Objective To study the Clinical efficacy and safety of ureteroscopic holmium: YAG laser lithotripsy in the treatment of upper urinary tract stones larger than 2cm.

Methods A total of 102 cases from January 2014 to January 2017 of upper urinary tract calculi treated with ureteroscopic holmium:YAG laser lithotripsy were included in the study.Analyze the clinical data of patients with age, sex, size, location,time of lithotripsy,stone removal and complications were retrospectively, and summarize the effectiveness and safety of operation.

Results  The mean cumulative maximum diameter of calculi is（28.56±20.45）min,the mean operative time is （44.18±20.45） min,the average hospitalization time is（7.2±2.4）days,the mean lithotripsy time is （28.56±20.45）min,and the mean length of hospitalization is （7.2±2.4）days.Complications occurred in 11 of 102 patients (10.78%), including fever,low back pain,hematuria,stone street and so on;There were no serious complications such as sepsis and septic shock.Multivariate regression analysis showed that hydronephrosis was the independent influencing factor of stone clearance rate and operative time was the risk factor for postoperative complications(P<0.05).

Conclusion The application of ureteroscopic holmium:YAG laser lithotripsy in the treatment of upper urinary tract calculi with clinical diameter larger than 2cm has high clinical safety.The rate of stone clearance is related to hydronephrosis, and the duration of operation is a risk factor for postoperative complications.

Objective To evaluate the clinical effect and feasibility of high power holmium laser wedge neck resection in patients with bladder neck contracture.

Methods 60 patients were randomly divided into two groups：30 patients in each group；the control group received transurethral resection of bladder neck；the experimental group received wedge resection of bladder neck with medical staff 80～100w and 550um holmium laser surgery system，and the clinical effect was observed.

Results Inthe control group，the operative time，catheter retention time，intraoperative blood loss and hospitalization time were（100.95±18.74）min，（7.86±1.95）d，（86.9±10.69）ml，（8.95±1.95）d，The experimental groups were（26.78±4.28）min，（2.96±0.54）d，（10.45±1.82）ml，（3.64±0.79）d，the comparison between the two was statistically significant（P<0.05）.Before treatment，there was no statistically significant difference in quality of life （QOL），international prostate symptom score （IPSS），postvoid residual volume （PVR）and  maxium urinary flow rate （Qmax）between the two groups（P>0.05）.7d After treatment，QOL score，IPSS score，PVR and Qmax in the experimental group and control group were（2.74±0.52）score，（10.68±1.94）score，（65.49±12.36）ml，（14.89±2.46）ml/s；（4.86±0.86）score，（15.95±2.89）score，（100.69±21.34）ml，（10.37±2.14）ml/s，all of which were significantly better than those before treatment（P<0.05），and the improvement degree of the patients in the experimental group was greater.Six months after treatment，the QOL，IPSS，PVR and Qmax  were（1.74±0.25）score，（6.84±1.49）score，（20.69±3.52）ml and（21.48±4.68）ml/s，in the experimental group，the control group were（2.96±0.48）score，（12.74±2.35）score，（43.74±6.84）ml and（15.43±3.92）ml/s，the experimental group was better than the control group（P<0.05）.The complication rate of the experimental group（3.33%）was lower than that of the control group（13.33%）（P<0.05）.

Conclusion High power holmium laser is safe and effective for neck wedge resection in patients with bladder neck contracture，with less bleeding，short operation time and simple operation，which is an ideal minimally invasive surgical method.

Objective To explore the clinicopathologic features，treatment and prognosis of cystic nephroma（CN）.

Methods The clinical data of 6 patients with pathologically confirmed CN from January 2000 to March 2019 were retrospectively analyzed，pathomorphological characteristics and immunophenotype of the tumor were observed and analyzed by HE and immunohistochemistry，and all patients were followed up.

Results All the 6 patients of CN were female patients，aged from 22 to 61 years old，with the median age was 46 years old.In the Bosniak classification，there were 5 cases of grade III and 1 case of grade IV.4 patients underwent partial nephrectomy，2 patient underwent radical nephrectomy.The pathomorphological features of CN showed multilocular cystic structure and composed of epithelial and stromal components.All the 6 patients expressed cytokeratin pan（CK pan），cytokeratin 7（CK 7），smooth muscle actin（SMA），Vimenti，estrogen receptor（ER）and Desmin，and 6 patients expressed progesterone receptor（PR，5/6），CD 10（2/6）and Inhibin（2/6）with varying levels.There was no recurrence or metastasis during a median follow-up period of 58（range 1231）months.

Conclusion CN is a rare benign tumor，which is difficult to be differentiated from other renal cystic diseases by radiological examination because of the similarity of their radiological features.Its precise diagnosis relies on pathologic and immunohistochemical examination.Nephron sparing surgery is suggested for treatment of CN for its good prognosis.

Objective To analyze the clinical efficacy of selective arterial embolization in the treatment of grade III and above closed renal trauma and to explore its application value.

Methods Collected from January 2009 to December 2017，126 cases of closed renal trauma patients，Ⅲ level more than 74 cases of renal trauma patients，according to different time were divided 74 patients into two groups，the traditional group（before March 2013）42 cases，adopts the traditional way of treatment.In the intervention group（after March 2013），32 patients were treated with interventional embolization.The differences in hematuria duration，blood transfusion volume，renal resection rate，unplanned secondary surgery，hospital expenses and hospital stay were compared between the two groups.

Results Traditional group hematuria duration [Ⅲ（8.10±1.23）d，Ⅳ（4.14±0.59），Ⅴ（4.01±0.28）d]，blood transfusion amount（95.13±5.28）for ml，renal resection rate 83.33%（35/42），8 cases of unplanned secondary surgery，hospitalization fee（3.11±0.45）ten thousand yuan，length of hospital stay（13.34±2.20）d.Duration of intervention group hematuria [Ⅲ（3.06±1.62）d，Ⅳ（3.07±0.83），Ⅴ（2.93±0.56）d]，blood transfusion amount（20.56±1.44）ml，without renal resection，2 cases，hospitalization fee（1.06±0.82）ten thousand yuan，length of hospital stay（7.06±1.41）d.The cost and length of hospitalization in the intervention group were better than those in the traditional group，with statistically significant differences（P<0.05）.The duration of hematuria，amount of blood transfusion，renal resection rate and unplanned secondary operation in the intervention group had significant advantages over the traditional group，with statistically significant differences（P<0.05）.

Conclusion Selective renal artery embolization Ⅲ magnitude of renal trauma than traditional operation method has obvious advantages，the patient basic requirements is low，the operation preparation time is short，fast hemostasis，high safety and repeatability，renal resection rate is low.

Objective To compare the application effect of silica gel external stent and double J tube in pediatric hydronephrosis surgery.

Methods 160 children with hydronephrosis were divided into control group and research group according to random number table method.80 cases in each group were treated with pyeloplasty.The control group was treated with silica gel external stent drainage and the research group was treated with double J tube drainage.The operation time，hospitalization time，renal artery flow velocity and resistance before and after operation，renal function，complications and hydronephrosis recovery were compared between the two groups.

Results The operation time and hospitalization time of the research group[（91.85±12.96）min，（7.95±1.14）d] were lesser than the control group[（102.22±15.93）min，（14.22±1.63）d]（P<0.05）.Before operation，there was no significant difference in the velocity，resistance and renal function between the two groups（P>0.05）.After the operation，the flow velocity and renal function of the affected renal interlobar artery and renal hilum artery increased，while the resistance，serum creatinine and urea nitrogen decreased in both groups.there was no statistical difference between the two groups（P>0.05）.The incidence of total complications in the study group（2.50%）was lower than that in the control group（11.25%，P<0.05）.There was no statistical difference between the research group and control group of truncation value of anterior and posterior diameter of renal pelvis was measured 6 months after operation[（1.66±0.27）vs（1.73±0.21）cm]，complete remission rate（36.25% vs 28.75%）（P<0.05）.

Conclusion Silicone external stent and double J tube can be fully drained in pediatric pyeloplasty，but double J tube drainage can effectively prevent the occurrence of related complications and improve safety.

Objective To investigate clinical effect of surgical treatment through lateral fissure approach on hypertensive intracerebral hemorrhage in basal ganglia.

Methods Eighty two patients with hypertensive intracerebral hemorrhage in basal ganglia who were treated at the Second Affiliated Hospital of Shenyang Medical College from October 2014 to June 2018 were randomly divided into two groups，with 40 patients in the control group and 42 patients in the observation group.Patients in the observation group were treated with a surgery through lateral fissure approach，and patients in the control group were given a surgery through the cortex of temporal lobe.The surgery time， the degree of hematoma clearance，Glasgow Coma Scale（GCS）， postoperative cerebral edema，complications and daily living ability scale（ADL）were compared between the two groups.

Results The surgery time of the observation group was slightly longer than that of the control group，but the difference was not statistically significant（P＞0.05）.The degree of hematoma clearance was better in the observation group（P<0.05）.After treatment，the GCS scores of the two groups were significantly different within 7 days（P<0.05）.The degree of cerebral edema of the observation group was significantly lighter than that of the control group at 3 days，5 days，and 7 days after surgery（P<0.05）.The postoperative complication rate was 45.24%（19/42）in the observation group，which was significantly lower than that in the control group（67.5%，27/40）（P<0.05）.The ADL scores of the observation group were significantly higher than the control group at 30 days，90 days and 120 days after surgery（P<0.05）.

Conclusion A surgery through lateral fissure approach for the treatment of hypertensive intracerebral hemorrhage in basal ganglia，is associated with slightly longer surgery time，better effect of hematoma clearance，slighter postoperative cerebral edema，fewer postoperative complications，and better functional recovery，is worthy of clinical promotion.

Objective Analysis of prognostic factors of invasive papillary carcinoma of the breast.

Methods To obtain female cases of invasive papillary carcinoma of the breast that have been registered in the Surveillance，Epidemiology，and End Results Program（SEER）database in the United States since 1990.According to the inclusion and exclusion criteria，the subjects in accordance with this study were selected.The clinicopathological distribution of the study data was described，and the Cox proportional hazard regression model was used to analyze the prognostic factors by univariate and multivariate analysis.

Results A total of 1413 cases of invasive papillary carcinoma of the breast were included in this study，of which 106 cases died specifically.Cox univariate analysis showed that tissue differentiation，estrogen receptor（ER），progesterone receptor（PR），T stage，N stage，M stage，operation and chemotherapy were related factors affecting prognosis（P<0.05）.Multivariate analysis showed that the higher the stage of lymph node metastasis，the higher the risk of poor prognosis.The risk of poor prognosis in stage T4 was 2.217times higher than that in stage T1（95%CI=1.056 to 4.655）.The risk of death in the PR negative group was 2.136 times higher than that in the PR positive group（95%CI=1.252 to 3.644），and the risk of death in breast conserving surgery was 0.086 times higher than that in the unoperated group（95%CI=0.029 to 0.252）.There was no significant difference in survival and prognosis between chemotherapy and chemotherapy（P=0.329，HR=0.787）.

Conclusion Patients with large tumor，locally advanced tumor，lymph node metastasis，negative PR and no treatment had a higher risk of tumor specific death.Early surgical intervention of invasive papillary carcinoma can slow down the progression of the disease and improve the prognosis，adjuvant radiotherapy and chemotherapy have no significant effect on the overall survival and prognosis of patients.

Objective To investigate the expressionof Sirtuin 4 (SIRT4) in colorectal cancer (CRC)cells and tissues and its clinical significance.

Methods  RT-qPCR and Western blot were used to detect the expression of SIRT4 mRNA and protein in normal colorectal epithelial cell, CRC cells, CRC tissues and paired adjacent tissues, respectively. Then, the expression of SIRT4 protein in CRC tissues of 85 cases was investigated by immunohistochemical method, andthe correlation of SIRT4 expression with clinicopathological factors and patients' prognosis were further analyzed.

Results Compared to normal colorectal epithelial cell, the mRNA and protein expression of SIRT4 in CRC cells was significantly decreased(P＜0.05, respectively).Consistently, the mRNA and protein expression of SIRT4 in CRC tissues was significant lower than that of paired adjacent normal tissues(P＜0.05, respectively).Immunohistochemical analysis showed that the low expression of SIRT4 in CRC tissues were significant association with tumor grade, depth of invasion, lymph node metastasis,lympho-vascular invasion, nervous invasion and TNM stage (P＜0.05, respectively), but not with gender, age, tumor site,tumor size andpreoperative CEA level (P>0.05, respectively). Further Kaplan-Meier univariate analysis demonstrated that the low expression of SIRT4 protein was significant related to poor prognosis of CRC patients (P＜0.05).

Conclusion The low expression of SIRT4 in CRC is closely related to the unfavorable clinicopathological factors and poor patients' prognosis, indicating that SIRT4 may become a new biomarker to evaluate the prognosis of CRC.

Objective To summarize the application experience of transcoccygeal transverse curved incision in debridement of sacral sinus infection after Miles.

Methods A total of 15 patients，taking the lithotomy position，refer to the preoperative sinus angiography results as needed to make a transverse arc incision the joint of the coccygeal's tip and both sides of ischial tuberosity，separating along the anterior sacral space to the sides，removing the sinus and sinus Wall scar tissue，if necessary，by the abdominal group physician through the abdominal incision along the iliac crest to the top of the sinus tract and meet with the perineal group of doctors，the deep sinus can be completely removed.According to the need，the greater omentum can be free after tamponade to the sacral anterior to promote healing.

Results All 15 patients underwent successful operation and were followed up until the incision was completely healed.All of them had an average of 109 minutes of surgery and an average of 265 ml of bleeding.The average time to heal the perineal incision was 27 days.Ten patients（66.7%）underwent debridement through the anterior transverse arc incision，and 5 patients（33.3%）were treated with transabdominal and posterior transverse arc shaped incision.Two male patients had anterior tibiofibular rupture hemorrhage during operation，and hemostasis was obtained after suture fixation and gauze padding compression and hemostasis.One male patient with sinus apex at the level of sacral sinus was treated with transperitoneal anterior transverse arc incision.The small intestine was perforated with pelvic floor peritoneal hiatus and anterior to the sinus.Excision and side to side anastomosis were performed.After the sinus was completely removed，the omentum was filled to the anterior iliac crest，and no infection occurred after the operation.Five patients with preoperative perineal bulge or appendix pain were significantly relieved or disappeared after the incision was completely healed.

Conclusion The key to the intractable infection of the perineal incision and the sinus formation after the mile is complete debridement.The debridement through the anterior cross curved incision of the tailbone is well exposed and easy to operate.

Objective To explore the safety and feasibility of shortening fasting and banning time on the selective perioperative period of patients.

Methods The PubMed，Embase，Cochrane Library，CNKI，CBM and Wanfang Data were searched for the randomized controlled trials（RCTs）between Jan，1998 and Aug，2018.Data extraction and screening were performed by two researchers independently.Meta analysis was conducted using RevMan 5.3 software.

Results 29 studies comprising 3049 patients were eligible for inclusion.Meta analysis showed that there were less hunger[OR=0.17，95%CI（0.10，0.29），P＜0.05]，thirst[OR＝0.15，95%CI（0.07，0.31），P<0.05]，fatigue[OR=0.04，95%CI（0.01，0.13），P<0.05] and hypoglycemia[OR=0.15，95%CI（0.06，0.38），P＜0.05] in new plan than in traditional plan.However，no significant differences were found in preoperative and intraoperative gastric secretion.Furthermore，the new plan was better than traditional plan in postoperative serum glucose[MD=-0.56，95%CI（-0.71，-0.42），P＜0.05]，insulin[MD=-3.60，95%CI（-5.02，-2.18），P＜0.05，insulin resistance index[MD=-2.41，95%CI（-3.11，-1.72），P＜0.05].

Conclusion The new plan is safe，feasible and recommended to be applied in clinical practice.It has advantages over traditional plan as it can reduce postoperative subjective discomfort，improve the perioperative metabolism and without increase the risk of anesthesia.

Objective This study was designed to evaluate the effect and mechanism of adipose derived stem cells（ADSCs） in the process of promoting fibroblasts proliferation and migration.

Methods ADSCs were obtained from back subcutaneous adipose tissue of porcine with collagenase digestion and cultured in vitro.Flow cytometric analysis and cyto immumofluorescence staining technique were carried to detect the immunophenotypes of ADSCs.Porcine skin fibroblasts were cultured by tissue pieces and cyto immumofluorescence staining technique were used to detect the immunophenotypes of cells.The experiment was divided into ADSCs group and fibroblast group，cell to cell co culture experiment and transwell co culture experiment were used to evaluate the proliferation effect of ADSCs supernatant to fibroblasts.MTT assay was used to detect the proliferation effect of conditioned medium of ADSCs to fibroblasts.Also whether the conditioned medium of ADSCs has the stimulatory effect on migration of fibroblasts were determined by in vitro wound healing models.The concentrations of vascular endothelial growth factor（VEGF）、platelet derived growth factor（PDGF-AA）and transforming growth factor（TGF-β1）in conditioned medium of ADSCs were detected by using enzyme linked immunosorbent assay（ELISA）.

Results The stem cells isolated from subcutaneous adipose tissue were positive for CD44（90.2%） and CD105（99.2%），lacking in CD34（0.3%） and CD45（1.2%）.Porcine skin fibroblasts were positive for Hsp47.ADSCs promoted fibroblasts proliferation，not only by cell-to-cell direct contact，which was confirmed by co-culture experiment，but also by paracrine activation through secretory factors，resolved by transwell co-culture and culturing with conditioned medium of ADSCs（P<0.05）.Additionally，the fibroblasts showed vigorous proliferate and migratory responses to the conditioned medium of ADSCs.ADSCs produced a variety of growth factors：VEGF（765.63±56.23pg/ml），TGF-β1（133.42±24.35pg/ml）and PDGF（78.43±16.56pg/ml）.

Conclusion ADSCs can promote the proliferation and migration of fibroblasts.This study can provide some theoretical and experimental basis for the treatment of wound healing.

Holmium laser is the most commonly used laser for minimally invasive treatment of urinary calculi.To understand the principle of the action of holmium laser and to reasonably set and optimize holmium laser parameters（pulse energy，frequency，pulse width）can improve the efficiency and effect of lithotripsy.We review the present status of laser lithotripsy technology and the recent advances in laser technology，such as Moses technology holmium laser，Laser Lithotripsy System with Automatic RealTime Urinary Stone Recognition and thulium fiber laser.

Ileostomy for protecting lowrectalanastomosiscanreduce thereo perationrateand the in cidence and mortality of anastomoticleakage，and isbeneficialtoalleviatelow anteriorresectionsyndrome.However，protective ileostomy significantly increases the postoperative complications of ileostomy，affecting the quality of life and the risk of operation.Indications for protective ileostomy：the lower margin of the rectal tumor is 6 to 7 cm from the anal margin.Preoperative neoadjuvant chemoradiotherapy，poor intestinal preparation，unsatisfactory anastomosis and large anastomotic tension，preoperative history of diabetes，hypoalbinemia，patients and their families can not withstand the second surgical blow after anastomotic leakage.The risk grade of anastomotic leakage in rectal cancer preresection can accurately evaluate the risk of anastomotic leakage in patients，and it is easy to grasp the indications of protective ileostomy.New approaches to protective ileostomy include virtual ileostomy and balloon catheter ileostomy without the need for reentrant ileostomy.These procedures can improve the patient's quality of life and reduce complications.Complications of protective ileostomy include ileostomy complications，disuse enteritis，acute kidney injury and severe kidney disease，and non-retentive of protective ileostomy.Protective ileostomy should be selected rationally in low rectal tumor preservation operation.Protective ileostomy should not be used routinely，nor should it be used routinely.

The idea of surgical treatment for anal fistula has gone through the process from damaged resection to repair to reconstruction and regeneration.The principle of surgical treatment for anal fistula is to pursue the protection of anal function on the basis of guaranteeing curative effect at present.Therefore，the prospects of minimally invasive treatment for anal fistula，which can maximize the protection of sphincter function，are very broad.This article reviews the articles on minimally invasive treatment for anal fistula in PubMed，Cochrane Library CENTRAL，Embase，CKNI，Wanfang and Weipu databases，and introduces the current research progress.

Postoperative pain is a series of physiological，psychological and behavioral reactions after surgical trauma.If not effectively controlled，it may increase the pathophysiological response of noxious sensation to the central nervous system，leading to a series of harmful acute and chronic effects.Preemptive analgesia can prevent the sensitization of pain in central nervous system caused by injury stimulation during operation，alleviate the pain after operation，accelerate recovery and prevent the occurrence of chronic pain.This article reviews the clinical application of preemptive analgesia in plastic surgery.

At present novel coronavirus pneumonia (COVID-19) is highly infectious, and the number of infected patients is rising rapidly. The hidden and complexity of its transmission has become a difficult problem in controlling epidemic situation. Novel coronavirus pneumonia prevention and control guidelines are formulated in the light of the fact that patients who can not completely exclude NCP need urgent operation because of their other emergency. In order to save the lives of patients and avoid cross infection in hospital, this paper develops the systematic preventive and control measures and management strategies combined with the guidelines issued by the national health and Health Committee on the prevention and control of new coronavirus pneumonia. So that the operator can safely carry out the operation for the patients under the overall protection.