Objective: To summarize our initial experience on single-incision laparoscopic ureterolithotomy in 6 patients, and to evaluate the efficacy and safety of this procedure. Methods: From Jun. 2009 to Jul. 2009, single-incision laparoscopic ureterolithotomies were performed in 6 patients who had a ureteral calculus. The clinical data and operative results were summarized retrospectively. Results: All 6 operations were performed successfully, with no conversion to an open procedure; neither an extra trocar for assistance was needed. No intraoperative complications were noticed. The average operative time was (93.5±30.4) min, the average estimated blood loss was (28.5±16.2) ml, and the average postoperative hospital stay was (5.4±1.1) d. Conclusion: Single-incision ureterolithotomy appears to be safe and effective, and has less trauma and better cosmetic outcomes; but it seems to be more difficult for the surgeon to operate.

Objective: To summarize our experience on laparoscopic radical prostatectomy via single incision in treatment of early localized prostate cancer. Methods: From June 2009 to August 2009, five patients with localized prostate cancer(T1c) received laparoscopic radical prostatectomy via single incision. A home-made multichannel port was inserted extraperitoneally through a 3 cm incision under the umbilicus. A 10 mm TROCAR and two 5 mm TROCAR were inserted. The prostate was isolated and excised, then the bladder urethral anastomosis was performed. Results The procedures were successful in all the five cases with no transversion to open or standard laparoscopic approach. The mean operating time, the mean operative time for prostate excision, and the mean time for urethrovesical anastomosis were (167±31. 5) min(ranging 135-210 min), (115±26) min (ranging 90-150 min), and (52±5. 7) min(ranging 45-60 min), respectively. The estimated blood loss averaged (90±62) ml (ranging 50-200 ml). Positive margin occurred in one case. Transient incontinence occurred in two cases after the catheter was removed one week later. All patients had a prostate-special antigen level < 0. 2 μg/L during a follow-up of 4-12 weeks. Conclusion: Laparoscopic radical prostatectomy via single incision is feasible and safety. Excellent instruments and skilled surgeon are the keys for the success of the operation.

Objective: To perform trans-peritoneal laparoscopic adrenalectomy via a single incision in treatment of adrenal tumors, and to discuss its clinical outcome and safety. Methods: Single incision trans-peritoneal laparoscopic adrenalectomy was used in treatment of three patients with adrenal tumors. The incision was made 3 cm below the costal margin of anterior axillary line; three Tocars were placed in the cut. The instruments used included single port access, CUSA, Hem-o-lok, etc.. Results: The three operations were all successful, and there were no conversion to open procedure or a need for extra Ttrocars. The operating time periods were 75, 116, and 135 min, with a mean of (108.7±30.7) min. The perioperative blood losses were 10, 20, and 30 ml, with a mean of (20±10) ml. The gastric canal and ureteral catheter were withdrew one day after operation, and the drainage tube was withdrew 3 d after operation. The mean postoperative hospital stay was 4 d. Conclusion: Single incision trans-peritoneal laparoscopic adrenalectomy has the advantage of little trauma, less blood loss, satisfactory safety, and prompt postoperative recovery, but is difficult to manage.

To observe the anti-tumor effect of adoptive immunotherapy with CTL induced by PSA-pulsed dendritic cell vaccine against prostate cancer in mice. Methods: Nude mice were s. c. inoculated with LNCaP tumor cells to establish prostate cancer model. CTL induced in vitro by different peptide-pulsed dendritic cells (Non-DC,Ova-DC,Lys-DC and PSA-DC) were used for adoptive immunotherapy of experiment nude model through vena caudalis on d 15 and d 22 after inoculation. The survival of nude mice and the sizes of tumors were observed with d 50 after the initial treatment as the endpoint. Results: The tumor sizes in Non-DC, Ova-DC, Lys-DC and PSA-DC groups on d 30 and d 50 after adoptive immunotherapy were significantly larger than that at d 15 after inoculation (P<0. 01). The tumors sizes in Lys-DC and PSA-DC groups were significantly smaller than those in the Non-DC and Ova-DC groups(P<0. 01). The survival periods of animals in Lys-DC and PSA-DC groups were significantly longer than those in the Non-DC and Ova-DC groups (P<0. 01). Conclusion: Adoptive immunotherapy with CTL induced by DC-based PSA vaccine can inhibit the growth of prostate cancer LNCaP cells in nude mice and increase the survival of the animals.

Objective: To construct of PSA-specific dendritic cell (DC) vaccine and to observe its in vitro anti-tumour activity, so as to pave a way for future study. Methods: Bone marrow precursors were isolated and bone marrow derived DCs were prepared. Mature DCs were pulsed by PSA, Lysate of cancer cells, OVA and PBS to yield PSA-DC, Lys- DC, Ova-DC, and Non DC, respectively. After primed by antigen, the changes of IL-12 p70 and IL-1β in the supernatant of dendritic cells were assessed by ELISA. The antigen-specific proliferation and cytotoxicity activity of T cell-primed by PSA-pulsed DCS were observed and the results were compared with those by Lys-, Ova- and PBS-pulsed DCs. Results: Mature DCs were successfully derived from bone marrow cells with a purity higher than 95%. ELISA assay showed PSA-DC, Lys-DC and Ova-DC group secreted high levels of IL-12 p70 and IL-1β than Non-DC group (P < 0.05). In addition, PSA-DCs and Lys-DCs had significantly stronger ability to stimulate the proliferation of CD4+ T cells in 3-day classic mixed lymphocyte reaction (MLR) compared with Ova-DCs and Non-DCs (P<0.01). Higher levels of IFN-γ and IL-2 were detected in PSA-DCs and Lys-DCs groups compared with the other two groups (P<0.01), whereas the levels of IL-10 and IL-4 were lower than the other two groups (P<0.05). Moreover, PSA-DCs and Lys DCs enhanced DTH responses of C57BL/6 mice after antigen immunization; the third antigen and control did not show the enhancement effect (P<0.05). To observe the in vitro anti-PSA CTL reactions induced by PSA-DCs and Lys-DCs, the LNCaP cell line (PSA specific) was used as syngeneic target and the E. G7 cell line (H-2b) was used as Ova-specific target cells. Compared with Ova-DCs and Non-DCs, CTL cells induced by PSA DCs, Lys-DCs had significantly enhanced antigen-specific CTL activity to LNCall cells (P<0.05). Conclusion: DC-based PSA-epitope vaccine can be prepared by pulsing DCs with PSA protein; the prepared vaccine has strong in vitro immune activity and can kill LNCaP cells.

The last ten years have witnessed a rapid development in laparoscopic surgery for urology, but there are still many specific problems need to be discussed concerning the operation procedures. From October 1998 to August 2006, 509 patients have received laparoscopic surgery in our department. Our experience is summarized as following: (1) Compared with the peritoneal approach, the retroperitoneal approach is faster in exposing the operative field and more experience from the open operation could be used, so retroperitoneal approach should be recommended unless for a few difficult cases or cases need to be treated bilaterally. (2) In radical nephrectomy, the kidney should be completely removed including the lymph nodes. Open operation should be considered if the diameter of the tumor is more than 10 cm. Adrenal gland resection should not be considered unless the tumor locates in the upper pole. In radical resection of the renal pelvic carcinoma, attention must be paid to prevent tumor metastasis into the ureter. The kidney vessels must be separated in the nephrectomy operation and the use of hemo-lock is recommended to block the kidney artery. (3) Laparoscopy is a golden standard for adrenalectomy; the operation procedure should be chosen according to the property, location, involvement, and blood supply of the tumors. (4) Whether to use laparoscopic surgery or not for patients warranting difficult surgeries such as radical prostatectomy should be decided considering the general condition of the patients and the skills of the surgeons. As for operations for varicocele, we do not recommend laparoscopic surgery because it can be readily treated with open operation.

Objective To investigate the protective role of losartan,an angiotensin Ⅱ receptor(AT1 type)blocker,in the mechanical ventilation-induced lung injury(VILI).Methods Forty Sprague-Dawley rats weighing 300-350 g were randomly divided into the following four experimental groups(10 rats in each group):control group(group A),normal tidal volume venti-lation group(group B),large tidal volume mechanical ventilation group(group C),large tidal volume mechanical ventilation plus Losartan pretreatment group(group D).The pulmonary tissues were removed for pathological examination and detection of NF-κB activity,and the lung lavage fluid was collected for analysis of white blood cell count,total protein concentration and the level of MIP-2,after the rats were sacrificed.Results The pathology of lung tissues was normal in groups A and B.There was obvi-ous inflammatory damage in lung tissues in group C.The pathological inj uries of lung tissue were significantly reduced in group D compared with group C.The NF-κB activity and the level of p65 were significantly higher in group C than in groups A and B (P<0.01);they were significantly reduced in group D compared with group C(P<0.05).Total protein concentration,the MIP-2 level and the white blood cell count were significantly higher in group C than in groups A and B(P<0.01).They were significantly reduced in group D compared with group C(P<0.05 or 0.01).Conclusion Losartan,a selective inhibitor of sub-type AT1 receptors for angiotensin Ⅱ,can relieve VILI by inhibiting the activity of NF-κB.

Aim To investigate the protective effects of omapatrilat on human umbilical vein endothelial cells (HUVECs) injury induced by angiotensin Ⅱ (AngⅡ) in culture. Methods Cultured HUVECs were randomly divided into 4 groups:①control; ②AngⅡ;③omapatrilat and ④AngⅡ+omapatrilat. Lactate dehydrogenase (LDH) leakage was evaluated by spectrophotometer and cell cycle by flow cytometry (FCM); Nitric oxide (NO) was measured by colorimetry and endothelin-1 (ET-1) by radioimmunoassay. Results 10 -7 mol?L -1 AngⅡ significantly increased LDH leakage and ET-1 release, and this increase was inhibited by omapatrilat (10 -6 mol?L -1). Omapatrilat promoted HUVECs proliferation and NO release. Conclusion Omapatrilat can protect human umbilical vein endothelial cells injury induced by angiotensin Ⅱ in culture, suggesting that it may play an important role in prevention and treatment of vascular diseases.

Objective To study the prevalence of toenail onychomycosis in the patients with diabetes mel-litus. Methods The incidence and predisposing factors of onychomycosis were studied in the in- and out-patients with diabetes mellitus(n = 456). The data were also compared with non-diabetic patients (control group, n = 350). Results The prevalence rates of toenail onychomycosis were 20.8% and 9.4% in the diabetics and control group, respectively, with statistical difference (P

Objective To analyze the impacts of early enteral nutrition (EN) and parenteral nutrition (PN) on the prognosis of acute pancreatitis.Method By searching relevant literature between January 1996 and August 2013 in Chinese and English databases including Wanfang,VIP,CNKI,PubMed,the Cochrane Library,CBM,and EMABSE,we compared the prognosis of acute pancreatitis after EN or PN in terms of casefatality rate,infections,multiple organ failure,and other complications.Result Compared with PN,early EN significantly reduced the case-fatality rate [OR =0.37,95％ CI (0.23,0.58),P ＜ 0.000 1],decreased the infection rate [OR =0.24,95％ CI (0.15,0.39),P ＜0.000 01],shortened hospital stay [MD =-9.87,95％ CI (-10.84,-8.89),P ＜ 0.000 01],and reduced complications [OR =0.26,95％ CI (0.12,0.58),P =0.001 0] in patients with acute pancreatitis,although the incident of multi-organ failure showed no significant difference [OR =0.35,95％ CI (0.10,1.19),P =0.09].Conclusions For patients with acute pancreatitis,early EN is superior than PN in terms of case-fatality rate,infection rate,hospital stay,and complications.Therefore,it should be applied in such patients whenever condition allows.