Objective:To investigate the feasibility of combination of en-bloc resection of bladder tumor (ERBT) with the NBI(narrow band imaging) flexible cystoscopy, immunotherapy and chemotherapy in bladder-preserving treatments(called as TMT) for patients with stage T 2 bladder carcinoma. Methods:We retrospectively reviewed and analyzed a series of 16 patients with pT 2N 0M 0 pathologically confirmed. All patients are male with a median age of 63yr(56, 73yr). The American Association of Anesthesiologists scored ≤Ⅱ in 12 cases and Ⅲ in 4 cases. There were 9 cases with smoking history, 5 cases with hypertension, 3 cases with diabetes, and 2 cases with heart disease. The results of preoperative tissue biopsy were all urothelial carcinoma. All patients were taken lithotomy position and performed ERBT with NBI imaging technique and thulium-laser energy platform under general anesthesia. The tumor was brown and the surrounding normal mucosa was cyan in color. The procedure was ensured with a minimal tumor margin of 1cm and minimal rection depth to the deep musculi, and with the acquirement for the en-bloc specimen of which the basal site was marked afterwards, the patients all took a full length of chemoimmunotherapy (four cycles of Tislelizumab combined with Gemcitabine and cisplatin regimens) followed by a secondary ERBT. The perioperative data from sequential operations including complications were comprehensively analyzed for evaluating the therapeutic outcome and safety. All patients received a follow-up to detect efficacy and safety of the treatment with the primary end point of pCR, downgrading rate and objective response rate. Results:All operations were successfully completed. There was no obturator reflex, severe bleeding or grade Ⅱ bladder perforation, only 4 patients got a grade Ⅰ bladder perforation. The postoperative 30-day complication occured in 2 cases(1 pt with hematuresis, 1 pt with bladder irritation). The pathologic complete response rate and tumor downstaging rate were 100%. One patient recurred during a median follow-up of 13.0 months (6, 36 months).Conclusions:The En Bloc Resection of Bladder Tumor with the narrow band imaging (NBI) flexible cystoscopy has several remarkable advantages, including a better intra-operative visual, a lower complication rate and tumor residual. The combination of ERBT with immunotherapy and chemotherapy lead to affirmative curative effect and the feasibility for clinical application is relatively high.

Objective:To explore the clinical feasibility of extra-peritoneal laparoscopic radical cystectomy based on the concept of 3D membrane anatomy.Methods:The clinical data of 10 male patients with bladder cancer who underwent 3D extra-peritoneal laparoscopic radical cystectomy + ileal-orthotopic-neobladder surgery from October 2020 to June 2021 were retrospectively analyzed. The median age was 67 years. The ASA score was 1-2 in 8 cases and 3 in 2 cases. There were 4 cases of hypertension, 2 cases of diabetes, 1 case of heart disease, no case of abdominal surgery history. During the operation, the concept of 3D membrane anatomy was used to identify the important fascia in the pelvic cavity and to find the key layers and structures in the pelvic cavity.It was separated from the prevesical fascia to the laterovesical space, and confluenced with Retzius space and Bogros space. It was dissected in the layer surrounded by the prevesical fascia, the vesicohypogastric fascia, and the urogenital fascia to complete the process of cystectomy.Results:The operations of 10 patients were completed successfully and there was no conversion to open operation. The median operation time was 276(237-325) minutes, and the median blood loss was 160(50-280)ml. The postoperative bowel recovery median time was 1.8(1-3)days, and the patients were out of bed about 1.3(1-2) days. The median postoperative hospital stay was 9(5-12) days. The number of median lymph node dissection in all patients was 10(6-20). Positive lymph nodes was found in 3 cases. Positive margin was found in no case. Postoperative tumor pathological stages were T 2 stage in 7 cases, T 3 stage in 3 cases. During the follow-up, all patients had no obvious complications. Conclusions:It is feasible to apply the concept of 3D membrane anatomy to identify and locate the key fascia structures and levels in extra-peritoneal laparoscopic radical cystectomy. The operative complications were less and the postoperative recovery was faster. The anatomy is clear during the operation, which has good safety and reduces the difficulty of the operation.

Objective To survey the anxiety status of university students in Xuzhou city ,and to analyze its influence factors to propose the effective improvement strategy .Methods The stratified cluster random sampling method was adopted to conduct the questionnaire survey on 1931 college students from 2 colleges in Xuzhou City .The statistical analysis was performed by using SPSS 16 .0 .Results The average score of anxiety in college students was (42 .23 ± 9 .70) points ,the total detection rate was 21 .4% .The main influencing factors of anxiety included the home ranking ,character ,specialty ,school record ,getting scholarship ,plan to partici-pate in graduate entrance examination ,employment prospect ,sleep quality ,physical condition ,relationship with classmates and ro-ommates ,love status ,work-study programs or go out to work situation ,family type ,communication with parents ,family income . Conclusion The anxiety status of college students in Xuzhou City is in middle level .So improving the college students′anxiety sta-tus needs the joint efforts of school ,family and students themselves .

Objective To understand the epidemiological characteristics of injury in college students in north jiangsu area ,a‐nalysis its related factors .Methods With the method of random cluster sampling ,1 857 students as the research object .Using self‐made questionnaire survey ,choose Chinese college students′ mental health scale (CCSM HS ) and Chinese perceived stress scale (CPSS) to investigate the mental health status of the research object .Results In 1 857 students ,639 students had more than once hurt ,harm the annual incidence of 34 .41% ;Incidence rate of injury was highest in junior college student(38 .94% ) ,lowest in gradu‐ate student(31 .75% ) .The highest constituent ratio of hurt types was fall/collision injury(34 .64% ) ,and lower extremity injuries was the main injured area .Education ,age ,ranking in the home ,parents′marital status ,students and their parents′physical condi‐tion ,the relationship with the students ,and the roommate to the occurrence of friction ,go out to work ,as well as the psychological stress test ,10 factors of college students′psychological scale ,10 factors oftotal pressure and tension factor were influencing factors of injury .Conclusion Damage and mental health problems is closely related .Safety education ,psychological education and interven‐tion should be carried out in order to effectively prevent and reduce the incidence of injury .

Objective To investigate the effect of antimicrobial-impregnated incise drape on preventing surgical site in-fection(SSI)following neurosurgical operation.Methods Patients undergoing neurosurgical operation from January to De-cember 2012 were divided into two groups:antimicrobial-impregnated incise drape group(group A)and general incise drape group(group B).The occurrence of SSI and risk factors for SSI were analyzed.Results Percentage of drape lifting at the wound edge in group A was lower than group B(38.3%[98/256]vs 96.88% [248/256],χ2 =200.57,P <0.01).Among 512 patients,SSI rate was 3.32%(n=17),SSI rate in group A was lower than group B(1.56%[4/256]vs 5.08%[13/256],χ2 = 7.93,P <0.05 ).Multivariate analysis revealed that body mass index ≥24,perioperative hypothermia,smok-ing,perioperative length of hospital stay ≥5 days,and lack of drape use were independent risk factors for SSI following neurosurgical operation.Conclusion Whether antimicrobial-impregnated incise drape is used in neurosurgical operation is one of the independent risk factors for SSI following neurosurgical operation,it can effectively reduce the drape lifting rate and incidence of SSI,and is recommended to be used in neurosurgical operation.

Objective The analysis healthy crowd skull magnetic resonance image formation(MRI) inspection result,understood healthy crowd skull common disease the type,favors the healthy physical examination project the reasonable establishment.Methods Medical Center sent medical examination of 380 cases of brain MRI data and retrospective analysis.Results 380 cases of brain MRI results show healthy physical examination:there are 9 kinds of disease,MRI exception occurred there were 109 cases,abnormal rate of 28.7％ ; by age is divided into three groups:30-40 sui,41-50 sui; 51-60 sui; 51-60 sui exception rate was highest in the age group,to 56.9％ ; the discovery of the disease,the highest incidence of disease with multiple lacunar cerebral infarction,73.4％ per cent of total incidence.Conclusion MRI no radiation,brain MRI examination should as a general project of middle and old aged healthy,early detection of brain tumor lesions and cerebral vascular lesion,disease prevention and healthy living for guidance.

To explore the diagnostic value of susceptibility weighted imaging (SWI) for intracranial cavernous hemangioma.The magnetic resonance sequences of SWI,conventional imaging (MRI) and diffusion-weighted imaging (DWI) were performed in 37 patients of intracranial cavernous hemangioma to compare their different imaging capacities.Among them,the number of lesions found on T1WI,T2WI,DWI and SWI sequences were 40,41,42 and 50 respectively.Thus SWI may detect regular MRI negative or smaller lesions of intracranial cavernous hemangioma.

To study the inhibitory effect of oxymatrine (OM) on quartz-induced secretion of TNF-alpha in the fibroblast proliferation, a given amount of quartz powder and OM of different concentrations were put into the media of pure culture containing macrophages. After 24 h of the culture, the TNF-alpha in the media was measured by double-antibody sandwich ELISA. The TNF-alpha (10 ng/mL) and OM of different concentrations were added into the media containing the fibroblasts of the 4th generations from neonate rats. The gamma values of cAMP and cGMP in fibroblasts were determined by the radioimmunoassay and the concentrations of cAMP and cGMP were calculated according to standard curve. The intracellular Ca2+ was determined by flow cytometry and cell proliferation was detected by MTT. Our results showed that at the concentrations between 200 microg/ mL-1600 microg/mL, OM inhibited the secretion of TNF-alpha by alveolar macrophages (AM) in a dose-dependent manner. Especially, there were significant differences, to various degrees, in the inhibitory effect of OM between the concentration range of 800 microg/mL-1600 microg/mL and the concentration of 10 ng/mL TNF-alpha. When compared with 10 ng/mL TNF-alpha, OM of different concentrations could dose-independently increased the level of intracellular cAMP and decreased the level of cGMP, thereby raising the ratio of cAMP/cGMP and lowering the concentrations of intracellular Ca2+. Moreover, OM of 800 microg/mL had the strongest inhibitory effect on cell proliferation and at this concentration, the cAMP/cGMP was highest and Ca2+ was at the lowest level. We are led to conclude that OM can antagonize the damaging effect of quartz on the membrane of AM and the effect of TNF-alpha promoting the proliferation of fibroblasts. It achieves its inhibitory effect on the promoting effect of TNF-alpha on fibroblast proliferation by elevating the cAMP level and decreasing the release of Ca2+.

To study the inhibitory effect of oxymatrine (OM) on quartz-induced secretion of TNF-α in the fibroblast proliferation, a given amount of quartz powder and OM of different concentrations were put into the media of pure culture containing macrophages. After 24 h of the culture, the TNF-α in the media was measured by double-antibody sandwich ELISA. The TNF-α (10 ng/mL) and OM of different concentrations were added into the media containing the fibroblasts of the 4th generations from neonate rats. The γ values of cAMP and cGMP in fibroblasts were determined by the radioimmunoassay and the concentrations of cAMP and cGMP were calculated according to standard curve.The intracellular Ca2+ was determined by flow cytometry and cell proliferation was detected by MTT.Our results showed that at the concentrations between 200 μg/mL-1600 μg/mL, OM inhibited the secretion of TNF-α by alveolar macrophages (AM) in a dose-dependent manner. Especially, there were significant differences, to various degrees, in the inhibitory effect of OM between the concentration range of 800 μg/mL-1600 μg/mL and the concentration of 10 ng/mL TNF-α. When compared with 10 ng/mL TNF-α, OM of different concentrations could dose-independently increased the level of intracellular cAMP and decreased the level of cGMP, thereby raising the ratio of cAMP/cGMP and lowering the concentrations of intracellular Ca2+. Moreover, OM of 800 μg/mL had the strongest inhibitory effect on cell proliferation and at this concentration, the cAMP/cGMP was highest and Ca2+was at the lowest level. We are led to conclude that OM can antagonize the damaging effect of quartz on the membrane of AM and the effect of TNF-α promoting the proliferation of fibroblasts. It achieves its inhibitory effect on the promoting effect of TNF-α on fibroblast proliferation by elevating the cAMP level and decreasing the release of Ca2+.

Objective To summarize the experience on clinical diagnosis and treatment for cervical neurilemmoma. Methods The clinical data of 77 cases of cervical neurilemmoma from 1976 to 2005 were retrospectively analyzed. Results The diagnosis was dependent on the anamnesis, clinical presentations, ultrasonography, CT and cytology of fine needle aspiration. Correct preoperative diagnosis was abtained in 51 cases (66. 2% ) , and the misdiagnosis rate was 33. 8% (26/77). All patients underwent surgical resection. The postoperative diagnosis was benign neurilemmoma by pathological examinations. The postoperative complications included recurrent laryngeal nerve injuries (6 cases) , Horner syndrome (4 cases) , tongue deviation (3 cases), neck pain or numbness (2 cases) and reffered pain in limb (1 case). Sixteen patients were followed up, and these symptomes disappeared after 3-11 months. Nerve dysfunction remained in 2 out of 3 patients in whom the vagus was wrongly amputated during the operation. Intraoperative inadvertent sympathetic nerve amputation caused permanent nerve dysfunction. Conclusion B-mode ultrasonography, CT and fine needle aspiration cytology are useful for the diagnosis of cervical neurilemmoma. Surgical resection is most effective among all available therapies.