Objective　To evaluate the status of urological laparoendoscopic single-site surgery (LESS) technique in China.　Methods　We had conducted a systematic review of literatures of urological laparoendoscopic single-site surgery published from Chinese institutions using WanFang,CNKI,VIP,CBM,GoogleScholar and MEDLINE databases.All relevant articles were selected with consensus and analyzed according to the inclusion and exclusion criteria.　Results　Overall,205 articles from 66 different centers all over China published between January 2009 and June 2012 were included in the analysis. Of which,there were 26 articles of science citation index papers and 179 articles from Chinese academic journals.The included literature was mainly composed of case series reports ( 133 articles,64.9％ ),comparison studies (13 articles,6.3％ ),reviews or comments (20 papers,9.8％ ),nursing related papers (28 pieces,13.7％ ),animal surgery studies (6 articles,2.9％ ),and training (5 articles,2.4％ ).A total of 1790 clinical cases were reported during the study period,56.9％ of these were procedures done in the upper urinary tract,only 5.8％ were in the lower urinary tract,and 37.3％ were genital or other procedures.Procedures of tumor-related and reconstruction required accounted for 18.8％ and 18.7％,respectively.Pure single-port technique was applied on 58.3％ of cases.In cases of a single-port platform used,45.6％ used the commercially available devices and 54.4％ used homemade devices.Transperitoneal accesses were adopted in 59.5％ of cases and the other 40.5％ were performed through extraperitoneal approaches.The umbilicus was used as the site of access in 58.5％ of cases.A total of 25 indications were reported,including adrenalectomy,nephrectomy and ureterolithotomy,etc. in the upper urinary tract,radical cystectomy,radical prostatectomy and transvesical enucleation of the prostate,etc.in the lower urinary tract,and varicocelectomy,orchidopexy and others. The three most often done procedures were varicocelectomy (601　cases,33.6％ ),renal cyst decortication (408 cases,22.8％ ) and adrenalectomy ( 179 cases,10.0％ ).The overall conversion rate was 5.5％,and complications were encountered in 3.4％ of cases.　Conclusions Laparoendoscopic single-site surgery has been widely adopted by Chinese urologists and largely covered the spectrum of conventional urologic laparoscopic procedures,with most of these being non-reconstructive operations for the treatment of benign diseases.In large,we are still under the initial stage of LESS application in urology.And more work on creative innovation and well-designed studies are needed to further evaluate its role in the urological minimally invasive surgery.

ObjectiveTo study the clinicopathologic features of post-transplant lymphoproliferative disorders (PTLD).Methods Three cases of PTLD in renal transplant recipients were studied.The clinical data,diagnosis and differential diagnosis,and relevant literatures were also reviewed.Results All the 3 cases studied had received cyclosporine A or Tac after transplantation.The duration between organ transplantation and diagnosis of PTLD was 10 years,4 years and 2 months respectively.Two cases were suffered from monomorphic PTLD and 1 from plasmacytic hyperplasialike PTLD in morphology.Two cases of monomorphic PTLD died within one year after diagnosis.Conclusion PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics.The main treatments included the dosage reduction of immunosuppressive agents,radiotherapy and chemotherapy.The prognosis of monomorphic PTLD was poor.

Objective To study the clinical effect of adenosine triphosphate and spermatic vein ligation combined treatment of children with primary varicocele disease.Methods80 cases of children with primary varicocele disease who were treated in pediatric surgery department of Hangzhou City Yuhang District MCH from May 2014 to May 2016 were selected, these children were divided into adenosine triphosphate and spermatic vein ligation combined treatment group (combined treatment group, n= 40) and spermatic vein ligation treatment group (monotherapy group, n=40) two groups according to the random number table, the postoperative pain score, gastrointestinal recovery time, hospital stay, cost of hospitalization, incidence of complications and recurrence of the two groups were statistically analyzed.ResultsThe postoperative pain score and hospitalization cost of the combined treatment group were significantly lower (P<0.05), the gastrointestinal function recovery time and hospital stay were significantly shorter (P<0.05), the incidence of complications 2.5% (1/40) was significantly lower than the monotherapy group 17.5% (7/40) (P<0.05), the recurrence rate 2.5% (1/40) was significantly lower than the monotherapy group 10.0% (4/40) (P< 0.05).ConclusionThe clinical effect of adenosine triphosphate and spermatic vein ligation combined treatment of children with primary varicocele disease is better than spermatic vein ligation treatment alone, so is worthy of promotion in the clinical.

A new method to revel RFLPs is presented. The human genomic DNAwas purified by saturatedNaCl solution and the pAW101 probe labelled with digoxigenin-dUTP. The relationships of RFLPsand genetic patterns of PGM1 (phosphoglucomutase),EsD (esterase D),GLO1 (glyoxalase)and ACP(acid phosphatase ) between the fillal generation and parental generation were detected in 15 families(among them 11 cases were aborted fetuses). The probability of paternity (w)was caculated accor-ding to Essen - Moller's formula, each w vlua was over 99. 73 %, reached the standard of incladingpaternity. An effective,rapid, and non-toxic RFLPs technique was established, which is easy to man-age in common lab oratories.

Objective To investigate the diagnosis and treatment of hepatic metastasis from gastrointestinal stromal turnor(GIST).Methods The clinical data of 16 patients with GIST who had been admitted to our hospitalfrom December 1993 to May 2007 were retrospectively analyzed.Results Of all patients,14 underwent radical resection and 2 underwent palliative operation.Two patients with palliative operation and 3 with radical resection were administered with imatinib postoperatively. All patients were followed up for 3-161 months,and GIST metastasis and invasion was observed in 8 of the 14 patients who received radical resection.Of the 7 patients with hepatic metastasis.3 were treated with hepatic artery chemoembolization,1 was administered with imatinib,2 received reoperation and 1 did not receive any treatment. Reoperation was carried out on 1 patient who had abdominal wall metastasis.The 1-and 3-year survival rates of the 16 patients were 92%and 74%,respectively.Conclusions The recurrence rate of GIST after hepatectomy is high.Complete surgical resection is the best curative treatment for hepatic metastasis from GIST and GIST recurrence.The combination of surgical resection and imatinib administration may help to improve the prognosis of patients with hepatic metastasis from GIST.

ObjectiveTo observe the expression of nephrin in hepatitis B virus-associated membranous nephropathy (HBV-MN),and investigate the impairment and significance of podocyte in HBV-MN.MethodsThe protein expression of nephrin in renal biopsy specimens in 35 patients,who were diagnosed as HBV-MN by renal biopsy,was determined by immunohistochemistry and tested by semiquantitative method.The relationship between the expression of nephrin and clinicopathological data was analyzed.Results Among the 35 cases with HBV-MN,6 were in MN phase Ⅰ,20 in MN phase Ⅱ and 9 in MN phase Ⅲ.A strong intensity expression of nephrin in normal glomerulus was found along capillary loop of glomerulus,while its expression in HBV-MN patients decreased obviously.There was no significantly difference in the expression of nephrin among the different stages of HBV-MN ( P ＞ 0.05 ).The expression of nephrin in different clinical types was significantly different ( P ＜ 0.05 ).The expression of nephrin in patients with nephrotic syndrome was significantly lower than that in patients without nephrotic syndrome (P ＜0.01 ).The expression of nephrin in different grades of 24-hour urinary protein excretion quantity was significantly different( P ＜ 0.05 ).There was negative correlation between the expression of nephrin and 24-hour urinary protein excretion quantity(r = -0.378,P ＜ 0.05).In the patients with HBV-MN phase Ⅱ,the expression of nephrin in patients with nephrotic syndrome was also significantly lower than that in patients without nephrotic syndrome( P ＜ 0.01 ).Conclusions The damage of podocytes emerge in the early stage of HBV-MN and the expression of nephrin in HBV-MN patients,especially in patients with nephrotic syndrome,are significantly down regulated.The descended expression of nephrin in HBV-MN patients may promote the production of proteinuria.

Objective To analyze and identify the differentially expressed proteins in human renal tubular epithelial cells (HK-2) after injury caused by oxalic acid and calcium oxalate monohydrate (COM) crystal, and to explore the potential role of renal tubular cell injury in kidney stone formation.Methods Normal HK-2 cells were cultured in vitro and the culture medium was changed with serum-free medium after cell growth to confluence. Oxalic acid and COM crystals (final concentration at 2 mmol/L and 200 mg/L, respectively) were added in the experimental group. Cells in both groups were then incubated at 37 ℃ for 12 h. The extracted proteins from both groups were separated by two dimensional electrophoresis followed by analysis, and the differentially expressed proteins were identified by liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS). Two identified proteins were then verified by western blot. Results Reproducible two dimensional gel images of the proteins from both groups were successfully obtained. By using LC-ESI-MS/MS, 12 proteins: FK506-binding protein 4, isoform alpha-enolase of alpha-enolase, isoform M1 of pyruvate kinase isozymes M1/M2, ATP synthase subunit alpha, isoform 1 of 3′(2′), 5′-bisphosphate nucleotidase 1, isoform 2 of nucleophosmin, L-lactate dehydrogenase B chain, Budding uninhibited by benzimidazoles 3, Cofilin-1, Fascin, pyIsoform 1 of cytosol aminopeptidase, were identified. The deferentially expressed proteins were related to cellular processes including energy metabolism, cell multiplication, apoptosis, Ca2+ channel activity regulation, cell movement and signal transduction. Western blot verified that higher ENO1 but lower Cofilin-1 expressed in HK-2 cells after the injury. Conclusions High level oxalic acid and COM crystals can cause protein expression profile changes in normal human HK-2 cells. The changes of protein expression may not only protect HK-2 cells from being injured, but also be related to kidney stone formation.

Objective To explore the significance of peritubular capillary C4d deposition in histopathological changes, renal function and prognosis of the patients with antibody-mediated chronic rejection (AMCR). Methods Deposition of C4d in the kidney was examined by irnmunohistochemistry on routine paraffin-embedded sections using anti-C4d polyclonal antibody. Seventy-seven patients were divided into C4d+ group (n = 35) and C4d- group (n = 42). The relationship of C4d and renal function,histopathological changes and prognoses of allografts were analyzed. Results The number of patients with tubular atrophy and glomerular basement membrane proliferation in C4d+ group was significantly more than that in C4d group (P＜0.05). Mean serum creatinine level was significantly higher in C4d+ group than in C4d- group 12 months after renal transplantation [(379.1 + 260.2)μmol/L vs (260.5 + 175.3) μmol/L, P＜0.05]. According to Kaplan-Meier analysis, the one-year graft survival rate was lower in the C4d+ group (62.9% ) than in the C4d- group (83.3% ) (logrank P＜0.05). Conclusion Patients with C4d deposition are associated with tubular atrophy and glomerular basement membrane proliferation. The serum creatinine level in C4d+ patients was significantly higher than in C4d- group at the 12th month after transplantation. More patients with C4d deposition lost their grafts during the study period.

Purpose To investigate the corre1ation of the epiderma1 growth factor receptor( EGFR)gene mutation and amp1ification and protein expression with occurrence and deve1opment of non-sma11 ce11 1ung cancer( NSCLC),and to exp1ore the re1ationship be-tween the mutation and amp1ification of EGFR gene and other c1inica1 patho1ogica1 parameters. Methods qRT-PCR,FISH and immu-nohistochemistry were used to detect EGFR gene(exons 18,19,20 and 21)mutation,amp1ification and protein expression in paraf-fin-embedded tissues of NSCLC. Results EGFR gene(exons 18,19,20 and 21)mutation rate was 58. 18%(32/55)in NSCLC with qRT-PCR techno1ogy,in which the occurrence rate of exon 19 de1etions and exon 21 mutation of L858R was 87. 50%(28/32). EGFR gene mutation rate was significant1y different in gender,smoking history and patho1ogica1 type(P<0. 01),but no statistica1 sig-nificance in age,1ymph node metastasis and TNM staging(P>0. 05). EGFR gene amp1ification rate was 23. 64%(13/55)and its protein expression rate was 70. 91%(39/55). Both EGFR gene mutation and amp1ification was c1ose1y corre1ated(P<0. 05),but the two states of EGFR gene and its protein expression had no corre1ation(P>0. 05). Conclusion EGFR gene mutation with high pro-tein expression of NSCLC is common1y found in fema1e,no-smoking and adenocarinoma patients,who are main candidates of a tyrosine kinase inhibitor( TKI)screening. EGFR gene mutation and amp1ification is typica11y corre1ated,but their consequence is unknown, which needs to be further investigated. EGFR gene mutation and amp1ification is not consistent with protein expression,its under1ying machanism is to be determined.

OBJECTIVE:To promote the work of clinical TCM pharmacists.METHODS:The problems faced by clinical TCM pharmacists were analyzed in respects of status quo of training in colleges and universities,status quo of hospital post training and status quo of continuing education.From the ability of post service,the ways to determine the duty orientation and improve the training quality of clinical TCM pharmacists were discussed theoretically.RESULTS & CONCLUSIONS:According to the nature of different types of medical institutions as TCM hospital,western medicine hospital,township community hospital and clinics,the responsibilities of clinical TCM pharmacists should be differentiated.TCM curriculum system of colleges and universities should be improved by adding social pharmaceutical education and TCM practical teaching.Based on the ability of post service,great importance should be attached to professional training of clinical TCM tablets after their employment.The theory,practice and research ability of clinical TCM talents should be improved by strengthening continuing education.The medical and pharmaceutical clinical TCM inter-disciplinary talent can be cultivated by improving rational drug use standard system.