[Objective] To explore the efficacy and safety of retrograde intrarenal surgery (RIRS) using a flexible negative pressure suction sheath in the treatment of upper urinary tract stones >2 cm in diameter, to provide reference for the diagnosis and treatment of such disease. [Methods] Clinical data of 155 patients who underwent surgery for upper urinary tract stones during Nov.2022 and Nov.2023 at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were retrospectively analyzed.The patients were divided into 3 groups: percutaneous nephrolithotripsy (PCNL) group (n=54), conventional sheath RIRS group (n=41), and flexible sheath RIRS group (n=60). The general and clinical data of the 3 groups were compared. [Results] The PCNL group had more patients with severe hydronephrosis (22.22% vs. 4.88%, 5.00%, P=0.027) and smaller IPA involving the lower calyx [(36.17±17.6)° vs. (48.57±17.56)°, (47.41±10.82)°, P=0.014] than the conventional sheath RIRS group and flexible sheath RIRS group.Three days after operation, the stone-free rate (SFR) was 90.74%, 53.66% and 78.33% in the PCNL, conventional sheath RIRS, and flexible sheath RIRS groups, respectively (P<0.05). At 1 month postoperatively, the SFR was 92.59%, 73.17%, and 81.67%, with no statistically significant difference between the PCNL and flexible sheath RIRS groups (P>0.05), but was higher than that in the conventional sheath RIRS group (P<0.05). The PCNL group had shorter operation time than the two RIRS groups [(65.22±17.67) min vs. (91.73±20.57) min, (94.38±24.75) min, P<0.001], longer postoperative hospital stay [(5.0(4.0, 7.0) d vs.3.0(2.0, 4.0) d, 3.0(2.0, 4.0) d, P<0.001], greater decrease in hemoglobin level [(18.00±5.78) g/L vs. (5.57±5.16) g/L, (7.42±5.09) g/L, P<0.001], and higher visual analogue scale (VAS) score [(4.83±1.48) min vs. (2.95±1.07) min, (3.05±1.21) min, P<0.001], while there was no difference between the two RIRS groups (P>0.05). The costs were lower in the flexible sheath RIRS group than in the conventional sheath RIRS group but higher than in the PCNL group [(23 311.19±1 341.20)yuan vs.(24 550.49±1 172.51)yuan, (15 351.97±1 101.4)yuan, P<0.001]. The overall incidence of complications was similar among the three groups, but stone street occurred only in the conventional sheath RIRS group. [Conclusion] For the treatment of patients with upper urinary tract stones >2 cm, RIRS has shorter postoperative hospital stay, lower hemoglobin decrease, and lower VAS score compared to PCNL; the early postoperative SFR of flexible sheath RIRS is superior to that of conventional sheath RIRS, and the 1-month SFR is comparable to that of PCNL, with a low incidence of stone street.

Objective:To design and compile quality evaluation questionnaire on problem-based learning (PBL) of Neurology and to test its reliability and validity.Methods:Referring to the framework of the evaluation system and according to the characteristics of the discipline, we designed the questionnaire on PBL of Neurology. The clinical medical students who participated in neurologic PBL course were taken as the objects of investigation. The reliability of the questionnaire and the reliability of internal consistency were tested. Correlation analysis and exploratory factor analysis were used to evaluate the validity of the questionnaire.Results:The questionnaire on PBL of Neurology included three first-level indicators: teaching plan quality evaluation, teaching method evaluation and teaching quality evaluation, containing 6 second-level indicators and 25 third-level indicators. The correlation coefficient ρ=0.990 ( P<0.01) showed that the retest reliability was good. The cronbach's α coefficient is 0.901, meeting the internal consistency reliability requirement. And the content validity correlation coefficient was 0.307-0.7 ( P<0.05), indicating that each third-level index had a significant correlation with the total score, and the questionnaire item design was good. The three first-level indicators were used as common factors to evaluate the structural validity by exploratory factor analysis and identify the direction of optimization. Conclusion:The questionnaire has good reliability and validity, which can be used as a tool for scientific evaluation on PBL of neurology, and also provide an optimization direction for further research in the future.

Objective Comparing the organ-system-based integrated curriculum model and tradi-tional teaching model in medical education to evaluate the effect of Integrated curriculum model. Methods The experiment group (Group A) included 45 students who had graduated in 2016 under integrated curricu-lum model, the control group (Group B) included 82 students who had graduated in the same year under traditional teaching model. Comparing the test score between two groups to see if a significant difference emerged, including general education courses, graduation examination, clinical intern examination, uninte-grated curriculum and National Medical Licensing Examination. Using SPSS 19.0 statistics, 2-Independent-sample T test. Results There were no significant difference in the scores of general education courses between the groups. The total score of graduation theory examination in group A was 54.71±8.58, which was significantly higher than group B (49.13±12.21) (P=0.008), especially in internal medicine, surgery, gyne-cology and obstetrics, the contrast of the two groups being P=0.015, P=0.022, P=0.002 respectively. The total score of OSCE in group A was 69.56±5.64, which was significantly higher than group B (65.74±5.37) (P=0.000), especially in diagnose, clinical thinking ability, interpersonal communication skills and total score, the contrast of the two groups being P=0.019,P=0.001, P=0.000 respectively. The scores of clinical Intern examination in group A were superior to group B, especially in internal medicine, surgery, gynecology and obstetrics, the contrast of the two group being P=0.029, P=0.015, P=0.003 respectively. The scores of 3 unintegrated curriculum in group A were the same with group B. The total score of National Medical Licens-ing Examination in group A was (429.690±31.197), which was significantly higher than group B (412.370± 46.858) (P=0.048), especially in Clinical medicine, Preventive Medicine, the contrast of the two groups were P=0.011, P=0.022 respectively, in the level of knowledge, comprehension, application, the contrast of the two groups being P=0.022, P=0.041 respectively. Conclusions The integrated curriculum modal has more advantages in developing students' Comprehensive ability. There is no fixed pattern of integrated curriculum, and it needs continuous evaluation and improvement to ensure the effect.

This study aimed at preparing the chemical reference substance of garcinol.A preparative high-speed countercurrent chromatography (HSCCC) was adopted for the isolation of garcinol from the twigs of Garcinia multifiora Champ,G.esculenta Y.H.Li and the fruits of G.xanthochymus Hook.f.ex T.Anders.The crude extracts were separated by HSCCC with two phase solvent systems composed of n-hexane-ethyl acetate-95％ ethanol-water (8∶8∶12∶4,volume ratio) using the upper stationary phase and the lower mobile phase.Under the conditions of a flow rate of 2.0 and 4.0 mL· min-1,and the apparatus rotation at 850 rpm,the column temperature at 25℃ and the detection wavelength at 254 nm,the fraction containing garcinol was purified by the Sephadex LH20 chromatography.The purity test in the extracts was determined by high-performance liquid chromatography.As a result,the contents of garcinol were 45,281 and 4080mg respectively separated from 104.765 g twigs of G.multiflora Champ,105.270 g G.esculenta Y.H.Li and 102.318 g the fruits of G.xanthochymus Hook.f.ex T.with the purity of 98.72％,98.36％ and 98.42％.Compared with the sample pretreatments and separation efficiency of the three plants,it was found that the fat-soluble extracts rapidly and efficiently extracted using n-hexane-ethyl acetate-95％ ethanol-water (5∶5∶5∶5,volume ratio) contained abundant garcinol taking fruits of G.xanthochymus Hook.f.ex T as the raw material with the combination of HSCCC and Sephadex LH-20 chromatography.In conclusion,it was indicated that the combination method is efficient with high operability and large preparation quantity.

Objective To investigate the expression of TAZ in peripheral blood and tumor tissue of the patients with colorectal cancer and to analyze their relationship and clinical significance.Methods Eighty-five cases of pathologically verified colorectal cancer treated by radical operation were selected as the operation group,and 35 cases with postoperative relapse served as the recurrent group.Meanwhile 50 age and sex-matched healthy persons were selected as the control group.The immunohistochemical(SP)technique was adopted to detect the expression of TAZ in tumor tissues and expression of TAZ in peripheral blood was tested with enzyme linked immunosorbent assay(ELISA).Results The level of preoperative TAZ in peripheral blood of the operation group was significantly higher than that of the control group(P＜0.05).The level of peripheral blood TAZ after operation in the operation group had no significant change compared with the control group (P＞0.05).The level of peripheral blood TAZ in the recurrent group was significantly higher than preoperative level of operation group(P＜0.05).The expression of tumor tissue TAZ was significantly higher than that of normal mucosal tissue(P＜0.05);the expression of tumor tissue TAZ in the recurrent group was higher than that in the operation group(P＜0.05).The tumor tissue TAZ level in the operation group and recurrent group had obvious correlation with peripheral blood TAZ level(P＜0.05).Conclusion Monitoring the TAZ level has obvious reference value for predicting colorectal cancer staging and timely understanding tumor recurrence.

Objective: To investigate the influence and significance of DHA on expression of angiogenesis-related genes in SGC7901 cells. Methods:SGC7901 were treated with DHA (5, 10, 20, 40, and 80μmol/l) for different times (24, 48, and 72 h), and the growth inhibition was detected by MTT. The expression of vascular endothelial growth factor (VEGF-C), cyclooxygenase-2 (COX-2) vascular cell adhesion molecule-1 (VCAM-1), and PTEN mRNA were detected by fluorescence-based quantitative poly-merase chain reaction (qRT-PCR). Their corresponding protein levels were tested by Western blot. Results:DHA significantly inhibited the growth of SGC7901 cells in a dose-and time-dependent manner (P<0.05). The expression of the angiogenesis-related genes signifi-cantly changed, as shown by RT-PCR and Western blot analyses. Compared with the control group, the expressions of VEGF-C, COX-2, and VCAM-1 were down-regulated, whereas the expressions of PTEN were up-regulated, after DHA treatment (P<0.05). Con-clusion:DHA inhibits cell growth in gastric cancer SGC7901 cells. The effect may be due to its reduction of VEGF-C, COX-2, and VCAM-1 gene expression, as well as its promotion of PTEN expression in gastric cancer cells.

Objective To evaluate the clinical results of posteromedial supine approach plus anterolateral approach for treatment of posteromedial condylar tibial plateau split fracture combined with lateral compartment depression.Methods A retrospective analysis was done on 48 cases of posteromedial condylar tibial plateau split fracture with lateral compartment depression operated through posteromedial supine plus anterolateral approaches from February 2011 through March 2013.There were 37 men and 11 women,aged 15-67 years (mean,42.5 years).Fracture occurred at the left side in 31 cases and at the right side in 17 cases.Interval between injury and operation ranged from 5 to 16 days (mean,8.7 days).Reconstructive or T-shaped plates were used for posteromedial condylar split tibial plateau fracture.Anatomical or locking compression plates were used for lateral compartment depression,but autogenous ilium bone grafting was performed laterally when bone defect was obvious.Results Average operation time was 2.8 hours (range,2-3.5 hours) and average length of stay was 21 days (range,12-45 days).All cases were followed up for mean 12.8 months (range,5-25 months).All fracture healed from 4 to 8 months (mean,6.7 months).Mean Rasmussen score for radiological results was 16.9 points (range,16-18 points) immediately after operation.Hospital for special surgery (HSS) knee score averaged 86.4 points (range,76-95 points) 8 months after bone healed,indicating the excellent results in 27 cases,good in 16 cases,fair in 4 cases and poor in 1 case with a good to excellent rate of 90％.At the last follow-up,postoperative knee range of motion averaged-5°-135°.All incisions healed primarily without vascular nerve injury and implant loosing or breakage.There was an extension lag in 1 case with knee range of motion of 20°-130° and osteoarthritis in 1 case,but both were improved with non-operation therapy.Conclusion Posteromedia] supine plus anterolateral approaches are suitable for posteromedial condylar tibial plateau split fracture with lateral compartment depression,for the combined approaches gain advantages of easy operation,good reduction,rigid fixation,few soft-tissue complications and satisfactory clinical results.

Ischemic stroke is closely associated with carotid atherosclerosis.Detecting carotid plaque components (including fibrous Cap,lipid core,hemorrhage,and calcification) using high-resolution 3.0T magnetic resonance imaging contributes to evaluate the risk of ischemic stroke and guide treatment.This article reviews the research status of magnetic resonance imaging of carotid atherosclerotic plaque components.

Objective To investigate the effects of dihydroartemisinin (DHA) on the proliferation of gastric cancer cell line SGC7901 and its mechanism.Methods SGC7901 cells were divided into the DHA group and the control group.SGC7901 cells in the DHA group were treated with DHA of different concentrations (6.25,12.50,25.00,50.00,100.00 μmol/L),SGC7901 cells in the control group were cultured in the 0.1％ DMSO medium.The proliferation of SGC7901 cells was detected by the MTF method at different time points (24,48,72 hours).Cell cycles of SGC7901 in the DHA group were observed by flow cytometry at 24 hours after treatment.The expressions of Cyclin A,Cyclin D1,Cyclin E,Cyclin-dependent kinase 4 (CDK4) and P16 were detected by Western blot after treating SGC7901 with DHA at concentration of 100μmol/L for 24 hours.The interaction between CDK4 with Cyclin D1 or P16 was examined using the co-immunoprecipitation assay.All data were analyzed using the one-way analysis of variance or the t test.Results The proliferation of SGC7901 cells was significantly inhibited after the treatment with DHA at different concentrations (6.25,12.50,25.00,50.00,100.00 μmol/L) for 24,48 and 72 hours (F =78.66,235.37,93.75,P ＜ 0.05).Compared with control group,the number of SCG7901 cells in the G0/G1 phase in the DHA group was significantly increased (F =18.42,P ＜0.05).After treating SGC7901 cells with DHA for 24 hours,the protein expressions of Cyclin D1 and CDK4 were 0.67 ± 0.15 and 0.64 ± 0.18 in the control group,which were significantly higher than 0.17 ± 0.05and 0.24 ± 0.06 in the DHA group (t =7.746,5.164,P ＜ 0.05).The protein expressions of Cyclin E were 0.42 ± 0.06 in the control group and 0.35 ± 0.06 in the DHA group,with no significant difference (t =2.021,P ＞ 0.05).The protein expressions of Cyclin A were 0.35 ± 0.09 in the control group and 0.38 ± 0.08 in the DHA group,with no significant difference between the 2 groups (t =1.266,P ＞ 0.05).The protein expressions of P16 were 0.29 ± 0.07 in the control group and 0.54 ± 0.12 in the DHA group,with significant difference between the 2 groups (t =4.408,P ＜ 0.05).The results of co-immunoprecipitation assay showed that DHA decreased the interaction between CDK4 and Cyclin D1,and increased the interaction between CDK4 and P16.Conclusion DHA induces SGC7901 cells arrested in G0/G1 phase,and the effect may be related with its downregulation of Cyclin D1 and CDK4,up-regulation of P16,decreasing the interaction between CDK4 and Cyclin D1,and increasing the interaction between CDK4 and P16.

Objective By analysing the clinical features of Indigo Naturalis-associated ischemic lesion of colon mucosa to improve the precautionary and therapeutic level of the disease.Methods Thirteen patients diagnosed as Indigo Naturalis-associated ischemic lesion of colon mucosa in Peking University Third Hospital from 2005 to 2010 were reviewed.The endoscopic and clinical features were analysed.Results The 13 patients with an average age of(60.6±14.1)years old were prescribed Chinese traditional medicine containing Indigo Naturalis for psoriasis or idiopathic thrombocytopenic purpura(ITP).The ratio of males to females was 1:1.6.The typical manifestations were abdominal pain and bloody stool with watering diarrhea before bloody stool in 61.5%patients.Endoscopic and pathological characteristics were coincident with ischemic lesion and more like a chronic index.Vasodilatic medicine was effective and the average hemostatic time was(1.7±0.8)days.The prognosis was well and no recurrence was found during 3 months follow-up.Conclusions Patients having psoriasis or ITP treated with Chinese traditional medicine containing Indigo Naturalis have an inclination to colon mucosa lesions, even ischemic lesion. Careful assessment and observation before prescribing arc necessary in these patients.