Objective To observe the results and reality of transurethral resection of bladder tumor(TUR-Bt) with upside down loop and plsamakinetic in the prevention of obturator nerve reflex.Methods A total of 211 patients with lumbar anesthesia received TUR-Bt.Firstly,the tumor tower above bladder wall was cut with the traditional way.When intraoperative findings were obturator nerve reflex,or to the obturator nerve mapping area,operation should be changed to superimpulse plasma column electrode vaporization to cut off residual tumor tissue,then after flipping the loop,the residual tumour was resected with upside-down loop from the tumour side wall.Results In 211 cases,192 cases had a little obturator nerve reflex,but the movement of body was not obvious,which did not influence the operation.The serious complication,such as perforation of bladder and injury of nerve and vessel,did not occur.Conclusions The lateral resection of bladder side wall tumour with upside-down loop can effectively avoid strong obturator nerve reflex,which is safe,uncomplicated,and efficacious and it does not increase the additional outlay and hurt.

Objective To investigate the effect of allicin on the development of atherosclerosis in apoE-/-mice and explore its underlying mechanism from the perspective of protein S-nitrosylation.Methods Thirty male apoE-/- mice were randomly divided into 3 groups:control group (saline,ig),low-dose group (allicin,9 mg/kg·d, ig)and high-dose group (allicin,18 mg/kg·d,ig).They were fed with high cholesterol diet for 12 weeks.The levels of plasma lipids,oxidized-LDL (ox-LDL),malondialdehyde,tumor necrosis factor-alpha and nitric oxide (NO)were measured.The atherosclerotic lesions in aortic root were evaluated after hematoxylin and eosin staining and elastica van Gieson and immunohistochemical staining,respectively.Furthermore,in vitro experiments were performed using human umbilical vein endothelial cells (HUVECs).The HUVECs were treated with allicin (10μmol/L or 20 μmol/L)for 24 hours in the presence of ox-LDL (50 μg/mL).The level of NO in supernatant was measured by a nitrate/nitrite assay. The protein S-nitrosylation of the HUVECs was detected through immunofluorescence.Results The histological analysis revealed that allicin treatment not only significantly decreased the areas of the atherosclerotic lesion (all P <0.05)but also suppressed the macrophage accumulation and smooth muscle cell proliferation in the lesion.There was no significant difference in the levels of plasma lipids between control and treated groups.However,allicin exerted obvious anti-oxidative and anti-inflammatory effects. Interestingly,the allicin treatment led to marked increase of the plasma NO level (P <0.05)and aortic protein S-nitrosylation.The experiments in vitro further proved that the allicin up-regulated the levels of NO and protein S-nitrosylation in HUVECs treated with ox-LDL (P < 0.01 ).Conclusion Allicin can inhibit the development of atherosclerosis.The mechanism is associated with the up-regulation of protein S-nitrosylation in endothelial cells, which plays an important role in anti-oxidization and anti-inflammation.

ABSTRACT:Objective To analyze the correlation between plasma nitric oxide (NO)level and atherosclerotic lesion in high cholesterol-fed (HCD ) rabbits.Methods Twenty male Japanese white rabbits were divided randomly into two groups,which were fed with normal diet (control group,n =10)or HCD (experimental group, n =10 )for 1 6 weeks.At the end of the experiment,plasma lipid and NO levels were measured.The gross atherosclerotic lesions in each group were detected by Sudan IV staining while intimal lesion area was measured by hematoxylin/eosin (HE)and elastica van gieson (EVG).Moreover,the macrophages (MΦ)and smooth muscle cells (SMC)were detected by immunohistochemical staining.The correlation analysis was made to reveal the relationship between atherosclerotic lesions and plasma NO level.Results Compared with those in control group, the total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C)and NO levels all increased significantly in experimental group.Atherosclerotic lesions appeared on the vascular wall in the latter group.The area of atherosclerotic lesions and MΦ in the plaque had a positive association with plasma NO level. Conclusion There is a relationship between plasma NO level and the size of HCD-induced atherosclerotic lesions in rabbits.Meanwhile,the MΦ positive area in the atherosclerotic plaque is also associated with plasma NO level in cholesterol-fed rabbits,suggesting that plasma NO level may be associated with the occurrence and progress of early atherosclerosis.

Objective:To investigate the feasibility and safety of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma.Methods:The clinical data of 12 patients from January 2018 to November 2019 with unilateral retrograde nephroureterectomy were analyzed retrospectively. There were 7 males and 5 females with an average age of 65.9 years, the age ranged from 50 to 78 years.There were 8 cases with left ureteral tumor, 6 cases with left renal pelvis tumor, 4 cases with right tumor(2 cases of right ureteral tumor and 2 cases of right renal pelvis tumor). Surgical methods: 1470 laser sleeve was used to remove the inner segment of the ureter bladder wall after the lower ureter was clipped through abdominal approach, and the urethra was inserted under the guidance of zebra guide wire.The operation time, intraoperative blood loss, intraoperative auxiliary cannula, postoperative hospital stay, postoperative drainage tube removal time, intraoperative and postoperative complications, postoperative pathology were recorded.Results:All of the operations were successful. The mean operation time was 194(135-260)min, the mean estimated blood loss was 50(25-100) ml, and the mean hospitalization time was 11.6(5-24)d. Among the 12 patients, 8 patients had abdominal drainage tube after operation. The mean time for drainage was 6.8(3-11)d. One patient added a 5 mm ancillary port.One patient had urinary leakage at the bladder anastomotic site, the catheter was removed 3 weeks later. The other patients had no postoperative incision infection, fever, bleeding, venous thrombosis and other related complications.No patient received blood transfusion and the pathological margin was negative. The median follow-up time was 12 months (5-15 months). One patient died of lumbar metastasis 8 months after operation, and others were neither tumor recurrence nor distant metastasis.Conclusions:The application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma is safe, accurate and effective, with less trauma and less bleeding. It is worth applying in clinical practice.