Analysis of stone composition and clinical characteristics of urinary calculi in infants in Xinjiang / 国际外科学杂志

Objective:To analyze the composition and clinical characteristics of urinary calculi in infants in Xinjiang.Methods:The clinical data of 75 infants with urinary calculi admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2021 were retrospectively analyzed, including the general situation of the children, stone-related parameters, random urine pH value, urine culture and biochemical examination results. The serum uric acid, serum calcium, urine pH value, positive rate of urine culture, and stone length between infants with and without ammonium urate stones were compared. Measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for inter-group comparison. Measurement data that did not conform to the normal distribution were expressed as the median (interquartile distance) [ M ( Q1, Q3)], and Mann-Whitney U test was used for comparison between groups. The Chi-square test, continuity-corrected Chi-square test or Fisher exact probability method were used for the comparison of count data. Results:The median age of infants with urinary calculi was 23.04 months, and the ratio of male to female was 3.2∶1. More than half of the infants (81.3%, 61/75) came from rural areas, 57.3% (43/75) were malnourished, 33.3% (25/75) were complicated with urinary tract infection, and 8.0% (6/75) were combined with urinary system congenital malformation. The calculi were found in 53 cases (70.67%) of kidney, 27 cases (36.0%) of ureter, 17 cases (22.67%) of urethra and 16 cases (21.33%) of bladder. The analysis of calculi composition showed that there were 44 cases (58.67%) of ammonium urate, 39 cases (52.0%) of calcium oxalate, 14 cases (18.67%) of apatite carbonate and 7 cases (9.33%) of uric acid. Kidney calculi was more common in female infants ( P=0.011). Compared with the infant group ( n=19), calcium oxalate stones were more common in the preschooler group ( n=56) ( P=0.039), but there were not statistical difference in the incidence of ammonium urate, apatite carbonate and uric acid stones. There were not statistical difference in gender, age, place of residence, nutritional status, serum uric acid, serum calcium, urine pH value, positive rate of urine culture, stone maximum diameter and incidence of bladder stones between ammonium urate group and non-ammonium urate group. Conclusions:The incidence of urinary calculi in infants is higher in boys, and the most common site of calculi is the upper urinary tract, especially in female kidney calculi. Ammonium urate is the main component of urinary calculi in infants. Calcium oxalate stones are more common in preschooler group. Infants with urinary calculi are mostly rural residents, and malnutrition and urinary tract infection are more common.

A study on the application of Hay and IPE in the position evaluation of functional departments directors at public hospitals / 中华医院管理杂志

Objective:To conduct a position evaluation of functional departments directors by means of Hay guide-chart profile (Hay) and international position evaluation (IPE) for heads of public hospital departments, and a comparative analysis of the results, for reference in reforming the performance-related pay system of the functional departments.Methods:From July to August of 2021, positions of ten functional department directors of a public tertiary general hospital were selected, and expert groups within and out of the hospital were invited for a position evaluation using both Hay and IPE. Cronbach α and intraclass correlation coefficient were used in the reliability and consistency evaluation. Technique for order preference by similarity to ideal solution (TOPSIS) was conducted to compare the differences between results of both methods, with the position value ranked by quartiles. Results:22 position evaluation forms were issued and 20 were recovered (12 for in-hospital experts and 8 for extramural experts). In Hay evaluation, the scores of medical affairs department and hospital head office were higher, averaging 757.30 and 727.21 respectively, and those of logistics management department were the lowest, being 279.94. In-hospital experts scored lower than those extramural experts on the posts of directors of scientific research management department, Party committee office and medical insurance department, while the scores of the directors of the hospital head office were higher than those extramural experts. In IPE evaluation, the position values of hospital head office and medical affairs department were the highest, averaging 680.25 and 621.00 respectively, and the score of the logistics management department was the lowest, being 365.05. In-hospital experts scored lower than those extramural experts on the posts of directors of Party committee office, scientific research management department and logistics management department, while the scores of the directors of the hospital head office were higher than those of extramural experts. The Cronbach α coefficients of position value scoring of functional department heads evaluated by two evaluation methods were 0.943 (Hay) and 0.800 (IPE) respectively. The hospital head office and medical affairs department ranked the first quartile, the Party committee office and nursing department ranked the second, while the medical insurance department and logistics department ranked the third and fourth respectively. In addition, the ranking differences of the information technology department, human resource department, financial department and scientific research management department were within one quartile. Conclusions:The position evaluation results of Hay and IPE are consistent, but the former is more sensitive. Ranking of position values by quartiles via TOPSIS can support the reform of performance-related pay system of functional departments of public hospitals.

A survey of sleep problems and influencing factors among preschoolers / 中国学校卫生

Objective@#To investigate the prevalence of sleep problems and influencing factors among preschoolers, so as to provide a reference for healthy sleep behaviors among preschoolers.@*Methods@#From December 2017 to June 2018, a questionnaires study was administered to parents of 8 456 preschoolers from kindergartens in Yangzhou, Zhenjiang and Xuzhou by using random cluster sampling method. Demographic characteristics, screen time, sleep patterns and the Children s Sleep Habits Questionnaire (CSHQ) were colleted.@*Results@#The average night sleep duration was (9.91±0.64)h, the rate of sleep deprivation was 51.7%, which increased with age ( χ 2 trend =34.19, P <0.01). The total scores of CSHQ were (49.46±5.02), and the prevalence of sleep problems was 95.0%, with the prevalence of specific sleep problems ranged from 2.3% to 76.4%. Multivariate Logistic regression analysis showed that only child, mothers age, parental education, and household economic status was significantly associated the sleep problems ( P <0.05).@*Conclusion@#The prevalence of sleep problems among preschool children is more prominent, varies by only child, parental education and household economic status. Parents and society should raise awareness of sleep problems.

Associations between sugar sweetened beverage intake and emotional and behavioral problems in preschoolers / 中国学校卫生

Objective@#To explore the consumption of sugar sweetened beverages (SSBs) and its association with behavioral problems in Chinese preschool children, and to provide a scientific basis for the prevention of behavioral problems of children.@*Methods@#A total of 7 634 children aged 3-6 years were chosen from kindergartens in 3 cities (Yangzhou, Xuzhou, Zhenjiang) in the lower reaches of Yangtze River using method of cluster sampling during October to November in 2017. Parental or guardian questionnaires were used to obtain information regarding child consumption of SSBs. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children s emotional and behavioral problems. Multivariate Logistic regression model was used to explore the association between different SSBs intake frequency and children s behavioral problems.@*Results@#A total of 5 509(72.2%) consumed SSBs less than once a day, 830(10.9%) reported SSBs consumption once a day, and 1 295(16.9%) had 2 times or more intake of sugar sweetened beverages per day. After adjusting for confounding factors including age, sex, BMI, family financial status, parental education, screen time, sleep duration, and physical activities duration, multiple Logistic regression model revealed that intake of SSBs once a day was associated with an increased risk of hyperactivity disorder ( OR =1.26, 95% CI =1.01-1.57) and SDQ total difficulties ( OR =1.44, 95% CI =1.14-1.82) in boys and with an increased risk of emotional symptoms ( OR=1.34, 95%CI =1.02-1.76), conduct problems ( OR=1.53, 95%CI =1.18-2.00), hyperactivity disorder ( OR=1.79, 95%CI =1.42-2.27) and prosocial behavior ( OR=1.48, 95%CI =1.14-1.91) in girls. Intake of SSBs≥2 times per day was associated with an increased risk of emotional symptoms ( OR=1.28, 95%CI =1.02-1.59) and SDQ difficulties ( OR=1.30, 95%CI =1.07-1.58) in boys and not with behavioral problems in girls.@*Conclusion@#Sex differences are observed with respect to the association between SSBs intake and behavioral problems in preschoolers, but no significant dose response relationship was observed. More longitudinal studies are needed to further explore the association between SSBs intake and behavioral problems in preschool children as well as the underlying physiological mechanisms in future.

Implication of enhanced recovery after surgery in the surgical management of hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) in the clinical management of hypopharyngeal squamous cell carcinoma (HSCC). Methods: In this retrospective study, a total of 168 patients with pyriform sinus carcinoma in Qilu Hospital of Shandong University from January 2015 to January 2019 were divided into two groups, based on the different perioperative interventions that patients received, i.e. the ERAS group (n=64) and the conventional group (n=104), including 164 males and 4 females, whose ages ranged from 42 to 84 years old. The difference between two groups in the operative time, postoperative nutritional status, incidences of postoperative complications and postoperative hospitalization time were compared using the student's t test, Chi-squared test or Fisher's exact test. Results: Compared with the conventional group, patients in the ERAS group had significantly shorter operative time [(166.8±58.2) min vs. (183.3±39.9) min,t=-2.72, P=0.031], higher levels of postoperative serum albumin [(38.3±4.2) μmol/L vs. (36.6±3.3) μmol/L, t=2.73, P=0.007] and more body weight [(65.4±9.4) kg vs. (62.1±9.4) kg, t=2.22, P=0.028], lower incidences of postoperative subcutaneous infection [7.8% (5/64) vs. 20.2% (21/104), χ²=4.64, P=0.03] and severe pneumonia [4.7% (3/64) vs. 15.4% (16/104), χ²=4.52, P=0.03], and shorter postoperative hospitalization time [(16.5±3.9) d vs. (18.2±4.3) d, t=-2.65, P<0.05]. Conclusion: ERAS is effective and safe in the surgical management of HSCC, with benefits in reducing the operative stress via saving operation time, shortening the hospitalization time, ameliorating nutritional status and decreasing the incidences of complications.

Rapidliver autotransplantation by magnetic anastomotic technique during ex situ liver resection in an animal model / 中华器官移植杂志

Objective:To invent a set of novel magnetic anastomotic device based upon the technique of magnetic compression anastomosis(MCA)for rapid venous reconstruction during ex situ liver resection, and verify its clinical value and performance in animal models. Methods:Fiften adult mongrel dogs of either gender underwent the ex situ liver resection. The novel magnetic vessel anastomosis device for the venous reconstruction of liver autotransplantation procedure was performed on 8 mongrel dogs(MCA group), and the traditional handsewing technique was used on 5 additional dogs(THS group). Time for completing venous reconstruction and time of venous anastomosis, venous velocity, intraoperative and postoperative survival and complications were recorded. Patency was detected via color Doppler ultrasound scans and X-ray cholangiography after surgery. The changes of intestinal lumen and kidney were also observed. Results:The time required to perform IVC and PV reconstruction for liver autotransplantation was significantly shorter for the magnetic vessel anastomosis device(9.5±2.5) min than for THS(30.7±3.4) min. There was significant difference in anhepatic period( P=0.0000). After operation, except one died, other nine animals in group A survived after operation but all five cases died in the THS group during liver autotransplantation. Vascular X-ray angiography and color Doppler ultrasound found blood flow MCA group normal, and there wasn't stoma stenosis. Conclusions:MCA technique could be fast and efficacious to complete venous reconstruction for liver autotransplantation in ex situ liver resection operation, and helpful to reduce organ ischemia-reperfusion injury.

Establishment and validation of a nomogram prediction model for early preoperative diagnosis of hepatocellular carcinoma with microvascular invasion / 中华肝胆外科杂志

Objective:To establish a convenient preoperative nomogram prediction model for early diagnosis of hepatocellular carcinoma (HCC)with microvascular invasion (MVI), and to evaluate the model through internal and external validations for use informulating reasonable and individualized treatment strategies for patients with early-staged HCC.Methods:The clinical data of 294 patients who underwent hepatectomy at the General Hospital of Ningxia Medical University from January 2017 to December 2020 were retrospectively collected and analyzed. Based on the different admission times, they were divided into the training group ( n=231) and the validation group ( n=63). Based on the results from previous published literatures and our relevant clinical experience, risk factors including γ-glutamyltranspeptidase (GGT), platelet-lymphocyte ratio (PLR), fibrinogen albumin ratio (FAR), lymphocyte monocyte count ratio (LMR) and ALT-platelet ratio (APRI) were subjected to multi-factor logistic regression analysis to determine independent risk factors of HCC with MVI, and a nomogram prediction model was then constructed. The validation group was applied to the model for validation. Results:Of 294 patients who were enrolled in this study, there were 231 patients in the training cohort, with an average age of (55.1±10.9) years. In the training group, 95 patients were MVI positive and 136 patients were MVI negative. In the validation group, 38 patients were MVI positive and 25 patients were MVI negative. Logistic regression analysis showed that FAR>0.06, GGT>50 U/L, APRI>0.16, tumor diameter>5 cm, LMR>3.57 and PLR>98.75 were independent risk factors ( P<0.05), and a nomogram prediction model was established. The correction curve of the nomogram showed that the actual prediction result was close to the ideal result of the prediction model. The internal validated results showed the C-indexes to be between 0.71 and 0.90, and the prediction model had good discrimination. DCA curve was used to evaluate the clinical net benefit of the predictive model. When the net benefit rate was above zero, the threshold of the prediction model was 4%-77%, indicating that the prediction model had good clinical practicability. Conclusion:The established nomogram prediction model based on preoperative clinical indexes of GGT, APRI, LMR, PLR, FAR and diameter of tumor could be used to predict early diagnosis of HCC with MVI. The nomogram has good clinical application values.

Research on the commonalities and characteristics of provincial-level performance appraisal plan for tertiary public hospitals / 中华医院管理杂志

Objective:To understand the commonalities and characteristics of provincial-level performance appraisal plan of tertiary public hospitals, and to provide reference for improving and promoting their performances.Methods:The provincial plans introduced from January 31, 2019 to March 31, 2020 matched with the performance appraisal of the national tertiary public hospitals were retrieved through portal websites of the provincial people′s government and health commission, and 19 programs supplemented with local indicators on the basis of the National assessment index were selected as the research objects. The key information such as release time, issuing authority, evaluation object, implementation subject and index system of the plans were extracted, and content analysis method was used to analyze the characteristics and commonalities.Results:Ten out of 19 plans were released during June to July of 2019, and 12 plans were issued by the general office of the provincial people′s government, and the main body of assessment was the provincial-level health commission. Two first-level indicators of Party building and social benefits were added. The supplement of second-level indicators mainly focused on mandatory tasks, quality and safety, primary-level organization construction, service process and moral culture construction. A total of 241 third-level indicators were added, of which qualitative indicators accounted for 65.15%(157 indicators). The top five provinces with the most supplementary indicators were Guizhou, Jilin, Heilongjiang, Liaoning and Zhejiang. Seven provincial-level regions of Shanghai, Ningxia, Guangxi, Qinghai, Guizhou, Anhui and Yunnan clarified the grading standards and methods for performance appraisal results.Conclusions:The supplementary indicators of provincial-level performance appraisal plans for tertiary public hospitals focus on social benefits, Party building, and quality of medical care. The proportion of qualitative indicators is high, the classification of assessment objects is not clear enough, the characteristics of localized supplementary indicators are obvious, and the grading and result of performance appraisal index need to be optimized.

Rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis technique / 器官移植

Objective To explore the feasibility of rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models using magnetic compression anastomosis (MCA) technique. Methods Twelve healthy adult crossbred dogs were evenly divided into the MCA and hand suturing (HS) groups according to the anastomosis method between abdominal aorta and artificial blood vessels. The intraoperative duration of abdominal aorta occlusion, intraoperative condition of anastomotic stoma and postoperative imaging examination of anastomotic stoma were compared between two groups. Results The intraoperative duration of abdominal aorta occlusion in the MCA group was significantly shorter than that in the HS group [(5.2±2.3) min vs. (24.4±4.3) min, P < 0.001]. No anastomotic leakage of blood or anastomotic stenosis occurred in the MCA group during the operation. Intraoperative anastomotic leakage of blood occurred in all of the 6 dogs in the HS group. Among them, 1 dog died of excessive blood loss, and 2 dogs experienced mild anastomotic stenosis due to repeated repair. Postoperative color Doppler ultrasound and angiography showed smooth blood flow at the anastomotic stoma without stenosis or thrombosis in the MCA group. In the HS group, 4 dogs presented with anastomotic stenosis on angiography at postoperative 4 weeks. Conclusions MCA technique may achieve rapid and sutureless anastomosis of artificial vascular replacement of abdominal aorta in dog models, which reduces the incidence of anastomotic complications and accelerates postoperative recovery.

Association between screen time and psychology behaviors of preschool children / 中国学校卫生

Objective@#To explore the correlation between screen time, exposure time to different screens and psychology behaviors of preschool children.@*Methods@#A total of 2 582 children from kindergartens in urban Xuzhou areas were recruited to perform the physical examination, a cluster sampling method being explored. Parent questionnaires were performed to understand the time of screens and children’s psychology behaviors. Multi-linear regression and Logistic regression models were also used to analyze the correlation between them in preschool children.@*Results@#The prevalence of abnormal internalization behavior of preschool children in Xuzhou City was 3.8%, the detection rate of abnormal externalization behavior was 22.4%, and the detection rate of prosocial behavior abnormality was 20.9%. The time spent by the preschool boys on TV time, learning day screen time and one-week video time is significantly higher than the girls (P<0.05). After adjusting for age and gender, the results of multiple linear regression analysis showed that the longer the average screen time, the more serious the problem of internalizing and externalizing problems; and the longer the average screen time of the weekend and the week, the worse the prosocial behavior of children (P<0.05). After correcting multiple covariates, it was found that the average screen time was positively correlated with children’s internal and external behavioral problems (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the average screen time of study day, weekend and week was a risk factor for preschool children’s internal and external behavior problems, and the average weekly screen time was a protective factor for prosocial behavior (P<0.05). After adjusting for multiple covariates, the learning day and the average weekly screen time were risk factors for children’s internal and external behavior (P<0.05). In addition, the results of association analysis between different types of video time exposure and psychological behavior showed that after adjusting for age and gender, all types of video exposures affected the internal and external behaviors of patients (P<0.05); after correcting multiple covariates The association was still statistically significant (P<0.05). Logistic regression analysis showed that after adjusting for age and gender, the exposure time of each type of video screen was a risk factor for children’s internal and external behavior problems (P<0.05). After correcting multiple covariates, all types of video exposure were internalized behavior problems. The risk factors, and the video time of other electronic products were risk factors for externalization behavior problems (P<0.05).@*Conclusion@#Average screen time has a significant positive correlation with psychological behavior, and the exposure time of screens such as TV and mobile phone could increase the incidence of psychological behaviors in preschool children.

Analysis of medical service efficiency of clinical departments based on data envelopment analysis-BCC model / 中华医院管理杂志

Objective:To analyze the output efficiency of medical services in clinical departments, so as to provide a breakthrough point for rational allocation of resources and improvement of service efficiency.Methods:The classic BCC model of data envelopment analysis(DEA) was used to evaluate the medical service efficiency of 44 clinical departments in a hospital, and the comprehensive efficiency, pure technical efficiency, scale efficiency and scale benefits were analyzed. The input indicators were the number of medical staff, medical costs and the number of beds at the end of the period. The output indicators were diagnosis-related group(DRG) indicators, including the number of DRG groups, total weight, case mix index, cost consumption index, time consumption index and mortality rate of low-risk group.Results:The average values of comprehensive efficiency, pure technical efficiency and scale efficiency of the whole hospital in 2018 were 0.897, 0.920 and 0.975 respectively. DEA was relatively effective in 16 departments(36%), weakly effective in 7 departments(16%), and ineffective in 21 departments(48%). In the case of constant output, the redundancy rates of the actual beds, medical staff and medical business expenditure of non DEA effective departments were 17.3%, 20.3% and 17.1% respectively; under the same input, the output of non DEA effective departments was insufficient.Conclusions:The comprehensive efficiency of medical services in this hospital is ideal, but the proportion of non DEA effective departments is relatively high. It is suggested to improve the efficiency of medical services by optimizing resource input, strengthening discipline construction, and strengthening cost control.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective@#To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years).@*Methods@#From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared.@*Results@#In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit drop was 0.026±0.029(range 0-0.135), totally tubeless rate was 86.4%(71/81), mean hospital stay was (2.5±0.9)days(range 1-5 days). Complications were observed in 9 cases and classified using Calvien grading system, Grade Ⅰ in 8 cases: postoperative fever in 4, hematuresis in 1, perirenal hematoma, postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, massive ascites was discovered during the surgery, and rcovered by puncture drainage.In adult group, mean operative time was (31.2±15.3)min(range 7-80 min), SFR and SFR at 1 month were 97.2%(69/71) and 98.6%(70/71), mean hemoglobin drop was (11.9±8.7)g/L(range 0-32 g/L), mean hematocrit drop was 0.030±0.027(range 0-0.106), totally tubeless rate was 87.3%(62/71), mean hospital stay was(2.4±1.1)days(range 1-8 days), urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). Complications were observed in 4 cases, Grade Ⅰ in 3 cases: hematuresis in 2 and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy. According to data about Hb drop, risk of hemorrhage is lower in children than adult significantly(P<0.05). There is not significant difference in stone free rate, stone size, operative time, hematocrit drop, surgery complications, totally tubeless rate, stone complexity, average length of hospital stay and urinary infection(P>0.05).@*Conclusions@#With the characteristics of safe, efficacious and rapid recovery, super-mini-percutaneous nephrolithotomy(SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children (＜ 14years).Methods From May 2015 to July 2018,81 cases of children(53％) and 71 (47％) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance.In the group of children,it's including 53 male and 28 female with 85 channels in total,the patients age ranged from 10 months to 14 years,[mean (56.0 ± 39.7) months],The stone size ranged from 0.8-3.5 cm,[mean (1.7 ± 0.7) cm].About stone distribution,42 cases of pelvic stones,25 cases of calyceal and pelvic stones,5 cases of calyceal stones,7 cases of upper uretaral stones,1 case of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 86.4％ (70/81),positive rate of urinary culture was 39.5％ (32/81).In the group of adults,it's including 43 male and 28 female,the patients aged from 18 to 81 years,[mean (44.1 ± 15.4) years],The stone size ranged from 1.0-3.0 cm,[mean (1.7 ± 0.6) cm].About Stone distribution,19 cases of pelvic stones,13 cases of calyceal and pelvic stones,7 cases of calyceal stones,24 cases of upper uretaral stones,3 cases of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 87.3％ (62/71),positive rate of urinary culture was 26.8％ (19/71).The patient was placed in the lithotomy position under general anesthesia.A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder.The patient was then turned prone.The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system.Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F).After the corresponding size of suction-evacuation sheath was placed,the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector.The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter.Stone free rate after surgery at lday(SFR) and 1 month(1 month SFR),stone size,operative time(from starting fragmentation to the end of the surgery),hemoglobin drop and hematocrit drop in the first day after surgery,rate of surgecal complications,tubeless rate (totally tubless:no ureteric stent and nephrostomy tube;tubeless:no nephrostomy tube but ureteric stent),average length of hospital stay and urinary infection were recorded and compared.Results In children group,mean operative time was (27.7 ± 13.0)min(range 5-60 min),SFR and SFR at 1 month were 96.3％ (78/81)and 98.8％ (80/81),mean hemoglobin drop was (8.0 ± 9.1) g/L(range 0-41 g/L),mean hematocrit drop was 0.026 ±0.029(range 0-0.135),totally tubeless rate was 86.4％ (71/81),mean hospital stay was (2.5 ±0.9)days(range 1-5 days).Complications were observed in 9 cases and classified using Calvien grading system,Grade Ⅰ in 8 cases:postoperative fever in 4,hematuresis in 1,perirenal hematoma,postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,massive ascites was discovered during the surgery,and rcovered by puncture drainage.In adult group,mean operative time was (31.2 ± 15.3) min(range 7-80 min),SFR and SFR at 1 month were 97.2％ (69/71) and 98.6％ (70/71),mean hemoglobin drop was (11.9 ± 8.7) g/L (range 0-32 g/L),mean hematocrit drop was 0.030 ± 0.027 (range 0-0.106),totally tubeless rate was 87.3％ (62/71),mean hospital stay was (2.4 ± 1.1) days (range 1-8 days),urinary infection rate was 87.3％ (62./71),positive rate of urinary culture was 26.8％ (19/71).Complications were observed in 4 cases,Grade Ⅰ in 3 cases:hematuresis in 2 and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy.According to data about Hb drop,risk of hemorrhage is lower in children than adult significantly (P ＜ 0.05).There is not significant difference in stone free rate,stone size,operative time,hematocrit drop,surgery complications,totally tubeless rate,stone complexity,average length of hospital stay and urinary infection (P ＞ 0.05).Conclusions With the characteristics of safe,efficacious and rapid recovery,super-mini-percutaneous nephrolithotomy (SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Sleep quality in preschool children in three provinces along the middle and lower reaches of the Yangtze River / 中国学校卫生

Objective@#To analyze the detection rate of sleep problems such as sleep delay and deficiency in preschool children in the middle and lower reaches of the Yangtze River in China,and to provide the reference for the standard of sleeping mode among preschool students.@*Methods@#From October to November 2017, a questionnaire survey was conducted among 27 200 preschool children in 11 cities in Hubei, Anhui and Jiangsu provinces in the middle and lower reaches of the Yangtze River in China. Epidemiology of sleep delays, deficiencies and sleep patterns in preschool children was described.@*Results@#The detection rate of sleep problems in preschool children in the middle and lower reaches of the Yangtze River was 15.3%. Taking the length of sleep and bedtime as the main analysis points, it was found that the average sleeping time point of each age group was 21:31, and the detection rate of bedtime delay was 86.5%. The average length of sleep was (10.60±1.12) hours. The detection rate of sleep deprivation in preschool children was 15.7%. Sleep delay was positively correlated with girls, age increase and parents’ higher educational level (P<0.05), and negatively correlated with living in the city, non-only child and bedroom without TV (P<0.01) .The detection rate of sleep deprivation was positively correlated with children of high age group (4yearold group：OR=1.32，95%CI=1.19-1.46；5-year-old group：OR=2.10，95%CI=1.91-2.32；6-year-old group：OR=2.47，95%CI=2.20-2.77)(P<0.01), and negatively correlated with no TV in bedroom (OR=0.91，95%CI=0.84-0.98) and no light in sleep (OR=0.87，95%CI=0.78-0.97)(P<0.05).@*Conclusion@#Preschool children sleep delay and sleep deprivation and other sleep problems are more prominent, affected by family environment and other factors.

Clinical effects of Safflor Yellow Sodium Chloride Injection combined with Compound Anisodine Injection on patients with NPDR / 中成药

AIM To observe the therapeutic effects of Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection on patients with non-proliferative diabetic retinopathy (NPDR).METHODS Sixty-eight pa-tients (102 eyes) were randomly divided into control group (32 cases,48 eyes) and observation group (36 cases,54 eyes).The observation group was given Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection in addition to conventional therapy administered to the control group,and yet patients of both groups had their changes of vision,fundus hemorrhage,effusion,microaneurysm and central macular thickness checked and compared before and after the treatment.RESULTS The observation group displayed better post-treatment vision recovery,fundus improvement and central macular thickness control than the control group (P ＜ 0.05,P ＜ 0.01).CONCLUSION The combination therapy of Safflor Yellow Sodium Chloride Injection and Compound Anisodine Injection can be an appropriate option for NPDR patients to improve vision and slow progression.

Pharmacokinetics Comparison of Baicalin between Traditional Slice Decoction and Dispensing Granule De-coction of Huanglianjiedu Decoction / 中国药师

Objective:To compare the pharmacokinetics consistence of baicalin between traditional slice decoction and dispensing granule decoction of Huanglianjiedu decoction. Methods:After the gastric administration of the two decoctions at low, middle and high dose in rats, an HPLC method was used to detect the content of baicalin in the plasma, and then DASS 2. 1. 1 software was used to cal-culate the pharmacokinetic parameters. Results:After the administration of the two decoctions at low, middle and high dose, the phar-macokinetic parameters were as follows:Cmax of 0. 25 and 0. 27μg·ml-1 ,0. 30 and 0. 31 μg·ml-1 ,0. 40 and 0. 45 μg·ml-1;AUC of 2. 48 and 2. 59μg·ml-1 ·h,3. 59 and 3. 71μg·ml-1 ·h,5. 71 and 6. 16μg·ml-1 ·h;Tmax of 3. 0 and 3. 0 h,3. 0 and 3. 0 h, 4.0 and 4.0 h;Vd of (2 822.4 ±118.2) and (2 998.9 ±255.6) L·kg-1,(3 102.6 ±176.3) and (3 405.3 ±213.8) L·kg-1, (4 231.2 ±155.4) and (4 486.0 ±187.0) L·kg-1;CL of (2 923.3 ±215.6) and (2 767.5 ±184.6)L·h-1·kg-1,(4 921.7 ± 225.4) and (4 040.8 ±246.7)L·h-1·kg-1,(5 255.9 ±189.7) and (4 868.7 ±260.4)L·h-1·kg-1;and t1/2 of (3.88 ± 0.41) and (3.71 ±0.37)h,(4.19 ±0.36) and (3.73 ±0.51)h, (5.54 ±0.38) and (5.80 ±0.54)h. Conclusion: The pharma-cokinetic parameters of baicalin have no significant difference between traditional slice decoction and dispensing granule decoction of Huanglianjiedu decoction.

Rapid Veno-venous bypass by magnetic anastomosis technique in ex situ liver resection animal model / 中华肝胆外科杂志

Objective To invent a set of novel veno-venous bypass (VVB) device based on magnetic anastomosis technique which can be used in ex situ liver resection, and verify its clinical value and performance in animal models.Methods Each VVB device was constructed using three magnetic rings and an inverted Y-shaped tube with magnetic rings on each end.The magnetic ring was made of NdFeB with electrode cutting, and the tube was made of polyvinyl chloride (PVC) and preconditioned with heparin coating on the surface of the lumen.Ten dogs underwent the ex situ liver resection, and VVB was established via magnetic anastomosis technique with the novel VVB device during the operation.The time for completing VVB was recorded, and the hemodynamic indexes including the venous flow velocity, carotid pressure, central venous pressure and portal pressure was detected.The changes of intestinal lumen and kidney were also observed.Results It only took 6 ～ 10 minutes to establish VVB by the novel VVB device in the operation,and the hemodynamics stability was maintained smoothly during the anheptic phase.The shunt index of inferior vena cava and portal vein was 76.2％ and 75.5％, respectively.The congestion of intestinal canal and kidney were also alleviated during the anheptic phase.Conclusions It could reduce the time to establish VVB with magnetic anastomosis technique in ex situ liver resection.This study showed that utilizing the novel VVB device for intraabdominal VVB during the anheptic phase could be helpful to maintain the hemodynamics stability.

Recombinant Human Granulocyte Colony-Stimulating Factor Promotes Preinvasive and Invasive Estrogen Receptor-Positive Tumor Development in MMTV-erbB2 Mice / 한국유방암학회지

PURPOSE: We investigated whether recombinant human granulocyte colony-stimulating factor (rhG-CSF) could promote the development of preinvasive and invasive breast cancer in mouse mammary tumor virus (MMTV-erbB2) mice with estrogen receptor-positive tumors. METHODS: MMTV-erbB2 mice were randomly divided into three experimental groups with 20 mice in each group. MMTV-erbB2 mice were treated with daily subcutaneous injections of vehicle or rhG-CSF (low-rhG-CSF group, rhG-CSF 0.125 microg; vehicle-rhG-CSF group, normal saline 0.25 microg; and high-rhG-CSF group, rhG-CSF 0.25 microg) at 3 months of age. Cellular and molecular mechanisms of G-CSF action in mammary glands were investigated via immunohistochemistry and reverse transcription polymerase chain reaction. RESULTS: Low, but not high, rhG-CSF doses significantly accelerated mammary tumorigenesis in MMTV-erbB2 mice. Short-term treatment with rhG-CSF could significantly promote the development of preinvasive mammary lesions. The cancer prevention effect was associated with reduced expression of proliferating cell nuclear antigen, cluster of differentiation 34, and signal transducers and activators of transcription 3 in mammary glands by >80%. CONCLUSION: We found that G-CSF was regulated by rhG-CSF both in vitro and in vivo. Identification of G-CSF genes helped us further understand the mechanism by which G-CSF promotes cancer. Low doses of rhG-CSF could significantly increase tumor latency and increase tumor multiplicity and burden. Moreover, rhG-CSF effectively promotes development of both malignant and premalignant mammary lesions in MMTV-erbB2 mice.

Analysis on Mechanism of Over-diagnosis and Over-treatment Problem Formation in Public Hospitals of China / 中国卫生经济

According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Protective role of triptolide in a rat model of antibody-mediated rejection in kidney transplantation / 中华器官移植杂志

Objective To investigate the protective effect and the mechanisms of triptolide on antibody-mediated rejection (AMR) in kidney transplantation.Method A rat model of AMR in kidney transplantation was constructed by sensitizing major histocompability complex (MHC) completely incompatible species of rats via blood transfusion before kidney transplantation.The protective effect of Triptolide on the renal function and pathologic injury was studied in this rat model.The levels of donor specific antibodies were measured by flow cytometry.C4d expression and macrophage infiltration were examined by immunohistochemistry and immunofluorescence.Result Triptolide could improve the function of transplanted kidney significantly (P＜0.05) and alleviate the pathologic injury.Triptolide can also reduce the levels of IgM,IgG2b and IgG2c in the serum of the recipient rats and inhibit the macrophage infiltration as well (P＜0.05).Conclusion Triptolide plays protective and therapeutic roles in AMR of kidney transplantation,which may be contributed to the inhibition of the production of donor specific antibody and the macrophage infiltration.