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OBJECTIVE: To observe the effects of electroacupuncture at Neiguan (PC6) at different time points on reperfusion arrhythmia (RA) after myocardial ischemia and reperfusion in rats, and to investigate the correlation of this protective effect with nerve growth factor (NGF), tyrosine kinase A (TrkA), tyrosine hydroxylase (TH), and norepinephrine (NE). METHODS：A total of 72 Sprague-Dawley male rats were randomly divided into six groups (n = 12 rats/group): normal group (Norm), sham operation group (Sham), ischemia reperfusion group (I/R), pre-ischemic electroacupuncture group (EAI), pre-reperfusion electroacupuncture group (EAII), post-reperfusion electroacupuncture group (EAIII). The myocardial ischemia-reperfusion injury (MIRI) model was induced by occlusion of left anterior descending coronary artery for 20 min followed by reperfusion for 40 min in rats. With no intervention in the Norm group and only threading without ligation in the Sham group. Electroacupuncture pre-treatment at 20 min/d for 7 d before ligation in the EAⅠ group, 20 min of electroacupuncture before reperfusion in the EAII group and 20 min of electroacupuncture after reperfusion in the EAIII group. The electrocardiogram (ECG) of each group was recorded throughout the whole process, and the success of the MIRI model was determined based on the changs of J-point and T-wave in the ECG. The arrhythmia score was used to record premature ventricular contractions, ventricular tachycardia and ventricular fibrillation during the reperfusion period to assess the reperfusion induced arrhythmias. The expression levels of NGF, TrkA, TH protein were measured by Western blot. Moreover, the expression levels of plasma and myocardial NE levels were detected by enzyme linked immunosorbent assay. RESULTS: The differences between Norm group and Sham group were not statistically significant in all indexes. Arrhythmia score, myocardial NGF, TrkA, TH, and NE expression were significantly higher in the I/R group compared with the Sham group. Arrhythmia score, myocardial NGF, TrkA, TH, and NE expression were significantly lower in each EA group compared with the I/R group. CONCLUSION: Electroacupuncture at Neiguan (PC6) at different time points can reduce the incidence and severity of reperfusion arrhythmias in rats. This protective effect is related to electroacupuncture regulating NGF, TrkA, TH, NE expression and reducing sympathetic hyperactivation.

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Objective To identify lipid metabolism genes in cerebral infarction;To explore the intervention effect of Huoxue Rongluo Prescription.Methods Multi-chip combined differential analysis(GSE61616,GSE30655)was used to identify lipid metabolism genes in cerebral infarction in combination with Reactome database,and the expression differences of lipid metabolism genes in cerebral infarction were identified and verified in GSE97537 chip;Pearson correlation analysis was used to analyze the correlation of 51 cerebral infarction samples in GSE61616,GSE30655,GSE97537,GSE137595,GSE22255,GSE163614,and GSE78731 datasets;PPI,GO and KEGG analysis of lipid metabolism genes in cerebral infarction were performed through STRING database and R clusterProfiler package.SD rats were made to the model of cerebral infarction,and was administered with Huoxue Rongluo Prescription extract 11.7 g/kg by intragastric administration for 7 days.The symptoms of neurological deficit,the changes of Nissl bodies and the mRNA expressions of PLA2G4A,SPHK1,and PTGES key genes in lipid metabolism in cerebral infarction were observed.Results TSPO,CYP1B1,PLIN2,CH25H,PLA2G4A,ANGPTL4,PTGS1,SPHK1,and PTGES were identified as lipid metabolism genes in cerebral infarction,and were significantly highly expressed and positively correlated in cerebral infarction.Among them,PTGS1,PLA2G4A,and SPHK1 interacted with each other,which were the key genes of lipid metabolism in cerebral infarction;the lipid metabolism gene in cerebral infarction mainly exerted molecular functions such as oxidoreductase activity,iron ion binding,heme binding,etc.,mediating arachidonic acid metabolism,phospholipase D signaling pathway,VEGF signaling pathway,involved in regulation of lipid metabolism process,fatty acid metabolism process,fatty acid derivative metabolism process.The symptoms of neurological deficit in the model rats with cerebral infarction were severe(P<0.001),and Huoxue Rongluo Prescription could effectively improve the neurological deficit of model rats(P<0.001).The Nissl staining indicated that the neuronal structure was abnormal and the number was significantly reduced after cerebral infarction(P<0.001).Huoxue Rongluo Prescription could increase the number of neurons(P<0.001)and repair the neuronal structure.RT-qPCR showed that the key genes of lipid metabolism in cerebral infarction were significantly higher in cerebral infarction(P<0.001),corroborated with the bioinformatics results,and Huoxue Rongluo Prescription could reduce the expression of key lipid metabolism genes of PTGS1,PLA2G4A,and SPHK1(P<0.001,P<0.01,P<0.05).Conclusion Huoxue Rongluo Prescription can down-regulate the expressions of PTGS1,PLA2G4A,SPHK1,exert molecular functions such as oxidoreductase activity,iron ion binding,heme binding,and mediate arachidonic acid metabolism,phospholipase D signaling pathway,and VEGF signaling pathway.It participates in the process of lipid metabolism regulation,fatty acid metabolism,and fatty acid derivative metabolism,increases the number of Nissl bodies,improves the symptoms of neurological deficits,and exerts neuroprotective effects.

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Objective:To investigate the clinical efficacy and safety of amisulpride in the treatment of schizophrenia.Methods:Ninety patients with schizophrenia admitted to Quzhou Third Hospital from August 2020 to March 2022 were included in this study. They were randomly divided into an observation group and a control group ( n = 45/group). The control group was treated with olanzapine, and the observation group was treated with amisulpride. All patients were treated for 8 consecutive weeks. Total response rate, Positive and Negative Syndrome Scale score, Clinical Global Impression Scale-Severity of Illness score, glucose and lipid metabolism indicators, Treatment Emergent Symptom Scale score, and adverse reactions were compared between the two groups. Results:Total response rate was 88.89% (40/45) in the control group and 93.33% (42/45) in the observation group. There was no significant difference in total response rate between the two groups ( χ2 = 0.14, P > 0.05). After treatment, the PANSS score [(52.14 ± 3.99) points] and CGI-S score [(3.05 ± 0.86) points] in the observation group were significantly lower than (56.38 ± 4.05) points and (4.34 ± 0.92) points in the control group ( t = 5.00, 6.87, both P < 0.001). The levels of fasting plasma glucose [(5.25 ± 0.33) mmol/L], total cholesterol [(4.08 ± 0.67) mmol/L], triglyceride [(1.29 ± 0.35) mmol/L], and low density lipoprotein-cholesterol [(2.60 ± 0.31) mmol/L] in the observation group were significantly lower compared with the control group [(6.02 ± 0.51) mmol/L, (4.71 ± 0.59) mmol/L, (1.61 ± 0.26) mmol/L, (2.91 ± 0.34) mmol/L, t = 8.50, 3.61, 4.92, 4.52, all P < 0.001]. High density lipoprotein-cholesterol level in the observation group was significantly higher than that in the control group [(1.57 ± 0.36) mmol/L vs. (1.18 ± 0.42) mmol/L t = -4.73, P < 0.001]. Treatment Emergent Symptom Scale score in the observation group was significantly lower than that in the control group [(2.39 ± 0.58) points vs. (2.87 ± 0.62) points, t = 3.79, P < 0.05]. The incidences of drowsiness [6.67% (3/45)], constipation [8.89% (4/45)], and weight gain [2.22% (1/45)] in the observation group were significantly lower than those in the control group [73.33% (33/45), 28.89% (13/45), 17.78% (8/45), χ2 = 4.14, 4.64, 4.44, P < 0.05]. Conclusion:The efficacy of sulfapride in the treatment of schizophrenia is equivalent to that of olanzapine. Sulfapride is better than olanzapine in improving symptoms and reducing disease severity and has better safety.

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For a long time, urological surgeons have been troubled by the treatment of long proximal and mid ureteral stricture, and the commonly used ileal ureteral substitution and autotransplantation have certain shortcomings. In recent years, the development of autologous graft technique has brought a new hope for these patients. The commonly used autologous grafts or flaps include oral mucosa, intestinal tissue, urogenital tissue, etc. The feasibility and safety of autologous graft technique have been preliminarily verified, but each kind of graft or flap has different advantages and disadvantages. The research progress of autologous grafts or flaps ureteroplasty in this article was reviewed and the related problems of this technique were discussed.

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Objective:To study the clinical manifestations and treatment of neonatal testicular torsion (NTT) and to summarize the experience of diagnosis and treatment.Methods:The clinical data of the patients with NTT admitted to the Department of Pediatric Urology in Guangzhou Women and Children's Medical Center from January 2015 to January 2021 were analyzed retrospectively. The data included demographic information, testicular torsion duration, clinical presentation, ultrasonography findings, surgical procedures, pathological results, follow-ups, and prognosis.Results:A total of 17 cases were enrolled in this study, and the median age was 5.2 d, ranging from 1 d to 17 d; the weight ranging from 2 800 g to 4 000 g. 11 cases of left testicular torsion and 6 cases of right testicular torsion. The median time from onset to medical attention was 3.8 d, ranging from 10 h to 15 d. The first manifestations being reported were scrotal swelling, color change, or painless mass. Emergency ultrasound revealed that the blood flow signal in the testis was significantly reduced or disappeared, and heterogeneous mass echoes were detected in the scrotum. Surgical exploration was performed in all 17 cases and confirmed to be testicular torsion. There were 15 cases of extravaginal torsion and 2 cases of intravaginal torsion. There were 6 cases of clockwise torsion and 11 cases of anticlockwise torsion. The average degree of twisted testis was 450.8°, ranging from 270° to 720°. The rate of orchiectomy was 88.2% (15/17). All patients were followed up for a minimum of 1 year postoperatively. None of the patients experienced postoperative bleeding or infection at the scrotal incision site. There were no instances of recurrent testicular torsion, and the contralateral testicles showed no abnormalities. In 2 cases where the affected testicle was preserved, ultrasound reevaluation at 6 months postoperatively revealed atrophy of the affected testicle.Conclusions:NTT is rare in clinics and lacks specificity, with a high rate of testis loss. When the newborns exhibit scrotal swelling, color change, or other abnormalities, testicular torsion cannot be ruled out, and early surgical exploration is required.

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Objective:To analyze students' learning behavior in the teaching practice of the presentation-assimilation-discussion (PAD) class based on Xuexitong platform.Methods:The PAD class based on Xuexitong platform was applied to the course of child and adolescent health in the specialty of preventive medicine. And the data were collected from the platform to analyze students' learning behavior, including the number of visits and its rules, the completion rate and duration of homework submission, the completion rate of task points, and the number of students participating in discussions. Questionnaires were used to investigate students' evaluation of the learning effect. SPSS 17.0 was used for Mann-Whitney U test, Kruskal Wallis H, and Chi-square test. Results:A total of 99 students visited the platform 40 322 times over 84 days, with a peak on the day of the discussion class, with the highest number of visits from 16:00 to 20:00, and 29.3% (29/99) of them visited the platform for less than 40 days. The completion rate of homework submission was 98.0% (582/594), with 31.1% (181/582) of the person-times less than 6 hours of homework submission duration. The completion rate of task points was 99.0% (3 919/3 960), and the number of students participating in discussions was 3 (2,7). In total, 86.9% to 90.9% of the students thought that the five aspects of learning effect were partly or basically achieved.Conclusion:Students' learning behavior is good on the whole, but their participation in discussion is few, and some of them learn passively, which needs to be further improved.

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Objective:Objectives The aim of the study is to evaluate the mechanical performance, safety and efficacy of the novel robotic-assistant flexible ureteroscopy system (Ra-fURS) under in vitro and in vivo environments.Methods:Combing with commercial flexible ureteroscopes, the novel Ra-fURS was used for the in vitro test and animal model operation in October 2020. The study included three sections. ①Basic mechanical performance assessment: including endoscope motion control (dual deflection, axial rotation and forward/backward distance), reaction time and fiber regulation. ②Simulated surgery in ex-vivo 3D-printing renal collecting system model: including completion rate and time of calyxes exploration, directional movement and laser fragmentation [gypsum models (0.5×0.5×0.5 cm) were used to stimulate kidney stones]. ③Intrarenal surgeries in animal models (two 5-month female Yorkshire white pigs). In total, 32 surgeries was performed (8 surgeons × 2 pigs × 2 kidneys/pig). In vivo assessments were carried out including: ①consuming time for Ra-fURS installation and offloading; ②completion rate and time of calyxes exploration; ③comfort score (ranging from 0-10) as compared to the manual f-URS, which was corresponding to each Ra-fURS surgery. In simulated surgery and animal surgery sections, 8 surgeons were enrolled in the study (group A 4 without flexible ureteroscopy experience; group B: 4 highly experienced), and results were compared between two groups.Results:Under the Ra-fURS control, the flexible ureteroscope movement in three degrees of freedom (forward / backward: + 11 to -11 cm, axial rotation + 225°to -225°; active duel-flection: + 270°to -270°, as well as the laser fiber regulation + 2.5 to -2.5 cm). In simulated surgery tests, both groups achieved 100% completion rate of calyxes exploration, and there were no statistical differences in the time of the calyxes exploration between group A and group B (116.0±8.0)s vs.(110.3±15.4)s( P>0.05). Time-consumption for laser fragmentation of group B was shorter than that of group A (525.8±58.5)s vs. (780.5±141.2)s( P<0.01). In animal surgery, the installation time of Ra-fURS gradually shortened within the first 7 cases was(234.0±43.0)s, and became comparable in the later 8-32 cases was(149.3±8.0)s. The average uninstall time was (43.9 ±5.9)s and was relatively stable. There were 51 renal calyxes in two pigs. It was higher for the completion rate of calyxes exploration in group B than in group A [(95.5±9.1)% vs. (59.1±9.1)%, P<0.05], and the exploration time was also statistically variant between the two groups group A and group B[(274.8±34.6)s vs.(127.3±18.2)s, P<0.05]. For all the operators, the comfort scores were favorable to the Ra-fURS as compared to the manual f-URS (8.9±0.3 vs. 5.9±1.1, P<0.05). Conclusions:This preliminary study demonstrated that the novel Ra-fURS was capable of controlling flexible ureteroscope to perform retrograde intrarenal surgery and fragmenting stones with laser. Besides, other features, including easy installation, stable performance and comfortable manipulating environment, made it easy to use in clinical application.

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The fracture risk of patients with diabetes is higher than those of patients without diabetes due to hyperglycemia, usage of diabetes drugs, changes in insulin levels, and excretion, and this risk begins as early as adolescence. Many factors including demographic data (such as age, height, weight, and gender), medical history (such as smoking, drinking, and menopause), and examination (such as bone mineral density, blood routine, and urine routine) may be related to bone metabolism in patients with diabetes. However, most of the existing methods are qualitative assessments and do not consider the interactions of the physiological factors of humans. In addition, the fracture risk of patients with diabetes and osteoporosis has not been further studied previously. In this paper, a hybrid model combining XGBoost with deep neural network is used to predict the fracture risk of patients with diabetes and osteoporosis, and investigate the effect of patients' physiological factors on fracture risk. A total of 147 raw input features are considered in our model. The presented model is compared with several benchmarks based on various metrics to prove its effectiveness. Moreover, the top 18 influencing factors of fracture risks of patients with diabetes are determined.

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Thulium fiber laser is a novel laser of good potential in lithotripsy, which gained the attention of urology society in recent years. This article aimed to discuss Thulium fiber laser referring to lithotripsy mechanism, ablation efficiency, laser safety, clinical application and so on. Thulium fiber laser shares a similarity of lithotripsy mechanism with Holmium laser, whereas Thulium fiber laser has a higher ablation rate, thinner fragments, and smaller retropulsion compared to Holmium laser. Thulium laser may bring revolution in the field of laser lithotripsy.

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Objective:To explore the relationship between smoking and the effect of antipsychotics in schizophrenics.Methods:From July 2017 to July 2019, 142 schizophrenics in the mental health center were treated with olanzapine, and the serum drug concentration and concentration/dose ratio (C/D) were calculated.The age, sex, liver function, smoking, combined medication and other clinical data of the two groups were collected, and the influencing factors of serum olanzapine concentration in schizophrenic patients were analyzed by multivariate logistic regression.Results:Forty-four patients were in the non-compliance group(serum olanzapine concentration <20ng/mL), and 98 patients were in the compliance group(serum olanzapine concentration 20-80ng/mL). In the non-compliance group, males accounted for 72.2%, the average age was (61.6±10.5)years old, smoking history accounted for 90.1%, and serum C/D was (2.5±1.1)ng·mL -1·mg -1·d -1, and in the compliance group, males accounted for 51.0%, the average age was (57.9±9.6)years old, smoking history accounted for 41.8%, and serum C/D was (3.2±1.8)ng·mL -1·mg -1·d -1, and there were statistically significant differences in sex, age, smoking history and serum C/D between the two groups ( t=5.86, χ 2=2.06, χ 2=5.43, t=2.38, all P<0.05). Multivariate logistic regression analysis showed that smoking and CYP1A2 genes were independently related to whether the plasma concentration of olanzapine was up to standard in schizophrenic patients.Compared with non-smokers, previous smoking increased the probability of blood concentration non-compliance by 11% and current smoking by 15% respectively( OR=1.15, P=0.001). And compared with CYP1A2 gene AA, CYP1A2 gene AC reduced the probability of blood concentration non-compliance by 15% and CYP1A2 gene CC by 13%( OR=0.87, P=0.002). Conclusion:There is an independent correlation between smoking and serum C/D value of olanzapine in schizophrenics.Quitting smoking can reduce the probability of substandard blood concentration.

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Objective:To investigate the clinical effect of oxcarbazepine combined with ziprasidone in the treatment of acute excitatory agitation in patients with schizophrenia.Methods:From January 2016 to January 2019, a total of 110 patients with acute excitatory schizophrenia who admitted in the Third Hospital of Quzhou were enrolled, and they were divided into observation group and control group according to the random digital table method, with 55 cases in each group.The control group was given ziprasidone capsule, and the observation group was given oxcarbazepine combined with ziprasidone capsule treatment for 4 weeks.The PANSS excitatory agitation factor(PANSS-EC), explicit aggressive behavior scale(MOAS), clinical efficacy rating scale(CGI-SI) score, serum neurocytokines[brain-derived nutritional factors(BDNF), nerve growth factor(NGF), glial-derived neurotrophic factor(GDNF)], homocysteine (Hcy), inflammatory factors[interleukin 1β(IL-1β), interleukin 6(IL-6), interleukin 12(IL-12), tumor necrosis factor α(TNF-α)] before and after treatment and the incidence of adverse reactions were compared between the two groups.Results:After treatment, the PANSS-EC, MOAS, CGI-SI scores, Hcy, IL-1β and TNF-α levels were decreased in the two groups( t=7.829, 14.952, 3.417, 15.511, 18.948, 7.193, 18.453, 24.161, 1.995, 3.378, 3.968, 6.820, all P<0.05), which of the observation group were lower than those of the control group[(15.34±3.56)points vs.(11.08±3.17)points, (5.36±1.68)points vs.(4.15±1.46)points, (5.56±1.21)points vs.(4.18±1.35)points, (14.29±2.42)μmol/L vs.(10.63±2.24)μmol/L, (48.15±15.63)ng/L vs.(42.18±10.51)ng/L, (29.57±8.76)ng/L vs.(23.48±6.76)ng/L]( t=6.628, 4.032, 5.645, 8.231, 2.351, 4.082, all P<0.05), while the BDNF, NGF, GDNF levels were increased( t=6.253, 6.346, 3.513, 13.906, 15.874, 7.507, all P<0.05), which of the observation group were higher than those of the control group[(9.34±1.23)μg/L vs.(11.35±1.34)μg/L, (21.37±2.85)μg/L vs.(26.87±3.21)μg/L, (439.51±56.42)ng/L vs.(489.63±58.15)ng/L], the differences were statistically significant( t=2.351, 3.523, 3.204, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups[25.45%(14/55) vs.12.73%(7/55), χ 2=2.884, P=0.089]. Conclusion:Oxcarbazepine combined with ziprasidone in the treatment of acute excitatory patients with schizophrenia can control the clinical symptoms, improve the serum levels of cytokines, Hcy and inflammatory factors, and has high safety.

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Objective To summarize the initial experience of flexible ureteroscopy combined with thulium laser for the treatment of high-risk upper urinary tract urothelial carcinoma (UTUC) in patients with solitary kidney or renal insufficiency.Methods A retrospective analysis was performed in 5 cases of UTUC with solitary kidney or renal insufficiency treated via flexible ureteroscopy combined with thulium laser from May 2016 to November 2018.Patients consisted of 4 cases of left side tumor,1 case of right side tumor,with median age of 73 years old(ranging 53-87 years old).Among the 5 cases,3 were solitary kidney with renal pelvis tumors,2 cases were renal insufficiency accompanied with proximal ureter or renal pelvis tumor.All the patients had tumors large than 2 cm in diameter.The creatine in 3 cases with solitary kidney was 102,128,143μmol/L,respectively.The creatine in 2 cases with reual insufficiency was 281,179μmol/L,respectively.Variable hydronephrosis was noticed in all paients.The cytological examination could reveal tumor cells in all cases.During the operation,part of tumor tissues were resected for pathological examination and the remaining visible tumor tissue was all ablated and vaporized.As there was no obvious residual tumor tissue,double J stent was retained.Patients were regularly reexamined after surgery.Results Of the 5 cases,4 patients were successfully performed,while intraoperative bleeding occurred in 1 case.The operation was suspended after indwelling double J stent.Then,the renal artery interventional embolism was performed after ineffective conservative treatment,and the bleeding was well controlled.One month later,the patient was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again.The pathology of all cases was high-grade invasive urinary epithelial carcinoma.Patients were followed up with regular imaging and endoscopic examination.The median follow-up period was 19 (4-26) months,during which 4 cases had local recurrence,one patient died of non-tumor factors.No recurrence of urothelial carcinoma occurred in the bladder during follow-up,the overall recurrence rate was 80％,and the median recurrence time was 6 (1-24) months.Patients with recurrence was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again.Conclusions Flexible ureteroscopy combined with thulium laser is an alternative treatment for high-risk upper urinary tract urothelial carcinoma in patients with solitary kidney or renal insufficiency,while with high tumor recurrence rate.Therefore,a stringent imaging and endoscopic follow-up should carry out postoperatively.

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Objective@#To summarize the initial experience of flexible ureteroscopy combined with thulium laser for the treatment of high-risk upper urinary tract urothelial carcinoma (UTUC) in patients with solitary kidney or renal insufficiency.@*Methods@#A retrospective analysis was performed in 5 cases of UTUC with solitary kidney or renal insufficiency treated via flexible ureteroscopy combined with thulium laser from May 2016 to November 2018. Patients consisted of 4 cases of left side tumor, 1 case of right side tumor, with median age of 73 years old(ranging 53-87 years old). Among the 5 cases, 3 were solitary kidney with renal pelvis tumors, 2 cases were renal insufficiency accompanied with proximal ureter or renal pelvis tumor. All the patients had tumors large than 2 cm in diameter. The creatine in 3 cases with solitary kidney was 102, 128, 143μmol/L, respectively. The creatine in 2 cases with renal insufficiency was 281, 179μmol/L, respectively. Variable hydronephrosis was noticed in all paients. The cytological examination could reveal tumor cells in all cases. During the operation, part of tumor tissues were resected for pathological examination and the remaining visible tumor tissue was all ablated and vaporized. As there was no obvious residual tumor tissue, double J stent was retained. Patients were regularly reexamined after surgery.@*Results@#Of the 5 cases, 4 patients were successfully performed, while intraoperative bleeding occurred in 1 case. The operation was suspended after indwelling double J stent. Then, the renal artery interventional embolism was performed after ineffective conservative treatment, and the bleeding was well controlled. One month later, the patient was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again. The pathology of all cases was high-grade invasive urinary epithelial carcinoma. Patients were followed up with regular imaging and endoscopic examination. The median follow-up period was 19 (4-26) months, during which 4 cases had local recurrence, one patient died of non-tumor factors. No recurrence of urothelial carcinoma occurred in the bladder during follow-up, the overall recurrence rate was 80%, and the median recurrence time was 6 (1-24) months. Patients with recurrence was treated with thulium laser tumor ablation and vaporizaiton under flexible ureteroscopy again.@*Conclusions@#Flexible ureteroscopy combined with thulium laser is an alternative treatment for high-risk upper urinary tract urothelial carcinoma in patients with solitary kidney or renal insufficiency, while with high tumor recurrence rate. Therefore, a stringent imaging and endoscopic follow-up should carry out postoperatively.

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Objective To study the effect of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differential diagnosis of hydronephrosis and pyonephrosis.Methods From March 2015 to October 2017,50 patients with renal stone and highly suspected infectious hydronephrosis underwent renal DW-MRI,and clinical materials were collected and analyzed retrospectively.Seventeen male and 33 female patients were enrolled with a mean age of (49.40 ±-10.51) years.The median maximum diameter of renal stone was 30.30 (17.38,56.01) mm and hydronephrosis was 46.39 (34.33,56.55) mm.No pyonephrosis was diagnosed by preoperative ultrasound or CT,while 29 cases of hydronephrosis and 21 cases of pyonephrosis were reported by preoperative DW-MRI.Final diagnoses of hydronephrosis and pyonephrosis were made according to whether the pelvic urine drainage was purulent or not during the surgery.DW-MRI reports and characteristics of DW images were analyzed retrospectively.Apparent diffusion coefficient (ADC) was calculated and ADC map constructed,which was compared between the two groups.Receiver operating characteristic curve (ROC) was drawn to analyze the area under curve (AUC) and the optimal cutoff of ADC value,with sensitivity and specificity.Results Thirty-three patients of hydronephrosis and 17 pyonephrosis were confirmed intraoperatively.The overall accuracy of diagnosis using DW-MRI was 84.00％ (42/50),with sensitivity of 88.24％ (15/17) and specificity of 81.82％ (27/33).Among 30 patients who underwent CT scan in our hospital,mean CT value of 18 hydronephrosis was (7.03 ± 3.26)HU and that of 12 pyonephrosis was (8.67 ± 3.52) HU,with no statistical significance (P ＞ 0.05).On DW image,when b ≥ 500 s/mm2,hydronephrosis signal intensity was lowered apparently,whereas pyonephrosis signal intensity was intensified.On ADC map,hydronephrosis appeared as hyperintensity,whereas pyonephrosis appeared as hypointensity.The mean ADC value of pyonephrosis group was lower than hydronephrosis group [(1.53 ±0.58) × 10-3 mm2/s vs.(2.86 ±0.56) × 10-3 mm2/s,p ＜0.01].ROC analysis revealed that AUC =0.92 (95％ CI 0.80-0.98),and the cut-off value of ADC for pyonephrosis diagnosis was 1.39 × 10-3 mm2/s,of which the sensitivity and specificity was 94.12％ and 84.85％ respectively.Conclusions Signal of pyonephrosis was enhanced on DW image,while decreased on ADC image.The ADC value of pyonephrosis was much lower than that of hydronephrosis,with which the differential diagnosis between pyonephrosis and hydronephrosis could be made efficiently.

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Objective To investigate the social function, adverse reaction and medication adherence of paliperidone, amisulpride, and olanzapine in patients with first episode schizophrenia.Methods A total of 96 patients with first episode of schizophrenia was randomly divided into three groups, with reference to random numbers, among which there were 32 in paliperidone group, 32 cases in amisulpride group, and 32 in olanzapine group.All the patients in all groups were assessed with negative and positive scale (PANSS), personal and social performance scale (PSP), drug attitude inventory (DAI) at baseline and the end of 6 months.Results (1) There was no significant difference in the therapeutic effect between three groups (P ＞ 0.05);(2) The scores of PSP and DAI were increased in three groups after treatment, and the difference was statistically significant compared to that before treatment (P ＜ 0.05).Conclusions Three drugs have similar efficacy in the treatment of first-episode schizophrenia, and there is no significant difference in improving medication compliance and social function.

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Objective@#To observe the effects of extract of Ginkgo biloba (Ginaton) on magnetic resonance imaging (MRI) and electroencephalography (EEG) in patients with delayed encephalopathy after acute carbon monoxide poisoning.@*Methods@#The 84 patients with delayed encephalopathy after acute carbon monoxide poisoning treated in our hospital from Jan. 2011 to Apr. 2016 were randomly divied into therapy group and observation group. The therapy group received routine treatments of hyperbaric oxygen, cure cerebral edema and promote brain cell metabolism, and observation group was given intravenous injection (intravenous drip) Ginaton 70 mg (adding 0.9% sodium chloride injection 250 ml) , once a day, 2 weeks for one therapeutic course. The changes of MRI and EEG before and after treatment between therapy group and observation group were observed.@*Results@#In the observation group, the white matter and globus pallidus lesions of 14 d after treatment were smaller than those in the treatment group, and the abnormal signal intensity was decreased. At 14 days after treatment the improvement of EEG in observation group were better than therapy group (P<0.05) .@*Conclusion@#Early treatment of extract of Ginkgo biloba (Ginaton) in delayed encephalopathy after acute carbon monoxide poisoning can effectively improve lesion and signal on MRI and abnormal rate on EEG. It has a certain therapeutic effect in clinical.

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Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .

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Objective To evaluate the efficacy and safety of the flexible ureteroscopy (FURS) with holmium laser lithotripsy in the management of stones in ectopic pelvic kidney (PK).Methods We retrospectively reviewed the records of 11 patients,ranged from 37-52 years old,who were underwent FURS with holmium laser for PK stones from January 2007 to April 2012.Three cases had solitary stones in renal pelvis,3 cases had solitary stones at lower calyx and multiple stones were found in 5 cases.Mean size of stone was 2.3 cm (ranged 1.8-3.7 cm).One case had history of ESWL and PCNL before surgery with unsatisfied result and 7 cases were underwent ESWL with poor outcome.The double J stent was placed into the ureter two weeks before the operation.Under the general anesthesia,the ureteral access sheath was placed firstly during operation.Then,flexible ureteroscopy was inserted into the renal pelvis through ureteral access sheath.Holmium laser was used to perform the procedure with the power less than 20 W (0.6-1.0 J/10-20 Hz).The stone fragments were taken out by stone baskets and double-J stent was set at the end of the procedure for additional two weeks.Results The successive rate of the ureteroscopic insertion was 100％.The average operation time was 62 min (ranged 31-87 min).No severe complications such as heavy bleeding,perforation or ureteral avulsion occurred.Small stone fragments were found in 3 cases.All of them located in the lower calyx.Since no one complained about the upper urinary obstruction or related symptoms,conservative observation was considered.All patients discharged the day after the operation.Within three months follow-up,no sign of urinary obstruction was found.Conclusions FURS with holmium laser is a safe,effective and minimally invasive technique.It could be the best option in the management of renal calculi in ectopic pelvic kidney.

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Objective To investigate clinical efficacy and adverse reactions of Citric acid tandospirone in treating generalized anxiety neurosis.By doing this study,we provide clinical evidence for citric acid tandospirone in treating generalized anxiety neurosis.Methods 92 patients with generalized anxiety were randomly divided into the control group and observation group according to the random number table.There were 46 cases in each group.In the observation group,the patients were given acid citrate edge tandospirone.At the starting the patients were taken 15mg/d. After 3 days the dose increased to 35mg/d by 5mg.The average dose was (31 ±3.4)mg/d.In control group,accord-ing to different patients sleep condition,oxazepam tablets were taken.The daily dosage does not exceed 30mg/d.After two weeks,the dose was gradually reduced to the end.The clinical efficacy,HAMA score and adverse reactions in the two groups were compared.Results Compared to prior treatment,after 2 weeks and 4 weeks the HAMA score in the two groups were significantly different (P0.05).The rate of adverse reaction in the observation group was 32.6%.The rate of adverse reaction in the control group was 63%.The rate of adverse reaction in the control group and observation group had sig-nificantly different (χ2 =8.58,P<0.05) .Conclusion Acid citrate edge tandospirone on the treatment of general-ized anxiety neurosis showed obviously effect and had fewer adverse reactions.The clinical program is worth of further study and clinical application.

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Objective To analyze the relationships and differences of the clin(HFMD) ical signs and the possibility of children with herpangina developing into HFMD by observing the clinical signs.Methods Eighty children diagnosed herpangina clinically firstly were divided into Group A,B and C.Group A included 42 cases with only herpangina,and Group B including 28 cases who were herpangina developing into mild HFMD and Group C including 10 cases with serve HFMD.The clinical signs of the three groups,including blood routine test and lymphocyte count,neutrophil count,and monitor the degree of fever,blood pressure,heart rate,respiratory and digestive system,nervous system symptoms were recorded.Results In Group A,B and C,white blood cell number,lymphocyte number,neutrophil number were no significant difference(P ＞ 0.05).However,fever degree,thermal history,heart rate,respiratory rate,systolic pressure,diastolic pressure were significant differences (F =5.03,3.62,4.83,3.65,6.72,3.74 ; P ＜ 0.05).Meanwhile The sigh of loss of appetite,vomiting,diarrhea,gastrointestinal symptoms and easily frightened,limb jitter,sleepiness were statistically significant(x2 =6.10,5.75,4.86,3.58,3.42,4.35;P ＜0.05).Conclusion The herpangina children with symptoms and signs such as higher fever and higher blood pressure,simultaneously with diarrhea,vomiting,hyperarousal and amyostasia,have the more chance to develop HFMD.