【Objective】 To evaluate the safety and efficacy of modified ultrasound-guided needle-like visible nephroscope (Needle perc) holmium laser lithotripsy in the treatment of 1-2 cm calyceal calculi, and provide a reference for the selection of clinical treatment methods. 【Methods】 The clinical data of 60 patients with single intrarenal calyceal calculi (the largest diameter 1~2 cm) treated in our hospital during Jan.2022 and May 2023 were retrospectively analyzed.The patients were divided into ureteroscopic holmium laser lithotripsy group (flexible ureteroscope group) and Needle perc group, with 30 patients in either group.The clinical data of the two groups were compared. 【Results】 Compared with the flexible ureteroscope group, the Needle perc group had shorter overall hospitalization time [(3.00±1.25) d vs. (4.00±1.25) d], shorter operation time [(44.63±5.42) min vs. (48.50±7.24) min], lower hospitalization expenses [(15 518±441) yuan vs. (16 872±903) yuan], higher stone-clearance rate [93.3% (28/30) vs. 50.7% (15/30), P<0.001], less increase of procalcitonin after operation [(0.02±0.01) vs. (0.12±0.18), P=0.007], and lower incidence of complications [3.3% (1/30) vs. 26.7% (8/30), P=0.030]. 【Conclusion】 The modified ultrasound-guided Needle perc holmium laser lithotripsy is safe and effective in the treatment of 1-2 cm lower calyceal calculi, with high stone removal rate and low complication rate.

OBJECTIVE: To explore the role of endoplasmic reticulum ryanodine receptor 1 (RyR1) expression and phosphorylation in sepsis- induced diaphragm dysfunction. METHODS: Thirty SPF male SD rats were randomized equally into 5 groups, including a sham-operated group, 3 sepsis model groups observed at 6, 12, or 24 h following cecal ligation and perforation (CLP; CLP-6h, CLP-12h, and CLP-24h groups, respectively), and a CLP-24h group with a single intraperitoneal injection of KN- 93 immediately after the operation (CLP-24h+KN-93 group). At the indicated time points, diaphragm samples were collected for measurement of compound muscle action potential (CMAP), fatigue index of the isolated diaphragm and fitted frequencycontraction curves. The protein expression levels of CaMK Ⅱ, RyR1 and P-RyR1 in the diaphragm were detected using Western blotting. RESULTS: In the rat models of sepsis, the amplitude of diaphragm CMAP decreased and its duration increased with time following CLP, and the changes were the most obvious at 24 h and significantly attenuated by KN-93 treatment (P < 0.05). The diaphragm fatigue index increased progressively following CLP (P < 0.05) irrespective of KN- 93 treatment (P>0.05). The frequency-contraction curve of the diaphragm muscle decreased progressively following CLP, and was significantly lower in CLP-24 h group than in CLP-24 h+KN-93 group (P < 0.05). Compared with that in the sham-operated group, RyR1 expression level in the diaphragm was significantly lowered at 24 h (P < 0.05) but not at 6 or 12 following CLP, irrespective of KN-93 treatment; The expression level of P-RyR1 increased gradually with time after CLP, and was significantly lowered by KN-93 treatment at 24 h following CLP (P < 0.05). The expression level of CaMKⅡ increased significantly at 24 h following CLP, and was obviously lowered by KN-93 treatment (P < 0.05). CONCLUSION Sepsis causes diaphragmatic dysfunction by enhancing CaMK Ⅱ expression and RyR1 receptor phosphorylation in the endoplasmic reticulum of the diaphragm.
Rats ; Male ; Animals ; Diaphragm/metabolism* ; Ryanodine Receptor Calcium Release Channel/metabolism* ; Rats, Sprague-Dawley ; Phosphorylation ; Muscle Contraction/physiology* ; Endoplasmic Reticulum ; Sepsis/metabolism*

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Objective:To explore the efficacy of the combination of radiofrequency ablation(RFA) and endoscopic metal stent in the treatment of patients with unresectable cholangiocarcinoma.Methods:From January 3, 2012 to June 30, 2019, at the Department of Endoscopic of the Third Affiliated Hospital of Naval Medical University, the clinical data of 44 patients with unresectable cholangiocarcinoma who were treated by the combination of RFA and endoscopic metal stent were retrospectively collected, which included age, gender, location of cholangiocarcinoma(hilar cholangiocarcinoma and distal cholangiocarcinoma), etc. Postoperative evaluation was conducted based on the follow-up, including clinical success rate, postoperative complication rate, time of stent patency and overall survival time (OS). The Kaplan-Meier method and log-rank test were used to analyze the difference of OS between patients with hilar cholangiocarcinoma and distal cholangiocarcinoma. Mann-Whitney U test was used for statistical analysis. Results:The age of the 44 patients with cholangiocarcinoma was (70.3±11.6) years old, with 20 males (45.5%). There were 22 patients (50.0%) with hilar cholangiocarcinoma and 22 patients (50.0%) with distal cholangiocarcinoma. The clinical success rate of 44 patients was 93.2%(41/44). A total of 5 patients(11.4%) had postoperative complications, which were all improved by appropriate treatment. The median time of follow-up of the 44 patient was 9.2 months(ranged from 3.1 to 57.6 months), the median time of stent patency was 7.0 months (ranged from 5.8 to 8.2 months). Thirty-two patients (72.7%) died during the follow-up, and the median OS was 10.9 months(ranged from 9.0 to 12.8 months). The median OS of patients with hilar cholangiocarcinoma was 7.8 months(ranged from 4.6 to 11.0 months) and that of patients with distal cholangiocarcinoma was 12.5 months(ranged from 5.7 to 19.4 months), and there was no statistically significant difference( P>0.05). Conclusion:RFA combined with endoscopic metal stent is safe and effective in the treatment of patients with unresectable cholangiocarcinoma.

A case of hemolytic disease of the newborn (HDFN) caused by immunoglobulin (Ig) G anti-E was analyzed in this study. The ABO and Rh blood group of the newborn was O and CcDEe, respectively. The ABO and Rh blood group of her mother was A and CCDee, respectively. Thus, the reason of ABO and RhD hemolysis were impossible. The incompatible antibodies were found in the newborn serum by three serological tests. The antibody screening and identification test using the plasma and the red blood cell eluate from the newborn and the plasma from her mother showed that the HDFN was caused by the IgG anti-E antibodies. The case was caused by failing to prenatal screening for irregular antibodies. Therefore, the prenatal screening for irregular antibodies seems necessary for pregnant women to prevent, diagnose or manage the HDFN at an early time, reducing the occurrence of perinatal complications.

Objective:Since December 2019, novel coronavirus infection has occurred in Hubei province and spread throughout the country quickly. This new crown viral pneumonia was named as coronavirus disease of 2019 (COVID-19) by WHO. However, at present, there is a high incidence of acute aortic dissection in winter and spring. How to prevent the spread of the epidemic and choose the appropriate treatment is an important topic for the patients with acute aortic dissection.Methods:From January 16, 2020 to February 26, 2020, a total of 37 of acute aortic dissection operations were carried out in several cardiovascular surgery centers in Hubei Province. There were 18 cases of Stanford type A aortic dissection and 19 cases of Stanford type B aortic dissection. There were 10 cases (55.55%) with ascending aorta replacement and 7 cases (38.89%) with Bentall procedure for aortic root surgery, and total arch replacement with stented elephant trunk implantation were performed in 14 cases (77.8%). In 19 patients with Stanford type B aortic dissection, thoracic endovascular aortic repair was performed, with the left subclavian artery chimney technique in 2 cases.Results:No deaths occurred within 30 days of hospitalization. Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection, and 3 suspected cases underwent emergency surgery. the three-level protective standard was adopted in the majority of the surgeries(62.2%, 23/37), and 11 patients were negative in the reexamination of viral nucleic acid after the operation.Conclusion:During the epidemic period, patients with acute aortic dissection should be carefully identified with actife COVID-19 before surgery. The treatment principles-" prevention and control of pneumonia epidemic should be emphasized, conservative medical management should be taken in the comfirmed cases, the selective operation should be delayed as far as possible, and the operation should be reasonable performed in critical cases" should be followed, which can save patients' lives to the greatest extent and prevent the spread of the virus.

Objective To investigate the prevalence and possible factors of hypouricemia in Peking Union Medical College Hospital.Methods A retrospective investigation.Serum uric acid, lipids, glucose and other chemistry tests were analyzed among 83176 outpatients(Male:30795,Female:52381), 15849 inpatients(Male:7402,Female:8447)and 24081 healthy subjects(Male:11859,Female:12222)in Peking Union Medical College Hospital from December 2015 to April 2016.Grouped by gender and age, the prevalence of hypouricemiawas analyzed in all subjects and the etiology and possible risk factors of hypouricemia were explored among all patients.Results The serum uric acid of outpatients,inpatients and healthy subjects were 286(235-348)μmol/L, 282(226-348)μmol/L and 298(244-358)μmol/L, respectively.And the prevalence were 0.6%(499/83176),2.5%(390/15849)and 0.2%(39/24081), respectively.The prevalence of hypouricemia ofwomen was significantly higher than that ofmen(outpatients:0.7%vs 0.4%,P<0.001;inpatients:2.8%vs 2.1%,P=0.004;healthy subjects:0.30%vs 0.04%, P<0.001).After analyzing 507 hypouricemia patients, the top three clinical diagnoses that related with hypouricemia were kidney diseases, tumor and rheumatic diseases.Compared with the control group, the prevalence of hypouricemia in hypertriglyceridemia group and group with eGFR higher than 90 ml/(min· 1.73 m2)were lower(OR:0.33, 95% CI:0.21-0.50; OR:0.16, 95% CI:0.09-0.29), and the prevalence of hypouricemia in hyperglycemia group was higher(OR:1.62, 95% CI:1.12-2.35). Conclusion The prevalence of hypouricemia of Chinese women was higher than that of men and may be related with TG,Glu and eGFR.

Objective To understand the utilization of spare time among medical college freshmen at different academic levels and to explore the factors that affect undergraduates' utilization of spare time and their solutions.Methods The questionnaire is designed by myself,including after-school time planning,arrangement purpose,arrangement content and time allocation,etc.392 freshmen with three different educational levels were selected by cluster sampling.The questionnaires were issued and recovered in anonymous way.Data was recorded and collated by EpiData software,and descriptive analysis and chisquare test was used by SPSS 19.0.Results There are basic or frequent arrangements in spare time for 40.5％ (155 people) of medical students.For 61.5％ (236 people) of medical students,relaxation is the purpose in arranging their activity in spare time.Medical students who surf the Internet,read books and sleep in spare time account for 28.7％ (110 people),28.5％ (109 people) and 22.3％ (85 people) respectively.60.5％ (232 people) of medical students chat and play games on the Internet.There are significant differences among the three groups of different academic levels in the purposes of arrangements,activity contents,internet surfing time and attitude of part-time job (P＜0.05).Conclusion There are deficiencies in the utilization of spare time among medical college freshmen,and different academic levels are probably one of the influential factors that affect college students' utilization of spare time.

Objective: To elucidate the effect of taurine on neurotoxicity induced by Mn by investigating cell cycle and apoptosis in manganese exposed rats. Methods: 156 healthy male SD rats were randomly divided into 1 control group, 3 manganese exposure groups (10, 15, and 20 mg/kg respectively) , and 9 intervened groups based on orthogonal design, with 12 rats in each group. After 12 weeks of exposure, all rats were decapitated and striatums were removed, cell cycle was analyzed by flow cytometry, the apoptosis was detected by TUNEL, level of Mn was determined. Results: The striatum apoptosis index of the 3 dose groups exposed to Mn were significantly higher than control group (P<0.05) . The striatum apoptosis index of the 9 intervened groups were significantly higher than control group (P<0.05) . 150 and 200 mg/kg of taurine could decrease apoptosis index of the group exposed to 10、15、20 mg/kg of Mn (P<0.05) . The striatum Mn content of the 3 dose groups exposed to Mn were significantly higher than that of the control group (P<0.05) . The G0/G1 proportion of the 3 dose groups exposed to Mn were significantly lower than that of the control group (P<0.05) , the S proportion of the 3 dose groups exposed to Mn were significantly higher than that of the control group (P<0.05) . Conclusion Mn could cause cell cycle arrest to S, increase level of apoptosis in striatum, to a certain extent, taurine can protect neurons from apoptosis induced by Mn.