Leptin and its functional receptors play a crucial role in hepatic fibrogenesis.However,the precise mechanisms underlying the profibrogenic action of leptin in the liver has not been well elucidated.There are two different mechanisms at present.Immunity system and some cytokines may act on it.The reseach on the mechanism of leptin offer a new way for the clinical treatment of hepatic fibrosis.

Objective To compare curative effects between laparoscopic and open surgery in the treatment of pediatric indirect inguinal hernia.Methods A group of 410 children with indirect inguinal hernia underwent micro-laparoscopic operation(Laparoscopic Group) from April 2001 to January 2006.This group was compared with another group of 408 children with indirect inguinal hernia,treated with open high ligation of the hernial sac(Open Group) from September 2004 to January 2006.In the Laparoscopic Group,a 5-mm trocar was inserted at the umbilicus for the exploration of bilateral internal rings.Another 5-mm trocar was inserted at the site slightly superior to the McBurney's point for introducing a needle holder.At the level of the neck of the hernial sac,the orifice of the vaginal process was circumferentially sutured and ligated.In the Open Group,high ligation of the hernial sac was conducted through a transversal incision at the external ring.Results The operations in the Laparoscopic Group were smoothly completed.The operative time for one side of hernia was significantly shorter in the Laparoscopic Group(33.4?9.6 min) than in the Open Group(38.0?7.6 min)(t=-7.596,P=0.000).In the Laparoscopic Group,no edema of the scrotum,subcutaneous hydrops,or infection occurred.The patients were followed for 1~55 months(mean,23.2 months).Short-term recurrence was observed in 3 children,who required a re-operation of laparoscopic repair.No testicular atrophy,iatrogenic retained testis,intestinal adhesion,or other long-term complications happened.In the Open Group,follow-up observations for 1~18 months(mean,10 months) revealed recurrence in 18 children,8 of whom were then cured with laparoscopic surgery and 10 of whom with open surgery.Iatrogenic retained testis happened in 9 children and a re-operation of open surgery was carried out.Conclusions Two-port laparoscopic high ligation of hernial sac for pediatric indirect inguinal hernia is minimally invasive,safe,and effective,but not suitable for children with cardiac insufficiency or newborn incarcerated hernia.

OBJECTIVE To investigate the clinical manifestation and the reasons of misdiagnosis of allergic rhinitis patients with postnasal drip. METHODS The clinical data of 3 patients with allergic rhinitis who had the symptom of postnasal dr ip and were mi sdiagnosed were s tudied. RESULTS The three patients to be misdiagnosed as chronic sinusitis treated by antibiotics drugs, post cold cough syndrome without any treatment, and chronic rhinitis treated with partial inferior turbinectomy. The 3 patients were diagnosed allergic rhinitis and cured with budesonide nasal spray. CONCLUSION The reasons of misdiagnosis are listed as follows. 1. The clinic doctors don't listen to the patient's complaint comprehensively and get incorrect information. 2. The symptoms of allergic rhinitis are not typical. 3. Postnasal drip is the main complaint and cause irritable cough, pharyngeal itching, globus. 4. The symptoms of allergic rhinitis are covered by other simultaneous diseases.

Objective To evaluate the effects and the side effects of three-dimensional conformal radiotherapy on recurrent cervical carcinoma with pelvic wall infiltration. Methods Twenty-one patients with recurrent cervical carcinoma infiltrating the pelvic wall were irradiated by three-dimensional conformal radiotherapy. The regimen was: total dose 30-52Gy,5-8.5Gy/f, 1f/2d. Results The rates of sciatic pain and leg edema relief response were 100 % and 61 % respectively. The CR+PR response rate was 71.4 %. The overall 1-, 2- and 3-year survival rates were 38 %, 14 % and 4 %. Conclusion Three-dimensional conformal radiotherapy is more effective than conventional radiotherapy and chemotherapy for recurrent cervical carcinoma infiltrating the pelvic wall. It doesn't increase the side-effects on the digestive system and the urinary system.

Chronic Disease ; Humans ; Liver Diseases

Objective To evaluate the short-term clinical effect of 125Ⅰ seeds interstitial braehytherapy for recurrent malignant tumor after radiotherapy. Methods 21 patients with recurrent gynecologic tumors after radiotherapy received 125Ⅰ seeds interstitial braehytherapy through TPS, ultrasound. 125Ⅰ seeds radiotherapy per grain was for 20.72-29.60 MBq. The distribution of seeds was checked by X-my after treatment. The clinical therapeutic efficacy was observed by chest CT, ultrasound. Results The overall effective rate was 100 %, CR 85.71%(18/21), PR 14.29 %(3/21). Conclusion 125Ⅰ seeds interstitial brachytherapy is minimally invasive, convenient, safe, utility and feasible in clinical practice. The radioactive protection is easy. It is a new and high technology of malignant tumor treatment. Colligation treatment method is increased by this technique. But this technology cannot replace routine method.

Objective To investigate the curative effect of synchronous radio-chemotherapy in medium-term and advanced cervical carcinoma. Methods 168 cases of medium-term and advanced cervical carcinoma were selected. The treatment group(grout A) included 84 pathologically verified cases of stage Ⅱ～Ⅳ cervical carcinoma. Each patient was given DDP with hydration at the dose of 40 mg/m2 intravenously.The treatment cycle was performed once every week for 3--4 circles. Radiotherapy was given at the same time. 60Co was used for external radiation with a total dose of 50 Gy, 192 Ir afterloading unit was used for brachytherapy at the dose of 7 Gy per week at point A with a total dose of 42 Gy. The control group (group B)included 84 cases of cervical carcinoma at the same stage in the corresponding period who received radiotherapy only.Short-term effect ,2-year survival rate and complications were observed. Results Effective rate was 92.85 %(78/84) in group A and 79.76 %(67/84) in group B respectively 3 months after radiotherapy, showing a significant difference(χ2 =6.10,P <0.05). 2-year survival rate was higher in group A (83.95 %) than in Group B(60.98 %) (χ2 =9.4,P<0.05). Local recurrent and distant metastasis were lower in Group A than Group B. In group A, there were tolerable bone marrow inhibition and reaction of digestive tract. Conclusion Synchronous radiotherapy and chemotherapy can remarkably improve the survival rate of medium-term and advanced cervical carcinoma. The application of DDP is effective and safe,and its side effect can be accepted by patients, but the long-term effect needs further observation.

Objective To evaluate the impact of different factors on long-term results in cervical carcinoma patients initially treated by surgery followed by radiotherapy. Methods In 1998, 525 cervical carcinoma patients were admitted, among whom 346 patients were first treated by surgery. 302 of these 525 patients were given postoperative radiotherapy. The stage distribution of these 302 patients were: stage I 142;stage Ⅱa 121;stage Ⅱb 23;and stage Ⅲa 16. ~ 60 Co ? or 6MV X-ray was used for radiotherapy. Perpendicular portals were alternately irradiated to 44-50Gy/4-5 week. Extending the portal, increasing the dose after constricting portal, adding intracavitary afterloading irradiation and adjuvant chemotherapy were carried out according to the different clinical requirements. Results The 5-year survival rate was 89.4%,77.7%,56.5% and 56.3% in stage I, Ⅱa, Ⅱb and Ⅲa lesion, respectively(?~2=22.22,P

Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A network in prenatal diagnosis, perinatal management and monitoring of congenital malformation was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed double-bubble sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed double-bubble sign, 1 showed single-bubble sign and 1 showed triple-bubble sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.

Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens.Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1 : 1.7).Their average age was 66.4 (range: 51-77 years).All patients underwent decompression and fusion surgeries through posterior approach.They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range.During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI).Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA).Postoperative complications were also recorded.Results All patients were followed up for average 2.2 years (range:1.5-3.5 years).No significant difference of age or gender was found between two groups (L: 22, S:10) of patients (P=0.066, 0.182).As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001).Operation time and blood loss of group L were statistically more than group S (P＜0.05).Postoperative VAS sores of back pain and leg pain as well as ODI were all improved significantly in two groups (P＜0.05).At the final FU, back pain VAS was more in group L than in group S (P＜0.05) , but no significant difference was found in leg pain VAS between two groups (P＞0.05);at the final FU, group L's ODI showed better functional recovery than group S's[(12.8±9.3)％ vs.(25.4±11.4)％, P＜0.05].With no obvious difference in the two groups (P＞0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P＜0.05).The same situation was found in C7-CSVL correction in two goup in FU (P＜0.05).Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery.The overall incidence of postoperative complications was 31.3％, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S.Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS.Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks;however, short-segment fusion showed higher safety with relatively inferior correction effect.Appropriate fusion mode should be chose according to the patient's deformity features.