Objective To investigate operative methods and indications for the surgical repair of hypospadias. Methods Clinical data of 91 cases of hypospadias repaired in this hospital between 1997 and 2003 were retrospectively analyzed. Results Postoperative urethral fistula took place in 15 cases, with an overall incidence of 16 5% (15/91), including 6 cases treated by Duckett procedure, 4 cases treated by Duckett combined with Duplay procedure, 1 case treated by Mathieu procedure, 2 cases treated by scrotal island flap procedure (Onlay procedure), 1 case treated by Denis-Browne procedure, and 1 case treated by Snod-grass procedure. Conclusions For patients with hypospadias associated with serious chordee, because the urethral plate can not be preserved, adaptable methods should include scrotal island flap procedure, Duckett procedure, or Duckett procedure combined with Duplay procedure. Urethral plate conserving operations are suitable for hypospadias without chordee or with mild chordee, involving the Mathieu procedure, Onlay procedure, Snod-grass procedure and Denis-Browne procedure.

Objective To evaluate the efficacy and feasibility of percutaneous microwave coagulation therapy(PMCT) combined with 125I seeds implantation for the treatment of advanced lung cancer.Methods CT-guided PMCT and implantation of 125I seeds were applied to 22 cases of NSCLC,including 15 cases of squamous carcinoma and 7 cases of adenocarcinoma.The maximum diameter of the lesions ranged from 5-12 cm.The part of focuses situated at thoracic wall or surrounding the large vessels and airways was treated with 125I seed implantation,and the other parts were treated with PMCT. Results In all the patients,PMCT was done in one session with multipoint ablation,and an average of 32.4 particles of 125I seeds were implanted for each of the focuses(712 particles in total).The main postoperative complications included slight hemoptysis(7 cases),pneumothorax(4 cases),fever(17) and lung inflammation(11) after PMCT,chest fluid(6),and dislocation of the particles(2).15 cases achieved PR,5 cases were SD,and 2 cases were PD in 2 months after the operation shown by CT.The effective rate(CR + PR) was 68.2%(15/22).The chest pain was relieved in 15 patients,and improved in 4.22 of the cases were followed up for 4 to 18 months(mean 7 months).No enlargement of the chest lesion was detected during the period. Conclusions For the advanced NSCLC sized ≥ 5 cm in diameter,PMCT combined with 125I seeds implantation is safe,minimally invasive,and effective.

Gui-Ling-Ji (GLJ), a classical prescription of traditional Chinese medicine (TCM), is the only existing compound of refining agent after 400-year testing. It is also one of 4 kinds of TCM secret varieties of the first batch after liberation. However, due to the lack of in-depth modern research, the magical effect of GLJ has not been fully understood and the clinical application has also been influenced. This article analyzed the situation and problems of secret varieties and GLJ. Experiences and strategies of the successful redevelopment of secret varieties were re-ferred to. Then, this paper proposed modern research thoughts of GLJ in order to realize the actively protection and the second development of the prescription.

Objective To explore changes of expression of pro-and anti-inflammatory cytokines in the hippocam-pus of Aβ1-42-induced Alzheimer’s disease (AD) rat model. Methods Twenty-four SD rats were divided into control group, PBS group (PBS was injected into CA1 area of hippocampus) and AD model group (Aβ1-42 was injected into CA1 area of hip-pocampus). The escape latency was evaluated by Morris water maze in three groups. Nissl staining was used to detect the le-sions of hippocampal CA1 neurons. Levels of amyloid precursor protein (APP) and protein phosphatase 2A (PP2A) in hippo-campus were measured by Western blot analysis. Real-time PCR was employed to examine the expressions of pro-inflamma-tory cytokines, including interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and the mRNA expressions of anti-inflammatory cytokines, including IL-4, IL-10 and transforming growth factor-β(TGF-β). Re-sults Rats subjected to Aβ1-42 injection in bilateral hippocampus led to a ability reduction of learning and memory, a loss of neurons in hippocampus and an increase in the expression of APP, and a decrease in PP2A expression in the hippocampus. In AD hippocampus, The mRNA expressions of the pro-inflammatory mediator, IL-1β, TNF-αand IFN-γ, were significant-ly up-regulated, but the expressions of the anti-inflammatory cytokines, IL-4, IL-10 and TGF-β, were markedly down-reg-ulated in AD group compared with those of control and PBS groups. Conclusion The pro-inflammatory/anti-inflammatory imbalance induced neuro-inflammation in AD rats, which was involved in pathogenesis of AD.

Objective To explore the clinical features of renal and urinary lesions in IgG4-related disease (IgG4-RD).Methods Clinical manifestation,laboratory profiles,iconography images,pathologic findings,treatment and prognosis of 6 IgG4-RD patients with renal and urinary system involvement from Peking Union Medical College Hospital during Aug 2010 to Dec 2011 were analyzed retrospectively.Results Six patients had renal and/or urinary lesions among IgG4-RD cases diagnosed in our hospital,including 4 males and 2 women,with median age of 59 years (36 to 72 years) and median disease course of 10.5 months.All the patients presented multiple organ involvement simultaneously.Urinary system lesion varied,including renal dysfunction,abdominal pain and edema.Hyperglobulinemia,elevated serum IgG (median 23.3 g/L) and IgG4 (median 4227.0 mg/L),tubular proteinuria were found in all the 6 patients,and elevated Scr (median 237 μmol/L) in 5 cases.Kidney CT image often showed renal swelling,hydronephrosis,multiple low density focus with attenuation and kidney atrophy.Renal pathology revealed interstitial inflammatory cells infiltration comprising predominantly plasma cells and lymphocytes,with a high prevalence of IgG4-positive cells often admixed with fibrosis,which fit the features of tubulointerstitial nephritis.Patients with IgG4-RD nephropathy presented good response to glucocorticoids.After therapy,the symptoms were improved and serum IgG,IgG4 and Scr decreased.Conclusions Renal and urinary lesions of IgG4-RD are heterogeneous in clinical manifestation,and are often complicated with various organ lesions.The feature of renal histopathology is tubulointerstitial nephritis infiltrated by plasma cells and lymphocytes with positive IgG4.Glucocorticoids treatment is effective for this disease.

Objective To explore experimently the effect of tumor angiogenesis on rapid progression of residual tumor of liver cancer after radiofrequency ablation ( RFA). Methods A rabbit VX2 hepatoma model was established. Inoculated tumors were treated by using RFA at 55 ℃ , 70 ℃ and 85 ℃ respectively to establish the residual VX2 hepatoma model. Rabbits implanted with VX2 hepatoma but receiving no RFA treatment served as controls. The expression of vascular endothelial growth factor (VEGF)was determined in tumors to assess the relationship between VEGF and the focal tumor volume and distant metastasis. The expression of VEGF and microvessel density ( MVD) in tumor tissues was assessed by immunohistochemistry. The protein expression of VEGF was assessed by Western blot. The expression of VEGF mRNA was detected by RT-PCR. Results There were significant differences of the local tumor volume between the control group (9.91 ±0.98) cm3 and the other groups (respectively t = -17.43,-10.11, -8.79,all P<0. 05). Compared with the 70 ℃ group (17. 08 ±2. 28 ) cm3 and the 85 ℃ group (15.95 ±4.95) cm3, the focal tumor volume of 55 ℃ group was the largest (21.26 ±2.32) cm3,( respectively t = 4. 69,6. 78, all P<0. 05). Much more metastatic lesions of lung were observed in the RFA treated groups in comparison to the control group. Moreover, the lung metastasis in 55 ℃ group was the most serious among the three RFA treated groups (respectively t = -21.65, -30. 15, all P<0. 05 ).Immunohistochemical staining indicated that the expression of VEGF and MVD in the RFA treated groups was much higher than those in control group ( MVD respectively t = -13.01, -5. 46, -5. 63, all P<0. 05), ( VEGF respectively t = 8. 00,4. 92,4. 21, all P<0. 05 ). Furthermore, the expression of both VEGF protein and VEGF mRNA in 55 ℃ group was the highest among the three RFA treated groups.Conclusions The over-expression of VEGF accelerating the tumor angiogenesis may be one of the mechanisms inducing rapid progression of residual liver tumor after RFA.

ObjectiveTo evaluate the efficacy, feasibility and safety of CT guided percutaneous 125Ⅰ seeds implantation in elderly patients of stage Ⅰperipheral non-small cell lung cancer ( NSCLC ).MethodsClinical data of 16 elderly peripheral stage Ⅰ NSCLC patients ( 10 squamous carcinoma and 6adenocarcinoma;13 stage ⅠA and 3 stage ⅠB ) who received radioactive 125Ⅰ seeds implantation because of refusal or being unsuited to operation or external radiotherapy were retrospectively analyzed. Prescribed dose was 140 - 160 Gy. Under CT guidance, 125Ⅰ seeds were implanted percutaneously into tumors for interstitial radiotherapy according to treatment plan system. ResultsMean number of 125Ⅰ seeds each patient received was21.1. 12 complete response (CR) and 4 partial response (PR) were achieved. Total response rate ( CR + PR) was 100％. 100％ patients completed 10 to 56 months of follow-up, 15, 13, 8 and 6 patients completed 1-, 2-, 3-and 4-years'follow-up, respectively. The median local progression free time was 14months. The 1-,2-,3-and 4-year overall survival rate were 60％, 54％, 50％ and 33％, respectively (median:14 months). 7 cases died of non-tumor disease and 5 died of metastasis. No severe complications were observed. ConclusionsCT guided 125Ⅰ seeds implantation is a safe, reliable and effective radical treatment method for elderly stage Ⅰ peripheral NSCLC patients, who refuse to or are unsuitable to operation or external radiotherapy.

Objective To retrospectively assess the prognostic impact of diabetes mellitus (DM) on patients with hepatocellular carcinoma (HCC) after curative resection.Methods A total of 417 HCC patients who had undergone curative hepatic resection were included into two groups.108 patients were classified into DM group and 309 patients into the non-DM group.Overall survival,disease-free survival,postoperative morbidity and mortality were compared between the two groups after reducing confounding bias by propensity score matching.Independent prognostic predictors were determined by Cox proportional hazards model.Results Propensity score matching resulted in 89 patients in each group,and variables were balanced between two groups.In the matched cohort,DM and non-DM groups showed similar morbidity and 30-and 90-day mortality after curative hepatectomy (respectively x2 =0.837,x2 =Fisher,x2 =Fisher,all P ＞ 0.05),the 1-,3-,and 5-year overall survival rates were 82.0％,59.9％,and 33.4％ in DM group and 90.7％,79.1％,and 69.3％ in non-DM group,respectively(P =0.001),however,there was no significant difference in disease-free survival between DM and non-DM groups.Cox multivariate analysis revealed that DM is an independent risk factor for overall survival in patients with HCC after curative resection,but not for disease-free survival.Conclusions DM does not increase the postoperative morbidity or mortality for patients with HCC after curative resection,however,DM may increase the risk of mortality of HCC patients in the long-term.

ObjectiveTo summarize the occurrence of missed diagnosis of periampullary diverticulum (PAD) with pancreatobiliary diseases and analyze its underlying reasons.MethodsWe conducted a retrospective analysis of 194 patients with PAD complicated with pancreatobiliary diseases from January 2006 to December 2011 in our hospital ResultsAt the first onset of pancreatobiliary diseases,the diagnosis of PAD was made in 48 patients (correct diagnosis group) and missed in 146patients (missed diagnosis group),with a rate of missed diagnosis of 75.3％.At the second,third and fourth onsets of pancreatobiliary diseases in the missed diagnosis group patients,the rates of missed diagnosis were 37.7％,21.8％,and 0％ respectively.There were no significant differences between the correct diagnosis group and the missed diagnosis group with respect to sex,age or the kinds of pancreatobiliary diseases (P＞0.05).But there were significant differences in the two groups with respect to different medical groups,period of admission,the frequency of application of CT,magnetic resonance (MRI) and magnetic resonance cholangiopancreatography (MRCP),duodenal endoscopy/endoscopic retrograde cholangiopancreatography (ERCP) and upper gastrointestinal contrast radiography (P＜0.05).The accuracy rates of CT,MRI,MRCP,upper gastrointestinal contrast radiography and duodenal endoscopy/ERCP for the diagnosis of PAD were 30.0％,31.5％,36.3％,64.5％ and 100.0％ respectively.At the first,second,third and fourth onset of pancreatobiliary diseases,the application rates of duodenal endoscopy/ERCP were 18.0％,33.6％,70.9％ and 91.7％,respectively.Compared with the missed diagnosis group,recurrence rate of symptom were lower significantly in the diagnosis group 1,2,and 3 years post-treatmnet.ConclusionsThe missed diagnosis of PAD complicated with pancreatobiliary diseases is rather common,mainly due to insufficient understanding for PAD.As a result,for PAD patients with pancreatobiliary diseases,the correct diagnosis rates of CT,MRI,MRCP and upper gastrointestinal contrast are low and the use of duodenal endoscopy/ERCP is insufficient.

Objective:The effect of antiviral therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after radical hepatectomy was assessed. Methods:A total of 478 HBV-HCC patients treated by radical hepatectomy were retrospectively col-lected. Patients in the treatment group (n=141) received postoperative lamivudine therapy (100 mg/d), whereas patients in the control group (n=337) did not. Recurrence-free survival rates, overall survival rates, treatments for recurrent HCC and cause of death were com-pared between the two groups. Propensity score matching was also conducted to reduce confounding bias between the groups. Results:The one-, three-, and five-year recurrence-free survival rates didn't significantly differ between the two groups (P=0.778);however, the one-, three-, and five-year overall survival rates in the treatment group were significantly higher than those in the control group (P=0.002). Similar results were observed in the matched data. Subgroup analysis showed that antiviral treatment conferred a significant sur-vival benefit for Barcelona Clinical Liver Cancer stage A/B patients. Following HCC recurrence, more people in the treatment group were able to choose curative treatments than those in the control group (P=0.031). For cause of death, fewer people in the treatment group died of liver failure than those in the control group (P=0.041). Conclusion:Postoperative antiviral therapy increases chances of receiving curative treatments for recurrent HCC and prevents death because of liver failure, thereby significantly prolonging overall sur-vival, especially in early-or intermedian-stage tumors.