[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Objective To evaluate the construction of expression vector for fusion protein of cell-penetrating pep-tide CCL (PEP-CCL).Methods CCL6-PEP-6XHis was inserted into plasmid pABP,pABP-CCL6-PEP plasmid was extracted and then transfected into HEK293 cells,CCL6-PEP-6XHis was expressed and purified by chromatog-raphy and detected with Western Blot.Results PEP-CCL express vector was successfully constructed and purified. PCR product of CCL6-PEP-6XHis Tag was ligated with T vector,recombinant was transferred into the host cells, then host cells were cultured,plasmid was extracted and sequenced,the sequence was identical to targeted gene. CCL6-PEP-6XHis was successfully inserted into the eukaryotic expression vector pABP,plasmid was extracted and digested,electrophoresis results revealed that a fragment with 430bp was digested by Hind Ⅲ+XbaⅠ,which was identical to the expected value.Western Blot revealed that CCL6-PEP fusion protein could be recognized by His monoclonal antibody.Conclusion PEP-CCL express vector can be constructed and expressed in eukaryotic cells.

Objective To compare the urodynamic parameters in female patients with incontinence with or without pelvic organ prolapse. Methods The urodynamic data from 140 patients diagnosed urinary incontinence and another 42 patients coexisted with pelvic organ prolapse were reviewed and analyzed. The urodynamics parameters were compared in perfusion, urination, bladder compliance, maximum urinary flow rate (Qmax), detrusor muscle pressure of maximum urinary flow rate (Pdet,Qmax), minimum urinary flow rate(Pdet, Qmax), urethral resistance factor (RUA), obstruction of bladder index (OBI) and normalized detrusor contractility. The influence of pelvic organ prolapses with incontinence on bladder filling and voiding function was evaluated also.Results There were no significant differences between 140 patients of urinary incontinence and 42 patients coexisted with pelvic organ prolapse in perfusion (P=0.142), bladder compliance (P=0.273), Qmax(P=0.192),Pdet (P=-0. 629), Qmin (P=0.365) and normalized detrusor contractility (P=0.380). There were significant differences in age(P=2.2×10-5), urination(P=0.034), Pdet.Qmax(P=0.045), RUA(P=0.018), OBI (P=0.017). Conclusions There is not clinically significant change in urine storage function of bladder in patients with pelvic organ prolapse, but the parameters of voiding function of bladder may existe difference. The increased bladder outlet resistance and postvoid residual urine are noticed in patients with pelvic organ prolapse.

Objective To explore the classification and risk factors of nocturia in patients with benign prostatic hyperplasia (BPH). Methods The 120 males aged 60 years old and over were enrolled who were first diagnosed as BPH or had ceased the BPH medication for at least 3 months.The patients were divided into six groups according to the nocturnal voiding episodes estimated according to the international prostate symptom score (IPSS). All 120 males were inquired about general information and medical histories. The time and volume of intake and voided urine were recorded for 72 hours. The indexes of prostate and bladder function in all cases were also examined and recorded. Results The incidence of nocturia in our study was 79.2%, the incidence of nocturnal polyuria and overactive bladder were 3.3% and 10.8%, respectively. The quality of life was affected by the duration between the time of patients' going to bed and the first time getting up at night. After excluding the cases of nocturnal polyuria and overactive bladder, statistical analysis indicated that the age, and residual urine volume of the bladder were positively associated with nocturia frequencies (NF), the nocturnal voiding volume negatively with NF, while the prostate volume and peak flow rate were not associated with NF. Drinking volume in 24-hours affected the nocturia (P＜0. 01). Conclusions Nocturia is a common complaint in elderly males with BPH and significantly affects the quality of life. The age and the storing function of bladder are more important factors as compared with prostate hyperplasia itself.

Objective To improve the finding of prostate cancer (PCa) and prevent the unnecessary biopsies, we select proper patients for biopsy and analyze. Methods The retrospective study included 258 patients who were biopsied for suspected early PCa. Then we analyse how the age, prostate volume, PSA, transrectal ultrasound sonography (TRUS) and MRI affect the finding of prostate cancer. Results Altogether 146 BPH and 112 prostate cancer by biopsy were detected. Positive ratio of biopsy was increased with the age or PSA increases but has no relationship with the prostate volume. Combination with digital rectal examination, PSA and TRUS, the positive ratio was improved and unecessary biopsies were avoided. The detective rate reached 84.6% when all of these three parameters were positive. The sensitivity of MRI was 98.3% but specificity was only 22.4%. The total efficacy was 21.8%. Conclusions The effect of DRE, PSA and TRUS in the screening of prostate cancer should be emphasized. However, importance of MRI is limited for the early detection of PCa.

Objective: To identify the influence of extracts and active components of Rhizoma Coptidis on gastric smooth muscle contractility of guinea pigs, and to explore the potential pharmacological mechanism of Rhizoma Coptidis in "invigorating the stomach" and "impairing the stomach". Methods: Observing the effects of the water extract and the alkaloids from Rhizoma Coptidis (at doses ranging from 0.3 to 1 000 mug/L) and other active components such as berberine, palmatine and jatrorrhizine (at doses ranging from 0.3 to 1 000 mumol/L) on the spontaneous and electrical field stimulation (EFS)-induced contractions of antral circular smooth muscle strips from guinea pig stomach via a force transducer in vitro. Results: The water extract or the alkaloids from Rhizoma Coptidis could improve the spontaneous contraction at the low doses, but inhibit the spontaneous contraction at the high doses. Berberine, palmatine and jatrorrhizine also showed the similar effects. Moreover, the water extract and the alkaloids of Rhizoma Coptidis, as well as berberine, palmatine and jatrorrhizine could increase the EFS-induced contraction. Among the three monomers, jatrorrhizine exhibited the most potent effect on EFS-induced contraction. Conclusion: The effects of Rhizoma Coptidis in "invigorating the stomach" or "impairing the stomach" may be related to its effect on gastric smooth muscle contractility. Berberine, palmatine and jatrorrhizine are all effective components of Rhizoma Coptidis affecting the contraction of gastric smooth muscle, among which jatrorrhizine is the most potent agent in promoting the contraction while berberine is the most potent one for inhibiting the contraction.

Objective To observe the efficacy of finasteride and M-receptor antagonist (tolterodine tartrate release tablet) in patients with benign prostatic hyperplasia (BPH) with overactive bladder (OAB).Methods 40 patients with BPH and OAB were treated with finasteride (5 mg,Qd) and tolterodine tartrate release tablet (4 mg,Qd) for 6 months.The clinical effects were evaluated by the International Prostate Symptom Score (IPSS),Overactive Bladder Symptom Score (OABSS),urgency rating scale,maximum flow rate,voiding volume,prostate volume before and after treatment.Results Compared with before treatment,the IPSS,OABSS,urgency rating scale,maximum flow rate,voiding volume,prostate volume were improved [(11.8±1.4) vs.(19.2±2.1),(4.6±2.6) vs.(9.3±1.8),(1.2±1.9) times/week vs.(4.7±1.0) times/week,(14.5±2.7) ml/s vs.(10.2±2.2) ml/s,(25.2±2.6) ml vs.(34.6±3.2) m1,(46.2±2.2) ml vs.(57.6±1.3) ml,all P＜0.05] after treatment.No urinary retention and other adverse reactions were found.Conclusions Finasteride combined with M-receptor antagonist (tolterodine tartrate release tablet) is an effective and safe therapeutic method for patients with BPH and OAB.

Objective To compare the efficiency between mini-percutaneous nephrolithotomy (MPCNL) and extracorporeal shock wave lithotripsy (ESWL) for monotherapy of renal calculi in infants less than 3 years.Methods Forty-six infants were treated with either SWL (22 infants) or MPCNL monotherapy (24 infants).The mean age was (22.6 ± 8.7) months vs (23.5 ± 6.6) months and the stone size was (21.4 ± 3.5) mm vs (21.7 ± 1.7) mm,and there were no significant difference.Results For MPCNL,mean operating time was (76.2 ± 23.4) min and mean hospital stay was (14.13 ± 5.8) d.The stone-free rates were 84.0％ (21/25) after first session and 96.0％ (24/25) after second-look procedure.Postoperative fever happened in 4 (16.0％) cases.Hemoglobin drop was (8.5 ± 4.4) g/L and no one needed blood transfusion.For ESWL,the stone-free rate were 31.8％ (7/22) after first session and 86.3％ (19/22) after second session for 11 infants (50.0％).Mean hospital stay was (6.6 ± 2.3) d and 10 cases (45.5％)had complications.Hemoglobin drop was (10.6 ± 12.7) g/L.MPCNL was lower than ESWL in complications rate and re-treatment rate,and the stone-free rate was higher,but the hospital stay and operation time was longer (P ＜ 0.05).GFR revealed improve or stable after operation in both groups.Conclusions For a higher success rate,lower complication rate and re-treatment rate,MPCNL was an effective option for the management of relatively larger stones in children (even in infants).

Objective To investigate the effect of endoscopic management of upper tract urothelial carcinoma (UTUC),and evaluate the indication and clinical value of postoperative prophylactic pelviureteric instillation chemotherapy.Methods Patients who met the inclusion criteria included elderly patients,patients who could not tolerate radical surgery,patients with renal insufficiency or needed dialysis after removal of the kidney,patients with bilateral UTUC,patients with tumor≥3 cm in diameter but could be completely resectted under ureteroscopy who required to preserve renal function.Surgical procedure was successful.The ureteral stents were placed,and prophylactic ureteral infusion chemotherapy via the retrograde transvesical ureteric catheterisation was conducted 1-2 times one week at 2 days after surgery.40 milligram of pirarubicin hydrochloride or epirubicin hydrochloride was dissolved in 40 milliliter sterile water for the prophylactic infusion chemotherapy.These instillations were completed within 40 minutes.Results Totally,9 patients (3 males and 6 females) aged 60-86 years,mean age of (69.7±6.4) years,were enrolled in this study.The carcinoma of the renal pelvis was found in 2 cases and ureteral tumors in 7 cases.In pathological results,ureteral polyps was found in 1 case,papillary ureteral neoplasm with low malignant potential in 2 cases,urinary tract epithelial carcinoma in 4 cases (1 case with poorlydifferentiation,1 case with well-differentiation,2 cases with urinary tract epithelial cancer),and 2 cases were lack of pathological reports because of too few pathologic specimens.4 patients received adjuvant chemotherapy by instillation successfully,and lumbago,fever or other complications were not found.Patients were followed up for a mean period of 15 moths (4-31 months).Only 1 patient had recurrence of bilateral ureteral tumor 15 months after surgery,and no tumor recurrence was found in other patients.Conclusions Endoscopic management is a safe and effective in treating UTUC,which can preserve renal function by avoiding nephrorectomy in some patients.The instillation chemotherapy after endoscopic management is safe,which has a satisfactory effect,but further validation in a large clinical sample is needed.Patients with tumor resection under ureteroscopy who cannot obtain the pathology results need to be closely followed up.

Objective To evaluate the clinical significance of tension-free vaginal tape(TVT) procedure in the treatment with elder female stress incontinence(SUI). Methods Six patients with proven SUI were undergone the TVT with SPRAC. Results Six patients were operated under low spinal anesthesia. Mean operation time was 31.6 minutes and the mean blood loss was 36.2 ml. Five patients were able to micturate spontaneously within 24 hours after operation. One patient with fatty and vaginal colpoptosis was in-dwelling catheter for one week. Patients were followed-up for 10-28 months. Five patients were completely cured and one patient was failed after operation three months. Two patients were de novo urgency. One patient complained of persistent suprapubic discomfort. Conclusions The tension-free vaginal tape operation is a safe and effective surgical procedure for the treatment of urinary stress incontinence with fatty vaginal colpoptosis in elderly females.