Objective To evaluate the significance and reasonability of select in various types of circumcision in children of different ages.
Methods A retrospective analysis was performed for 1 440 children of different ages(3-15 years) between Jan 2019 and Sep 2019 in urological ward and ambulatory surgery area of our hospital.280 were preschool children,620 were school-age children,240 were adolescent children.In different ages,divide them into 4 groups by different types of circumcision：traditional circumcision group,circumcision group with ligation device,circumcision group with anastomoses device,circumcision group with stitching instrument.The indications such as blood loss、operating time、  pain duration、 shedding time、 short-term complication and long-term complication were compared.
Result Among the 4 surgical procedures,preschoolers had the shortest pain duration,shedding time and fewer short-term complication.School-age children had the lowest operative time and blood loss by circumcision with ligation device.Adolescent children had lower operative time,blood loss and the fewer long-term complication by circumcision with stitching instrument.
Conclusion With the development of circumcision apparatus,different surgical methods should be adopted for children's  circumcision in combination with different age.Traditional circumcision should be recommended for preschoolers,circumcision with ligation device for school-age children,circumcision with stitching instrument for adolescent children.

Objective To compare the therapeutic effect of silver ion antibacterial dressing and povidone iodine gauze on the incision and drainage of the abscess.
Methods From March 2019 to November 2019,62 patients were included in this study,and divided randomly into the observation group and the control group with 31 cases in each group.The patients in the observation group were treated with silver ion antibacterial dressing,while the patients in the control group were treated with povidone iodine gauze.The patients in the two groups were recorded in detail.The infection control time of abscess incision was compared before treatment,the third day and the second week after the first treatment,the number of dressing changes and wound healing time of the two groups,and the clinical effect of the patients was evaluated.
Results .The time of wound control in the observation group was (13.9±1.81)d,shorter than that in the control group (23.4±2.32)d(P<0.05);the BWATBWAT(Bates-Jensen Wound  assessment tool，BWAT) score of the observation group in the second week after the first treatment was (14.98±1.51),lower than that in the control group (19.78±2.46)(P<0.05);the times of drug change and wound healing in the Observation group were significantly shorter than that in the control group(P<0.05).
Conclusion Compared with the traditional povidone iodine gauze,the silver ion antibacterial dressing can control the wound infection and improve the wound healing more quickly,and the dressing change times are less,the wound healing time is obviously shortened.

Objective To explore the clinical practice of best evidence-based practice program for nasogastric tube insertion and evaluate its application.
Methods By referencing to Australia JBI model for evidence-based healthcare, we retrieved and summarized the best evidence for preoperative insertion of nasogastric tube, judged the position of nasogastric tube and alleviated the discomfort caused by the nasogastric tube insertion.Then we formed inspection indicators, maded baseline inspections before application of the best evidence on 29 medical staffs and 50 patients who met the inclusion criteria in department of hepatobiliary surgery, took transformative measures to boost application of the best evidence, and made post-application inspections to evlaute the effect.
Results After the application of the best evidence, the routine operation process of gastric tube insertion was improved; the awareness rate of audit indicators in medical staffs, audit indicators implementation rate, and the correct rate of gastric tube implantation were significantly improved (P<0.05 for all).
Conclusion The summarization and application of the best evidence for preoperative nasogastric tube insertion can improve medical staffs' operation level of nasogastric tube insertion,standardize the operation behaviors,reduce the patients' discomfort caused by the nasogastric tube insertion and improve their satisfaction.

Objective To investigate the clinical effect of patella steel plate and gram needle tension band fixation on patella fracture.
Methods The study subjects were 67 patients with eligible patella fractures admitted in the hospital from January 2015 to October 2020.After excluding the late follow-up of the lost patients,30 cases each of the steel plate group and the tension band group were selected to facilitate the statistical comparison.Among them,the steel plate group is a patella steel plate,the tension band group is a modified gram needle titanium cable tension band.The operation time,bleeding volume,incidence of complications and the function of the knee joint were analyzed and evaluated.
Results Operation time,steel plate group(63.53±7.07) min,tension band group(76.53±4.16)min.Cut-out length,steel plate group(6.28±0.57)cm,tension band group(7.73±0.77)cm.The knee activity was measured 6 months after surgery,steel plate group(124.07±4.35),tension band group(118.40 ± 4.55).Surgical bleeding volume,steel plate group(118.42±10.39)ml,tension band group(133.77±12.43)ml.The relative statistical comparison differences between the two groups have statistical significance(P<0.05).
Conclusion Compared with the steel plate group and the tension band group,t he operation time was shortened,and the incision length was also overall shorter than the tension band group;and the satisfaction of postoperative knee activity in the steel plate group was also stronger than that of the tension band group.The treatment of patella fracture has good biomechanical stability and is significantly better than that of tension-band fixation.Worth the promotion in the clinical work.

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.

The complex anatomy of the distal radioulnar joint is the basis for its forearm rotation function and power transmission.It is important to research the anatomical structure and biomechanical mechanism of the distal radioulnar joint to understand the mechanism of the instability of the distal radioulnar joint.The instability of the distal radioulnar joint can be divided into primary instability，post-traumatic or postoperative instability.The combination of medical history，physical examination and imaging findings on the classification of instability of the distal radioulnar joint is helpful for the diagnosis and treatment of the disease.The treatments for the instability of the distal radioulnar joint are conservative treatment and surgical treatment.

Articular cartilage is a major tissue distributed at the joint surface;it plays a role in loadbearing and lubricating.The articular cartilage of the joints in the extremities mainly consists of hyaline cartilage composed of collagen II.Fibrocartilage formation is easily observed when the cartilage is injured or degenerated,which has abundant type I collagen.In this study,a new viewpoint and concept,focusing on the modification of fibrocartilage in situ approach and regeneration of hyaline cartilage,namely “fibrocartilage hyalinization”,was proposed as a practical clinical strategy.We conducted preliminary discussions and prospects on the feasibility and potential mechanisms of fibrocartilage hyalinization.It is hoped that the strategy will be helpful to the development and clinical transformation of cartilage regeneration research.

Patients with critical neurological diseases are prone to or complicated with intracranial infection due to primary diseases and/or complications.Intracranial infection significantly increases the morbidity and mortality of patients with critical neurological diseases.The risk of intracranial infection is higher in critical neurological patients than those in general ward.The common risk factors for intracranial infection includes advanced age，long operation time，multiple operations，cerebrospinal fluid leakage，open wounds，etc.The diagnostic criteria of intracranial infection include etiological diagnostic criteria and clinical diagnostic criteria，and the detection of cerebrospinal fluid etiology and related biomarkers is also of great significance for the diagnosis of bacterial intracranial infection.The treatment of intracranial infection has its particularity and therapeutic characteristics，including early initiation of empirical antimicrobial therapy，timely adjustment according to drug sensitivity results，selection of antimicrobial agents that are easy to cross the blood-brain barrier，recommendation of intravenous administration，long-term treatment，intrathecal drug delivery，etc.Surgical treatment and symptomatic support treatment are also very important.It’s important to prevent the occurrence of intracranial infection from every clinical details.

Objective:To investigate the effect of Solifenacin on detrusor function and prognosis in patients with overactive bladder.Methods:128 cases of patients with overactive bladder admitted to our hospital from March 2016 to December 2018 were selected，and 64 cases were divided into control group and research group according to different treatment methods.The control group was treated with trotrodine and the research group with Solifenacin.The clinical efficacy of the two groups was compared and analyzed.Results:The bladder compliance of the study group，the number of bladder compression inhibition，the initial bladder urination，the maximum bladder volume，and the maximum urine flow rate[（53.1±26.4）ml/cm H2O，（1.5±1.2）times，（177.0±88.0）ml，（298.0±88.0）ml，（53.4±17.1）ml/s]was significantly better than the control group[（58.2±29.5）ml/cm H2O，（1.9±1.5）times，（155.0±90.0）ml，（275.0±98.0）ml，（54.0±20.1）ml/s，and the difference was statistically significant（P<0.05）.The OABSS score（5.9±2.4）scores of the study group before and after medication were better than the control group（6.7±3.4），and the difference was statistically significant（P<0.05）.The incidence of adverse events in the study group was 4.6% significantly lower than that in the control group（14.0%），and the difference was statistically significant（P<0.05）.Conclusion:The use of solifenacin for the treatment of OAB patients，the clinical results are satisfactory，the adverse reactions are mild，it is worthy of clinical use.

The deficiency disease of 5αreductase 2 is a common genetic disease of AR,which karyotype is 46,XY.As the boy patients were born,some abnormity in various degrees would occur on the majority of their external genitalia.Blurring of external genitalia or being similar to female phenotype is the most common phenomenon.Also,being close to normal external genitalia of male phenotype could be found.Some patients would visit a doctor on account of diminutive penis or maldevelopment of gonad.The boy patients who have the deficiency disease of 5αreductase 2 with diminutive penis would be inclined to be misdiagnosed or never diagnosed.Thus,the time for treatment would always be delayed.The article is a summary of genotype characteristics、pathogenesis、clinical feature、diagnostic basis and progress of treatment in allusion to the deficiency disease of 5αreductase 2 with diminutive penis.