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Background: Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction. This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction. Methods: Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study. After adequate pre-oxygenation, 5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min. After motor responses to jaw thrust disappeared, a SAD was inserted and insertion conditions were graded. The anatomic position of SAD was assessed using a fiberoptic bronchoscope. Results: The SAD was successfully inserted at the first attempt in all patients. Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%), respectively. The fiberoptic views of SAD position were adequate in 28 patients (93%). Conclusions: Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients. Clinical trial registration: ChiCTR1800016868; http://www.chictr.org.cn/showproj.aspx?proj=28646. Key words: Obesity; Inhalational induction; Sevoflurane; Supraglottic airway device; Jaw thrust test

Purpose: This study aimed to assess the effect of intravenous dexmedetomidine (DEX) on sevoflurane EC50 for supraglottic airway device (SAD) insertion in spontaneously breathing morbidly obese patients. Patients and methods: Thirty-eight morbidly obese patients with a body mass index 40-57 kg/m2 who were scheduled for bariatric surgery under general anesthesia requiring tracheal intubation were randomly allocated to two groups receiving the different treatments: group S, saline was given intravenously, and group D, a bolus dose of DEX 1 μg/kg was administered intravenously over 10 mins, followed by intravenous DEX infusion at a rate of 0.5 μg/kg/h. Five percent sevoflurane was initially inhaled for anesthesia induction and then end-tidal expiratory sevoflurane concentration (ETsev) was adjusted to a target value as to the modified Dixon's up-and-down method. Patients' response to SAD insertion was classified as "movement" or "no movement". The average of the midpoints of all crossover points was defined as calculated sevoflurane EC50 for successful SAD insertion. Furthermore, the probit regression analysis was used to determine sevoflurane end-tidal concentrations where 50% (EC50) and 95% (EC95) insertions of SAD were successful. After the observation was completed, flexible bronchoscope-guided intubation was performed through the SAD. Results: The calculated sevoflurane EC50 for successful SAD insertion was significantly lower in group D than in group S (1.75±0.32% vs 2.92±0.26%, p

BACKGROUND Mechanical ventilation is an important part of advanced life support in the intensive care unit (ICU). This study aimed to investigate the effects of ABCDE bundle on hemodynamics in patients on mechanical ventilation (MV). MATERIAL AND METHODS This study used a cross-sectional overall controlled approach in which 143 patients on mechanical ventilation were divided into 2 groups. In the pre-ABCDE bundle group (n=70), conventional sedation and analgesia strategy were used. In the post-ABCDE bundle group (n=73), ABCDE bundle was used. Changes in hemodynamics parameters and related prognostic indicators were monitored at various time points before (T0) and at 1 d (T1), 3 d (T3), 5 d (T5), and 7 d (T7) after implementation of the 2 strategies. RESULTS Mean arterial blood pressure (MAP), central venous pressure (CVP), heart rate (HR), and oxygenation index (PaO2/FiO2) in the bundle group were improved more significantly than those in the pre-ABCDE bundle group (P

Candidate oncogene placenta specific 8 (PLAC8) has been identified to participate in different cellular process and human diseases. However, the effects of PLAC8 on cell proliferation and migration in human kidney cancer (KC) remained unclear. In current study, physiological effects of PLAC8 in immortalized human embryonic kidney cell line (HEK293T) were investigated in vitro. Two PLAC8 knockout (KO) cell lines were established via CRISPR/Cas9-mediated methods combined with fluorescence activated single cell sorting. To classify the characteristic of PLAC8 during cell proliferation and migration in HEK293T, cellular proliferative activity was analyzed by cell counting and colony formation assay. Cell cycle distribution was analyzed by flow cytometry. Cellular motile activity was analyzed by wound-healing and migration assay. Further underlying molecular mechanism was explored via western blot. With the KO cell lines, it was found that PLAC8 KO could decrease cell proliferation. Moreover, the inhibitory effects of PLAC8 KO on cell proliferation were associated with a G2/M arrest in cell cycle progression concomitant with a remarkable inhibition of Cyclin B1 and elevation of Cyclin A. The alteration of cell cycle proteins and E-cadherin might further associate with the enhancement of cell motility. Our study revealed a novel role for PLAC8 in cell proliferation and migration of HEK293T cells, which might shed light on further study of PLAC8 on human KC.

Introduction: The etiological and clinical characteristics of patients with infectious diarrhea have changed during the last decade in Shanghai. Methodology: The records of 29,210 patients with infectious diarrhea in the outpatient department of the Jinshan Hospital (Shanghai, China) between January 1998 and December 2013 were analyzed. Results: A total of 2,849 samples were positive for intestinal pathogenic bacteria including Vibrio parahaemolyticus (2,489; 84.0%), Salmonella spp. (235; 8.3%), and Shigella spp. (125; 4.4%). V. parahaemolyticus infections are mainly characterized by abdominal pain, nausea, and vomiting, whereas Shigella spp. infections can, in addition, induce fever. In contrast, Salmonella infections can produce all of these symptoms but in a smaller percentage of patients. During the 16-year study, both the number of patients and the positive infection rate declined. Notably, the rate of infections by V. parahaemolyticus decreased while the detection rates of Salmonella spp. increased year by year from 2006 on with the introduction of a new detection method. Conclusions: Salmonella has been identified as the third-most frequent cause of diarrhea from 1998–2006, as the second-most frequent cause from 2006–2010, and as the most frequent cause from 2011–2013, which was mainly due to a sharp decrease of V. parahaemolyticus infections in 2011–2013. Salmonella strains collected in 2011–2013 showed high susceptibility to imipenem (100%) and meropenem (100%), whereas susceptibilities for ampicillin (39%) and piperacillin (40%) were low.

Introduction: The typical manifestations of patients with a trisomy 21 syndrome are mental retardation and anatomical deformities of face and neck. In the available literature, all case reports regarding anesthetic management of mentally retarded patients have focused on elective surgeries. There is no report regarding anesthetic management of mentally retarded patients undergoing emergency surgery. Patient concerns: A 47-year-old woman with a mental retardation grade 2 by trisomy 21 syndrome suffered from an esophageal foreign body for 3 days and needed emergency removal of esophageal foreign body. The patient had a poor cooperation and obvious anatomical abnormalities of head and neck. Diagnoses: Difficult anesthesia and airway managements for emergency removal of esophageal foreign bodies in a trisomy 21patients with mental retardation and predicted difficult airways. Interventions: Combined use of an intubating supraglottic airway and the flexible bronchoscope-guided intubation after intravenous anesthesia induction. Outcomes: Effective airway was safely established and an esophageal foreign body was successfully removed by rigid esophagoscopy under anesthesia. The patient recovered smoothly without any complication. Lessons subsections as per style: When general anesthesia and emergency airway management are required in the patients with mental retardation and predicted difficult airways, a combination of the supraglottic airway and the flexible bronchoscope maybe a safe and useful choice for airway control.

γ-tocotrienol (γ-T3), a tocotrienol isoform belonging to the vitamin E family, has been revealed to exert inhibitory effects on proliferation, migration and invasion in human gastric cancer cells. However, its precise mechanism of action is still unclear and needs to be further tested. Cyclooxygenase-2 (COX-2) is well known for its key role in promoting the migration and invasion abilities of human gastric cancer cells. In light of these data, our study aimed to validate whether the inhibitory actions of γ-T3 could be achieved by downregulation of COX-2 activity in vitro. In the present study, a Cell Counting Kit-8 (CCK-8) assay was performed to observe proliferation in human gastric cancer cells (SGC-7901 and MGC-803 cells), and wound healing and Transwell chamber assays were performed to detect migration and invasion. Western blot analyses were performed to analyse the relative expression of COX-2, matrix metalloproteinases-2 and -9 (MMP-2 and MMP-9) proteins, and enzyme-linked immunosorbent assays (ELISA) were used to determine the exocrine roles of MMP-2 and MMP-9. The results revealed that γ-T3 exerted significant inhibitory effects on proliferation, migration, invasion and COX-2 protein expression, as well as on exocrine functions of MMP-2 and MMP-9 in SGC-7901 and MGC-803 cells. Therefore, our results indicated that γ-T3 exerts inhibitory effects on migration and invasion, which may be mediated through downregulation of COX-2 expression in SGC-7901 and MGC-803 cells.

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In order to ensure work safety, large cranes generally use two motors together to upgrade the load, so often there is a synchronization error, control accuracy is affected. To address this issue, the paper crane hydraulic lifting system to study proposed control strategy based on fuzzy PID's. The results show that the method used to effectively reduce the synchronization error between the two motors to improve the control precision crane, a certain reference value.

Concerning the uneven distribution of energy in Chinas regional power grid, power of big energy base should be transmitted through long distance. Therefore, calculating available transfer capability (ATC) of large interconnected grid is necessary. However, it is difficult to collect the needed data, so ATC of the large interconnected grid cannot be calculated directly. To solve these problems, this paper presents a decomposition calculation method to calculate ATC of the large interconnected grid. The basic principles are: According to the executive partition, the large interconnected grid is divided into several subsystems, of which ATC can be calculated directly and easily. Then, according to series or parallel combination between the subsystems, ATC of the large interconnected grid can be calculated indirectly by the obtained ATC of subsystems. The series and parallel ATC probabilistic calculation models are established, used for synthetizing ATC of the subsystems. Illustrations verify the correctness and feasibility of the calculation method.

In this paper, we propose a general discussion on the digital library security from the perspectives of management risk, security demand and target, the security architecture of library digital information. The specific solution for implementation is presented for the information security of library digital information in the aspects of hardware infrastructure security, firewall technology, encroachment test, access control, virus protection, data backup and security management.

With the globalization of economic development, the application of mathematics throughout the various areas of probability and statistics is the use of modern engineering, social and economic research is a core of mathematics. Mathematical modeling provides a new way of thinking to the economic problems from the economic decision-making issues mathematical model of probability and statistics in the economic field.

The Bcr-Abl oncoprotein is the cause of chronic myelogenous leukemia (CML). Crystal structure analysis suggests that Bcr30-63 is the core of the Bcr-Abl oligomerization interface for aberrant kinase activity; however, the precise role of other residues of Bcr1-72 excluding Bcr30-63 have not been evaluated. In this study, Bcr30-63 was named OD2 and other residues of Bcr1-72 were named OD1. Cytoplasmic transduction peptide (CTP) was used to carry molecules into cytoplasm. CTP-OD1 and CTP-OD2 fusion peptides were expressed from a cold-inducible expression system. Our results demonstrated that both fusion peptides could localize into the cytoplasm, specifically interact with the Bcr-Abl protein and further inhibit growth, induce apoptosis, and decrease the phosphorylation of Bcr-Abl in K562 cell lines. However, the viability of THP-1, a Bcr-Abl negative cell line, was unaffected. These results suggested that CTP-OD1 and CTP-OD2 may be an attractive therapeutic option to inhibit the activation of Bcr-Abl kinase in CML.

A single ultrasonic sensor can only measure narrow range and mistakes can happen in the process of gathering information. Multiple ultrasonic sensors applied in intelligent robot, can make up for this defect and obtain reliable and accurate environmental information. So in this paper, aloha robot is taken as the research object, and multiple ultrasonic sensors are installed in the interior of aloha robot for the environmental obstacle information, then aloha robot control the rotation speed of maxon DC motor so as to move forward or backward, and turn left or right.

Direct vapor-phase methanol carbonylation, without any methyl iodide in the feed as a promoter, was carried out over NiCl2-CuCl2/HMOR catalysts. The results showed that NiCl2-CuCl2/HMOR catalysts exhibited high activity for methanol carbonylation. The optimum component of the composite catalyst was 5wt% NiCl2 and 15wt% CuCl2. In addition, the effects of reaction pressure and temperature on catalytic performance of 5%NiCl2-15%CuCl2/HMOR catalyst were investigated. It was revealed that methanol conversion of 84.2% and carbonylation selectivity of 73.5% could be obtained under the optimum reaction conditions of P=1.5MPa and T=623K.

Kruppel-like factor 7 (Klf7) has been extensively studied in the mammalian species, but its function in avian species is unclear. The objective of this study was to reveal the function of chicken Klf7 (Gallus gallus Klf7, gKlf7) in adipogenesis. The results of real-time reverse transcription polymerase chain reaction demonstrated that the relative mRNA level of chicken Klf7 (gKlf7/gβ-Actin) in the abdominal adipose tissue was significantly associated with the abdominal fat content and the age of broilers (P < 0.05), and gKlf7 was more highly expressed in preadipocytes than in mature adipocytes (P < 0.05). In addition, Oil red O staining showed that gKlf7 inhibited chicken preadipocyte differentiation, and MTT assay indicated that gKlf7 overexpression promoted preadipocyte proliferation. Additionally, luciferase assays showed that gKlf7 overexpression suppressed the chicken CCAAT/enhancer-binding protein α (C/ebpα), fatty acid synthase (Fasn), and lipoprotein lipase (Lpl) promoter activities (P < 0.05), and gKlf7 knockdown increased the chicken peroxisome proliferator-activated receptor γ (Pparγ), C/ebpα and fatty acid-binding protein 4 (Fabp4) promoter activities (P < 0.05). Together, our study demonstrated that chicken Klf7 inhibits preadipocyte differentiation and promotes preadipocyte proliferation.

Stable carbon and nitrogen compositions (δ13C, δ15N) of sedimentary organic matter were determined in the tidal flat of northern Yellow sea. The results showed that stable carbon and nitrogen isotopes compositions of the sediment samples ranged from −24.669～−19.457‰ and 2.125～7.043‰, respectively. The highest value was in St.DLD, and the lowest was in St.Z. Similar δ13C values were observed in St.H (−21.996±0.651‰) and St.P (−22.021±0.187‰), and similar δ15N values were between St.DLJ (5.502±0.223‰) and St.P (5.310±0.294‰). The δ13C and δ15N values did not show any significant regularity. The δ13C and δ15N signatures showed some fluctuation, no obvious regularity. The major source of terrestrial organic matter was from the emissions of river and human pollutant.

A moderately halophilic, Gram-stain-negative, non-endospore-forming endophytic bacterium designated strain ST307T was isolated from the euhalophyte Suaeda salsa in Dongying, China. Strain ST307T was aerobic, rod-shaped, motile and orange–yellow-pigmented. The organism grew at NaCl concentrations of 0.6–20 % (w/v) (optimum 5–6 %, w/v), at temperatures of 5–45 °C (optimum 35 °C) and at pH 5–9 (optimum pH 7–8). It accumulated poly-β-hydroxybutyric acid and produced exopolysaccharides. The major fatty acids were C18 : 1 ω7c/C18 : 1 ω6c, C16 : 0 and C16 : 1 ω7c/C16 : 1 ω6c. The predominant lipoquinone was ubiquinone Q-9. The polar lipids consisted of phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, a glycoaminolipid and a phosphoglycoaminolipid. The DNA G+C content was 60.5 mol%. Phylogenetic analyses of 16S rRNA gene sequences and concatenated atpA, rpoD and secA gene sequences revealed that the strain represents a member of the genus Larsenimonas . The closest related type strain was Larsenimonas salina M1-18T. Mean DNA–DNA relatedness values between strain ST307T and the related species L. salina M1-18T, Chromohalobacter beijerinckii DSM 7218T, C. canadensis DSM 6769T, C. israelensis DSM 6768T, C. marismortui CGMCC 1.2321T, C. nigrandesensis DSM 14323T, C. salexigens DSM 3043T and C. sarecensis DSM 15547T were 15±2−45±1 %. On the basis of phenotypic, chemotaxonomic and molecular features, strain ST307T clearly represents a novel species of the genus Larsenimonas . The name Larsenimonas suaedae sp. nov. is proposed, with ST307T (=CGMCC 1.8902T=DSM 22428T) as the type strain.

According to the temperature, humidity, air quality and other environmental factors, the indoor environment monitoring system is designed, which collects the signals of a sensor using the NI company’s WSN module, uploads to the computer, and uses graphical programming software-LabVIEW, for PC software design. The function of real-time display and alarm of data, the alarm history records, and data storage in the different positions in the room environment are realized, and then the indoor environment monitoring system is built quickly.

An air source heat pump system (ASHPS) was set up, which provided space heating and cooling, as well as hot water for an office building in Tianjin. Its operating performance in winter was evaluated based on test data. Considering the local abundant solar radiation and the way to provide energy in an office building, a simulation study was carried out on the combsystem of ASHP and flat plate air collector (FPAC). The effects of collector area and its outlet parameters on the heating performance of ASHP were studied, and the favorable operating and matching mode were recommended. The results indicate that ASHPS is a technically viable method in Tianjin in winter, but not economically, and the air-solar combsystem should be taken into account for its massive replacement for conventional energy.

Several modals on Tunnel Boring Machine (TBM) in tunneling are introduced, the revolving rock tunneling simulator set-up is designed, the finite element model of cutter parts of the experimental bench is built, and free mode analysis of it is performed, and the model on system of cutter head, cutter and rock is established. It is shown that natural frequency on the cutter parts is higher, the frequency of first step is 4536Hz, and the most modes are deformations of the cutter loop, vibration acceleration of the cutter decreases with fracture tunnel width increasing, in some degree broken rock mechanics is achieved, foundation is provided for improving using life and adaptability of the cutter, and optimizing arrangement of plate cutter on the cutter head, and finally realizing high efficiency and low energy consumption.

According to discussion of process management, workflow technology and the requirement of CE to PDM system, workflow based PDM system is built in this thesis, which takes process management as the main line to implement the projects management, parts management and documents management. PDM prototype is built and workflow based process management in PDM system is validated.

This paper adopted combined admixture of limestone powder and substandard fly ash to prepare the machine-made sand concrete, and studied its performance, compressive strength and micro-properties. The results showed that this kind of machine-made sand concrete owned a good performance, for its 60min slump loss within the range of 15mm to 85mm; the changes in the ratio of limestone powder to low-quality fly ash had little effect on the its compressive strength; with the increase of the ratio between limestone powder and low-quality fly ash, the Ca(OH)2 diffraction peak also increased; when hydration was up to 120d, the limestone powder was not involved in the hydration reaction.

Arsenic produces liver disease through the oxidative stress. While lutein can alleviate cytotoxic and oxidative injury, nuclear factor erythroid 2-related factor 2 (Nrf2) pathway plays a critical role in defending oxidative species. However, the mechanisms by which lutein protects the liver against the effect of arsenic are not known. Therefore, this study aims to investigate the mechanisms involved in the action of lutein using mice model in which hepatotoxicity was induced by arsenic. We found that mice treatment with lutein could reverse changes in morphological and liver indexes and result in a significant improvement in hepatic function comparing with arsenic trioxide group. Lutein treatment improved the activities of antioxidant enzymes and attenuated increasing of ROS and MDA induced by arsenic trioxide. Lutein could increase the mRNA and protein expression of Nrf2 signaling related genes (Nrf2, Nqo1, Ho-1, and Gst). These findings provide additional evidence that lutein may be useful for reducing reproductive injury associated with oxidative stress by the activation of Nrf2 signaling. Our findings suggest a possible mechanism of antioxidant lutein in preventing the hepatotoxicity, which implicate that a dietary lutein may be a potential treatment for liver diseases, especially for arsenicosis therapy.

Obese patients are more likely to encounter with difficult airway management, and supraglottic airway device has been adopted to facilitate tracheal intubation. The optimum anesthetic concentration for obese patients to insert a supraglottic airway device with spontaneous respiration has not been investigated. This study was designed to determine the end-tidal concentration of sevoflurane that would provide acceptable condition for supraglottic airway device insertion with propofol at induction in obese patients without using neuromuscular blockade.Thirty elective obese patients [body mass index (BMI) 30-50 kg/m] scheduled for bariatric surgery were enrolled in this study. Sevoflurane was inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1 minute) according to lean body weight. The target concentration of sevoflurane was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down method. Five minutes after target concentration achieved, the insertion of supraglottic airway device was attempted.The minimum alveolar concentration of sevoflurane for successful insertion of supraglottic airway device calculated using up-and-down method were 2.25 (0.53) % for obese patients. The values of the effective concentration of sevoflurane for successful supraglottic airway device insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit regression analysis were 2.09% (95% confidence interval 1.48-2.68) and 3.31% (95% confidence interval 2.70-8.12), respectively.We conclude that sevoflurane at a minimum alveolar concentration of 2.25% can provide optimal conditions for insertion of supraglottic airway device with spontaneous respiration in obese patients with 1 mg/kg propofol at induction.

ObjectiveTo obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department.Design, setting and participantsThis qualitative study was conducted in a 4500-bed university hospital in northwest China. To collect data, in-depth semistructured interviews were conducted with parents of children with acute leukaemia (n=12) and haemato-oncology paediatricians (n=11) using purposive sampling. Interviews were audiotaped and transcribed and subjected to thematic analysis.ResultsThe suffering of procedural pain among paediatric patients was not adequately recognised and properly treated at the paediatric haemato-oncology department. The current paediatric procedural pain management is inadequate for paediatric patients. Crucial factors were identified including lack of awareness about the damage of uncontrolled pain in children, parents’ low supportive ability, the limited capacity to provide general analgesia by anaesthetists, inadequate knowledge in the usage of analgesia and sedation and lack of efficient analgesic for children’s procedural pain. The participants strongly expected optimal interventions to improve paediatric procedural pain management.ConclusionsThe result suggested a perceived and actual poor management of paediatric procedural pain in haemato-oncology department in northwest China. A relevant pain management education programme for paediatricians and parents as well as an effective pain medication are urgently needed in northwest China.Trial registrationChinese Clinical Trial Registry. Identifier: ChiCTR-INR-16007989.

Hepatitis B virus X protein (HBx) plays an important role in the development of hepatocellular carcinoma (HCC). Emerging evidence has shown the association between aberrantly expressed miR-221 and cancer development; however, little is known concerning its potential role in hepatitis B virus (HBV)-related HCC. In the present study, functional studies demonstrated that HBx leads to the promotion of cell proliferation and cell growth viability. Obviously overexpressed miR-221 was found in HBx-transfected cells compared with the mock counterparts. Suppression of miR-221 significantly inhibited HCC cell proliferation. Western blot analysis indicated that estrogen receptor-α (ERα) was downregulated in HCC tissues and cell lines. Bioinformatic analysis combined with validation experiments identified ERα as a direct target of miR-221. The present study suggests that miR-221 modulates HCC cancer cell proliferation by suppressing ERα, functioning as a tumor promoter. Moreover, our data imply that miR-221 has potential as an miRNA-based therapeutic target for HBV-related HCC.

Chimeric T cell receptors (chTCRs), composed of the single-chain variable fragments (scFv) of murine antibodies and human signaling molecules, are used to redirect the specificity of autologous or allogeneic T lymphocytes. To develop novel therapeutic agents for treatment of chronic myeloid leukemia (CML), we engineered a scFv from the hybridoma cell line CMA1 which produces monoclonal antibody specific against CML. The genes encoding the heavy and light chain variable regions were amplified from CMA1 cDNA and a humanized chTCR was constructed. Expression of the novel hchTCR was verified in NIH3T3 cells transduced with retroviral vectors. The results demonstrated that hchTCR can be expressed and presented on cell surface normally. These results suggest that retroviral vectors expressing hchTCR specific for CML cells may be used to redirect human T lymphocytes.

AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model. METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endsocope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation. RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure. CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.