Objective To evaluate the feasibility, advantages and pitfalls of trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, and to compare pure natural orifice transluminal endoscopic surgery (NOTES) with hybrid NOTES. Methods Two female pigs of 30kg were used in the study, one for pure NOTES, the other for hybrid NOTES. Each pig received trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, respectively, followed by postmortem examination for organic lesions and closure of incisions.The two approaches were compared in terms of intra-operative situation and manipulation. Results The vital signs of the pigs were stable during the procedures, with no peri-incision organic lesions. There were blind areas in trans-gastric as well as in trans-colonic peritoneoscopy. It was easier to close the colonic incision than the gastric one. The situation in trans-umbilical peritoneoscopy was similar to laparoscopic surgery. Hybrid NOTES seemed superior to pure NOTES with regard to safe access, stable pneumo-peritoneum and adequate visualization. Conclusion Three routes for NOTES appear to be reasonable and feasible. Hybrid NOTES is more effective and safer than pure NOTES with current instruments.

Objective To investigate the relationship between ?hCG genes expression and the clinicobiological behavior of bladder cancer. Methods RT-PCR method combined with restriction endonuclease analysis was adopted to detect the expressions of ?hCG mRNA and its subtypes in 37 cases of bladder cancer tissues. Results 26 of 37 cancer tissues (70%) were positive for ?hCG mRNA expression. The positive rate was higher in invasive tumor (T 2～T 4,13/14) compared with that in superficial tumor (Ta～T 1,13/23) ( P 0.05). Most of superficial tumors only expressed ?7 gene, while invasive tumor expressed ?7,?5, ?3, or ?8 . Conclusions The positive rate of ?hCG mRNA expression is related to tumor stage. The expression of hCG gene ?5, ?3 or ?8 in addition to ?7 indicates a worse differentiated or advanced bladder tumor.

Objective To discuss the opportunity of transurethral resection of prostate (TURP) after transrectal prostate biopsy.Methods We analyzed 60 cases of benign prostatic hyperplasia(BPH) who underwent TURP after transrectal prostate biopsy from September 2013 to September 2015.All the patients were divided into either group A or group B in chronological order, with 30 cases in each group.There were no significant differences in age, prostate specific antigen (PSA), prostate volume, hemoglobin level, and international prostate symptom score (IPSS) between the two groups.The group A and group B were treated by TURP at 1 week and 4 weeks after transrectal prostate biopsy, respectively.The parameters including operation time, excised prostate weight, intraoperative total blood loss, bladder irrigation time, and IPSS at 3 months after operation were recorded.Results The operation time, intraoperative total blood loss, bladder irrigation time, and IPSS in the group B were significantly lower than those in the group A [(58.3±6.0) min vs.(62.0±3.3) min, t=2.952, P=0.005;(154.1±15.8) ml vs.(167.4±29.5) ml, t=2.181, P=0.035;(19.2±0.8) h vs.(20.6±2.3) h, t=3.034, P=0.004;(18.3±2.5) points vs.(20.3±2.0) points, t=3.419, P=0.001].The excised prostate weight in the group B was significantly higher than that in the group A [(37.1±4.0) g vs.(33.3±7.8) g, t=-2.341, P=0.024].Conclusions TURP performed at 4 weeks after transrectal prostate biopsy can significantly increase the excised prostate weight, reduce intraoperative total blood loss volume, shorten the operation time and postoperative bladder irrigation time, and improve urinary symptoms.In brief, we recommend that TURP be executed at 4 weeks after transrectal prostate biopsy.

Objective To investigate the surgical managements and effects of congenital islated penile curvature. Methods The degloving of penile shaft,penile dorsal tunical plication,urethral division and urethroplasty were performed in 23 patients with this entity including 2 cases of type Ⅰ,11 cases of type Ⅱ,6 cases of type Ⅲ,4 cases of type Ⅳ,mean age 7 years (age 1 to 21 years). Results Of all 23 patients 17 cases of type Ⅱ and Ⅲ were succesfully repaired by degloving of penile shaft;1 case of type Ⅰ,by degloving of penile shaft and dorsal tunical plication;1 case of type Ⅰ and 2 cases of type Ⅳ,by degloving of penile shaft,dorsal tunical plication and urethral division;2 case of type Ⅰ and Ⅳ,by urethroplasty.One case was complicated with urethrocutaneous fistula after urethroplasty,which was succesfully repaired 8 month later;16 cases were followed up average 24 months (range 7 months to 57 months),15 cases showed complete straight penis beside one case with mild curvature less than 15 degree. Conclusions The abnormalities of skin,dartos and Buck's fasciae are main causes of congenital islated penile curvature.Penile degloving,dorsal plication are main surgical methods with minimal complications.

ObjectiveTo evaluate the effect of increasing doses of tamsulosin in lower urinary tract symptom (LUTS) of benign prostatic hyperplasia (BPH).MethodsA prospective self-controlled clinical trail was performed.Two hundred and sixty-one patients who had LUTS of BPH were enrolled in this prospective 4 weeks study of tamsulosin.The patients were randomly divided into 2 groups:took tamsulosin 0.2 mg QN (n =126,group A) and 0.4 mg QN (n =135,group B) respectively.The IPSS score and maximum flow rate before and after treatment were compared between the 2 groups.ResultsThe IPSS score of group A decreased from 17.72 ± 2.50 to 10.21± 1.95,average decreased 7.59 ± 2.74 ； maximum flow rate was elevated from (8.78 ± 3.70) ml/s to ( 12.74 ± 2.99 ) ml/s,average increased (4.31 ± 3.01 )ml/s.The IPSS score of group B decreased from 19.24 ± 3.22 to 11.21 ± 3.02,average decreased 8.49 ±3.73； maximum flow rate was elevated from (7.74 ± 1.97) ml/s to ( 12.04 ± 2.46) ml/s,average increased (4.73 ± 2.97) ml/s.There was no significant difference of the changes of IPSS score between the 2 groups ( P ＞ 0.05 ),but there was a significant difference of the changes of maximum flow rate between the 2 groups ( P ＜ 0.05 ).The results was further analyzed by sub grouped ( by patient body weight,divided into ≤55.0 kg,55.1 -65.0 kg,65.1 -75.0 kg,＞75.0 kg group).There were significant differences of the changes of IPSS score and maximum flow rate between the 2 groups in 65.1 - 75.0 kg and ＞ 75.0 kg subgroups ( P ＜ 0.05 ).The incidence of side effects between the 2 groups was not significantly different (P ＞ 0.05).ConclusionsFor most patients,the use of high-dose tamsulosin in improving LUTS caused by BPH can not bring significant benefits.But if the patient's weight is more than 65.0 kg,increasing the dose of tamsulosin is suggested for consideration.

Objective To discuss the early diagnosis and interventional therapy of acute renal infarction.Methods The diagnosis and therapy of 5 cases of acute renal infarction were retrospectively analyzed.There were 4 male and 1 female patients,aged 38-68 years.The symptoms were severe back pain or upper abdominal pain,with or without nausea and vomiting and the time to hospital was 1 to 16 h.Four cases had rheumatic heart disease and 4 cases had artrial fibrillation history.The lab assay results: WBC 8.9-15.8 × 109/L,urine RBC-to + + +,albumin + to + + +,serum creatinin 66-216 μmol/L,serum LDH 350-920 U/L.The doppler ultrasound and CT scan showed large infarction in 3 cases and focal infarction in 2 cases.Percutaneous arteriography,thrombolytic therapy and thrombosuction via catheter were applied promptly.Results The 5 cases were diagnosed and treated timely and effectively.The emboli were cleared.Four patients were followed up for 3-12 months.The creatinin recovered to 53-122 μmol/L,and the blood perfusion of the infarction lesion was satisfactory.Conclusions Early diagnosis and interventional therapy is important for achieving satisfactory recovery of the acute renal infarction.Three dimensional CT angiography could conduce to early diagnosis and follow-up.Thrombosuction via catheter plus thrombolytic therapy is efficient for greater embolus.

Studies on NaCl concentration, pH tolerance and selectivity to different concent rations of Na +, K +, Mg 2+ and Ca 2+ of 43 isolates from th e saline soils in XinJiang, HeBei and QingHai Provinces of China and 4 type stra ins were performed in this paper Results showed that halotolerant actinomycete s have extensiv e adaptability to Na +, K + and Mg 2+ and only a few of them can grow in low CaCl 2 concentration Halophilic actinomycetes have extensive adaptability to Na +, and for most halophilic actinomycetes, Na + can be substituted by K + , Mg 2+ , but not for Ca 2+ For some halophilic actinomycetes , it is necessary to have Na + for their growth It also showed that the growth of al l halophilic actinomycetes had se lectivity with different concentration of Na +, K +, Mg 2+ So it is pre sumed that only Kaliumphilic or Magnesiumphilic Actinomycetes maybe exist in hig h salt environments In addition, the growth pH range were 6 0～9 0 and the o ptimum pH were 7 0～8 0 not only for halophilic but also for halotolerant acti nomycetes The dis tribution of halophilic actinomycetes also have some relativity to isolation sit es

Objective To evaluate the clinical characteristics, surgical treatment effect and prognostic factors of post-operative hypertension in the 2 subtypes of primary aldosteronism (PHA),aldosterone adenoma (APA) and unilateral adrenal hyperplasia (UNAH). Methods In the collection of surgical treatment of PHA from 2002-2009, 135 cases, 68 males and 67 females, with age of 26-79 years (mean, 51 years) were analyzed. Of them, there were 83 APA patients, 52 UNAH cases. All the cases with PHA were with hypertension symptoms and met the preoperative diagnosis criteria. All the patients were performed preoperatively blood biochemical and hormonal tests and CT scans. The diagnosis was confirmed by pathology. All cases undergone adrenal reserved surgery (ASS) and followed-up. According to the postoperative recovery of blood pressure was normal or still in hypertension, Logistic regression analysis and comparison between the 2 groups were carried out,the clinical data of various factors in predicting the role of postoperative blood pressure were considered. Results One hundred and thirty-five patients were operated successfully. The mean follow up was 2. 5± 1.6 years (1-7 years). There were significant decreases in both systolic blood pressure and diastolic blood pressure at final follow up compared with those before surgery. Antihypertensive requirement was decreased at final follow-up. Serum aldosterone levels, plasma renin activity and potassium levels were improved significantly. Overall, blood pressure returned to normal in 51 cases(37.8%). Other 84 cases (62.2%) continued with high blood pressure, of whom 58 cases reduced antihypertensive drug use. Patient's age over 49.5 years, hypertension duration over 6. 5 years, family history of hypertension were higher risks of postoperative continuous high blood pressure. Conclusions APA and UNAH are 2 types of PHA with similar performance of patients, surgical treatment effect. ASS can be used in the treatment of these 2 types of disease. Age, hypertension duration, family history of hypertension are independent factors predicting sustained hypertension after surgery.

Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.

Objective To explore the technological and therapeutic value of endoscope for removal of hepatobiliary necrosis after liver transplantation.Methods Data of 36 patients with suspected hepatobiliary diseases,who underwent choledochoscopy or duodenoscopy to remove necrosis after liver transplantation,were reviewed.Liver function before and after the treatment were compared.Results Hepatobiliary necrosis located in common bile duct (n =6),intrahepatic bile duct (hilar bile duct included) (n =24) and intraand extra-hepatic duct (n =6).The total success rate was 72.2％ (26/36).Full clearance of bile duct necrosis was accomplished in 16 patients,partial clearance in 15 patients and the necrosis could not be removed in 5 others.The serum bilirubin and transaminase decreased significantly,compared with those before endoscopic treatment (P ＜ 0.05).No serious complications or death related to endoscopy occurred during the treatment.After 6-84 month follow-up,in 17 survivals,3 patients underwent a second liver transplantation with good prognosis.All the survivals had a life of good quality with no placed drainage tube except for one with drainage tube for four years with unstable serum bilirubin.Nineteen patients died from biliary tract related complications or other diseases during the long-term follow-up,among which eleven patients survived beyond four years.Conclusion Endoscopy for hepatobiliary necrosis removal,a minimally invasive method,is effective and safe.