stenosis≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis admitted to the Department of Neurology, Liaoning Provincial People's Hospital were enrolled. According to the presence or absence of PCAL on the ipsilateral side of ICA stenosis, they were divided into positive group and negative group, and the severity of WMHs was compared between the 2 groups. The patients were grouped according to the severity of overall WMHs and deep WMHs (DWMHs) and periventricular WMHs (PWMHs) on the ipsilateral side of ICA stenosis. Multivariate logistic regression analysis was used to determine the independently relevant factors of WMHs. Results A total of 131 patients were enrolled, 65 of them (49.62% ) had ipsilateral PCAL positive. The proportion of severe DWMHs in this group was significantly lower than that in the ipsilateral PCAL negative group (38.46% vs. 59.09% ; χ2 =5.578, P=0.018 ). Multivariate logistic regression analysis showed that advanced age (odds ratio [ OR] 2.196, 95% confidence interval [ CI] 1.278-3.773; P=0.004), hypertension (OR 3.279, 95% CI 1.107-9.709; P=0.032), and high systolic blood pressure (OR 1.027, 95% CI 1.002-1.053; P=0.031) were independently associated with severe overall WMHs; advanced age (OR 1.957, 95% CI 1.141-3.358; P=0.015) and hypertension (OR 4.739, 95% CI 1.570-14.286; P=0.006) were independently correlated with ipsilateral severe DWMHs, ipsilateral PCAL (OR 0.340, 95% CI 0.135-0.856; P=0.022 ) was independently correlated with ipsilateral mild DWMHs; advanced age (OR 1.805, 95% CI 1.175-2.775; P=0.007) and high systolic blood pressure (OR 1.030, 95% CI 1.007-1.053; P=0.010) were independently correlated with ipsilateral severe PWMHs. Conclusion Ipsilateral PCAL is an independent protective factor for ipsilateral DWMHs in patients with severe ICA stenosis.

Objective To compare the size of target volume,amplitudes of movements in different directions,movement vector,dose to the diseased lung,whole lung volume,and setup error between free breathing fixation (method A) and four-dimensional computed tomography (4DCT)-guided abdominal balloon compression fixation (method B),and to demonstrate that the 4DCT-guided abdominal balloon compression fixation is effective in the treatment of non-small cell lung cancer (NSCLC).Methods A retrospective analysis was performed among 80 patients with NSCLC in our hospital.In those patients,40 received method A and 40 method B.The GTVfree and GTVpress were delineated on the maximum intensity projection (MIP) images of 10 respiratory phases using method A and method B,respectively.The PTVfree and PTVPress were obtained by expansion of the GTVfree and GTVpress,respectively.The paired t test was used to analyze the differences in the PTV,maximum amplitudes of movements in three dimensions,absolute value of the movement vector (|V|),and volume between method A and method B.The treatment planning system was used to compare the V5,V10,V20,and V30 of the diseased lung and the whole lung volume between method A and method B.All patients underwent cone-beam CT (CBCT) scans after positioning.Setup error was obtained by matching the CBCT images with the MIP images in the XVI system based on bone and grayscale values.Results The PTVfree and PTVpress were (283.2± 12.74) and (201.8± 12.99)cm3,respectively (P=0.002).The maximum amplitudes of movements in the right-left,superior-inferior,and anterior-posterior directions as well as thel V | value were (0.22±0.02),(1.85±0.08),(0.43±0.26),and (1.91±0.27) em,respectively,for method A,and (0.05±0.01),(0.41±0.03),(0.16±0.16),and (0.44±0.16) cm,respectively,for method B (P=0.120,0.001,0.070).The V5,V10,V20,and V30 for the diseased lung and total lung volume were (61.26± 4.27) ％,(44.52± 1.70) ％,(28.22± 3.13) ％,(18.26±5.17)％,and (3556±223.12) cm3,respectively,for method A,and (52.74±4.78)％,(38.76±4.92) ％,(23.71 ±4.03) ％,(15.54±3.43) ％,and (3376±311.65) cm3,respectively,for method B (P =0.001,0.003,0.004,0.021,0.004).There was no significant difference in setup error obtained by the XVI system between the two fixation methods (P＞0.05).Conclusions Without increasing setup error,abdominal balloon compression can effectively control the lung movement amplitude,reduce the planning target volume,and reduce the radiation dose to the lung in patients with NSCLC.

Objective To systematically review the efficacy and safety of Jinlian Qingre Effervescent Tablet (JQET) compared to Ribavirin for acute upper respiratory tract infection in children.Methods CNKJ,CBM,WanFang Data,VIP,PubMed,EM base,Web of science,and Cochrane Library databases were searched from the date of establishment to December 2016 for all randomized controlled trials (RCTs) and quasi-RCT on the use of JQET in children with acute respiratory infections.Meta-analysis by using Rev Man 5.3.Results A total of seven RCTs involving 782 patients were included,while the group of JQET involving 392 patients,Ribavirin involving 390 patients.The results ofmeta-analysis indicated that the efficacy in Jinlianqingre group was superior to that of Ribavirin control group,such as clinical effectiveness [RR=l.26,95％CI=(1.18,1.34),P＜0.000 01],fever subsidence time [MD=-1.54,95％CI (-1.79,-1.30),P＜0.000 01],the time of subsided cough [MD=-1.53,95％CI (-1.79,-1.27),P＜0.000 01],the disappearance time of pharyngalgia [MD=-1.29,95％CI (-1.88,-0.70),P＜0.000 1],and Pharyngeal congestion disappearance time [MD=-2.80,95％CI(-3.11,-2.49),P＜0.000 01].The difference was statistically significant.There were three adverse reactions reported in JQET group.Conclusion JQET is superior to the Ribavirin control group in clinical effectiveness,fever subsidence time,time of subsided cough,disappearance time of pharyngalgia,and pharyngeal congestion disappearance time to treat acute upper respiratory tract infection in children.However,these results should be carefully interpreted,and this conclusion has to be further verified by high quality,large scale RCTs.