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.

Correspondence analysis was used for determining the important factors from the six factors influencing analysis of cephalosporin in reversed phase-high performance liquid chromatography (RP-HPLC). Experiments were planed by U7（76）, then the synthetical correspondence between a series of optimizations and the factors was calculated. Result indicated that that proportion of organic solvent, pH and concentration of buffer were three most important factors. It showed that the correspondence analysis was a better method to determining the important factors in RP-HPLC

Objective To investigate the cause,treatment and prevention of delayed gastric emptying (DGE) after operation for esophageal carcinoma.Methods The clinical data of 13 cases with DGE after operation for esophageal carcinoma were analyzed retrospectively.Results DGE occurred at 10th day after operation.10 cases with functional delayed gastric emptying(FDGE) recovered after conservative treatmeut.3 cases with mechanical delayed gastric emptying(MDGE) were given surgical treatment.Conclusions The anatomical displacement of stomach may be the main cause of DGE.DGE is also related to vagus nerve and postoperative inadequate gastrointestinal decompression.Clinical symptoms,X-ray barium meal radiography and gastroscopy examination are the important diagnostic method.Conservative treatment should be the first choice for FDGE.The use of some gastro-intestinal prokinetic drugs may have a beneficial effect on FDGE.Once the diagnosis of MDGE is established,surgical treatment should be performed as early as possible.The fully preoperative preparation,the precise and concise techniques in operation and postoperative appropriate management may decrease the occurrence of DGE.

Objectives To evaluate the association between serum cystatin C and carotid atherosclerosis.Methods Medical data,including physical examinations,serum levels of cystatin C,bilirubin,uric acid and other biochemical markers and duplex ultrasonographic scanning for the carotid artery,of 1741 healthy adults (1193 men and 548 women) who sought physical check-up at Peking Union Medical College Hospital during January 2010 and December 2011 were collected,and those with hypertension,diabetes and liver or renal function failure were excluded.Based on the results of carotid duplex uhrasonography,all the adults checked were assigned to two groups,one with thickened intima-media and atherosclerotic plaque (group A),the other with non-thickened intima-media and non-atherosclerotic plaque (group B).Difference in serum cystatin C,bilirubin,uric acid and other biochemical markers between the two groups was analyzed by using Student's t test.The correlation between the markers and carotid plaque was analyzed by using Spearman correlation analysis.The correlated factors of the carotid thickness and plaque appearance were analyzed by using unconditional Logistic regression analysis.Results Serum level of cystatin C was significantly increased in group A (t =-8.85,P ＜ 0.05).Thickness of carotid intima was positively correlated with serum cystatin C (r =0.21,P ＜ 0.05).In multivariate Logistic regression analysis,high level of serum cystatin C was not an independent risk factor of carotid atherosclerosis.Conclusion Relationship between serum cyatatin C and carotid atherosclerosis was not confirmed in our populations,which should be explored further in cohort studies.

The difference in serum calcium levels between patients with typical hyperthyroidism and apathetic hyperthyroidism was analyzed. Serum calcium levels in patients with apathetic hyperthyroidism were higher than those in patients with typical hyperthyroidism, while bone-specific alkaline phosphatase levels were lower. The atypical manifestation of apathetic hyperthyroidism may be due to the significant elevation of serum calcium level.

Objective To evaluate the reliability of lactate clearance rate in evaluating the efficacy of early fluid resuscitation in the patients with severe sepsis.Methods One hundred and forty-two patients with severe sepsis,aged 28-87 yr,were enrolled in the study.Isotonic crystalloid fluid was infused after admission to ICU to maintain central venous pressure ≥ 8 mmHg,mean arterial pressure ≥ 65 mmHg,central venous oxygen saturation (ScvO2) ≥ 70％,and urine output ≥ 0.5 ml·kg 1 ·h-1 within 6 h.The patients were divided into 2 groups according to the treatment outcome:survival group and death group.Immediately before fluid resuscitation and at 6,12 and 24 h after fluid resuscitation,blood samples were collected from the central vein for blood gas analysis and ScvO2 was recorded.Blood samples were collected from the peripheral vein for determination of the concentration of lactate and lactate clearance rate was calculated.Results Compared with survival group,the lactate clearance rate was significantly decreased at 6,12 and 24 h after fluid resuscitation,and no significant change in ScvO2 was found in death group.Conclusion Lactate clearance rate can evaluate the efficacy of early fluid resuscitation in the patients with severe sepsis.

Objective To explore the effects of extracellular regulated protein kinase 1/2 (ERK1/2) signal pathway on cardiomyocyte apoptosis and tumor necrosis factor-α (TNF-α) expression at different glucose-lowing rates,and the influence of glucose-lowing rate on cardiomyocyte injury and inflammatory secretion function,as well as its mechanism.Methods Cardiomyocytes of Wistar neonate rat were maintained in medium supplemented with 25 mmol/L glucose for 72 h.Then the medium was changed to different concentrations of glucose and all cells were divided into five groups.Group A was control group whose medium supplemented with 25 mmol/L glucose.Medium of group B,C,D,E was supplemented with 20,15,10,5 mmol/L glucose (glucose-lowing rate was 5,10,15,20 mmol/L) respectively.Survival rate of cardiomyocyte was measured by CCK8 kit.Cardiomyocyte apoptosis was measured by flow cytometry instrument and laser confocal microscope after Annexin V-PI.TNF-α was measured by ELISA.ERK1/2 protein and phosphorylation were measured by Western blot.Cardiomyocyte apoptosis and TNF-α levels were measured again after U0126 was added.Results At the same time point,along with the glucose-lowing rate increased,survival rate of cardiomyocyte in group A was increased and those in group C,D,E were decreased (P＜ 0.05).TNF-α concentration was increased in group B,C,D and decreased in group E.After 24 h,apoptosis rate decreased in group B and increased in group C,D,E (P＜0.05).ERK1/2 phosphorylation level increased in group B,D,and E(P＜0.05).The ERK1/2 phosphorylation level in group B was the lowest.After U0126 was added,survival rates of cardiomyocyte in all groups were increased (P＜0.01) while TNF-α concentrations were decreased (P＜0.05).In every group,survival rate of eardiomyocyte after 48 h was lower than that after 3 h and 24 h,while TNF-α concentration was higher (P＜0.05).Conclusion Influence of glucose-lowering rate for cardiomyocyte apoptosis and TNF-o is caused by ERK1/2 pathway.In the glucose-lowering course,ERK1/2 pathway promotes cardiomyocytes apoptosis and TNF-α secretion is related with not only osmotic pressure,but also ERK1/2 signal pathway activation as well.

Objective To determine the significance of the quantitative parameters obtained from intravoxel incoherent motion ( IVIM) diffusion weighted imaging ( DWI) in differentiating renal tumors from normal renal tissues.Methods Twenty-four patients with surgical pathology-proven renal tumors and 13 volunteers with healthy kidneys were included.DWI was performed with 9 b-values (0, 20, 50, 100, 200, 400, 600, 800 and 1 000 s/mm2).The slow component of diffusion (Dslow), fast component of diffusion ( Dfast ) and fraction of fast ADC ( f) of the biexponential DWI were calculated for the clear cell renal cell carcinoma (CCRCC), the normal renal parenchyma and the non CCRCC ( NCCRCC) .The ADC was calculated for all b-values using linear regression yielding standard ADC ( ADCtot ) .The parameters were compared among the groups, and the receiver operating characteristic ( ROC ) analysis was performed. Results CCRCC showed higher ADCtot (1.73 ±0.43) ×10 -3 mm2/s, Dfast (14.75 ±14.73) ×10 -3 mm2/s, Dslow(1.34 ±0.38) ×10 -3 mm2/s than NCCRCC (ADCtot(1.23 ±0.26) ×10 -3 mm2/s, Dfast(9.47 ± 5.27) ×10 -3 mm2/s, Dslow(0.58 ±0.15) ×10 -3 mm2/s), and the differences of ADCtot(P=0.037) and Dslow(P=0.001) were significant.The normal renal parenchyma showed higher ADCtot (2.25 ±0.11) × 10 -3 mm2/s, Dslow ( 1.74 ±0.17 ) ×10 -3 mm2/s, f ( 35.00% ±9.37%) than CCRCC ( f, 31.13% ± 10.75%) and NCCRCC(f, 33.76%±24.02%), and the differences between the normal renal parenchyma and CCRCC of ADCtot ( P =0.000 ) and Dslow ( P =0.001 ) were significant.There were no differences between the normal renal parenchyma and the tumor ipsilateral renal parenchyma of all parameters.Dslow had higher accuracy ( sensitivity 95%, specificity 100%) in distinguishing CCRCC and NCCRCC, with area under the curve of 0.988.Conclusions Multi-b-value DWI derived quantitative parameters including ADCtot and Dslow may differ significantly between the renal tumor and normal renal parenchyma.Dslow is the best parameter in distinguishing CCRCC and NCCRCC.

ObjectiveTo explore the significance of colonoscopy examination in healthy subjects.MethodsA total of 537 health examination cases who underwent colonoscopy from January 2010 to June 2011 in Peking Union Medical College Hospital (PUMCH) health examination center were enrolled,in which 529 cases underwent total colonoscopy.Detection of colorectal lesion,polyp types and pathology were recorded and the correlation between detection rate of polyps,lesion sites and ages as well as gender were analyzed.ResultsThere were 315 male and 214 female,with a mean age of 48.3 ± 9.3 years.A total of 158 colorectal polyps were detected in 104 cases ( 19.7％ ),including 84 ( 15.9％ ) adenomas,17 (3.2％ ) advanced polyps and 1 (0.2％ ) rectal cancer.Other abnormalities were hemorrhoids in 61 cases ( 11.5％ )and inflammation in 22 (4.2％ ).Colorectal polyps were more frequent in men (P ＜0.001 ).Adults older than 50 had higher rates of colorectal polyps (P ＜0.001 ) and advanced polyps ( P ＜0.05).The proportion of patients with proximal polyps increased with age,whereas that of patients with distal polyps decreased with age ( P ＜0.05).ConclusionColonoscopy is an effective screening modality for colorectal lesions and the importance of colonoscopy on health examination population to prevent colorectal cancer should be stressed.

Objective To compare the changes of high sensitive-C reactive protein (hs-CRP) and cardiac troponin Ⅰ ( cTn Ⅰ ) levels before and after intensive therapy in patients with type 2 diabetes,and to find out the reasonable glucose-lowering rate.Methods One hundred and thirty-two cases of type 2 diabetes( T2DM group) and 135 cases of type 2 diabetes with coronary heart disease( T2DM+CHD group) received intensive therapy.After testing hs-CRP and cTn Ⅰ levels,the variations were analyzed.Results The ranges of the change in cTn Ⅰ and hs-CRP levels were different under four glucose-lowering rates in the T2DM+CHD group( P＜0.05 ).cTn Ⅰ and hs-CRP levels were higher than those before intensive therapy in the T2DM+CHD group with glucose-lowering rate greater than 4.0mmol· L-1 · d-1.The other two subgroups with glucose-lowering rate less than 4.0 mmol· L-1 · d-1 showed decreased cTn Ⅰ and hs-CRP levels.While at the end of 3 months follow-up,cTn Ⅰ and hs-CRP levels were all significantly lower than those before intensive therapy in four subgroups ( P＜0.05 ).Conclusions The increase of cardiovascular events after intensive therapy may be due to excessively fast glucose-lowering rate.The reasonable glucose-lowering rate for patients with type 2 diabetes should depend on whether there is accompanying coronary heart disease.For type 2 diabetes with coronary heart disease,excessively fast glucose-lowering rate could lead to acute rise ofcTn Ⅰ and hs-CRP levels,which causes myocardial injury.The mechanism of myocardial injury resulted from excessively fast glucose-lowering rate may be due to activation of the inflammatory pathway.In type 2 diabetes with coronary heart disease,long-term good control of blood glucose could alleviate inflammatory response and cardiac damage resulted from excessively fast glucose-lowering rate.