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.

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 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.

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 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 summarize the reasons of mis-diagnosis and mis-treatment of autoimmune pancreatitis (AIP). Methods Clinical data of 17 patients with AIP,who were admitted to the hospital from May 2005 to July 2010 and experienced mis-diagnosis and mis-treatment, were retrospectively analyzed. Results The main clinical manifestations included epigastric pain (13 cases),progressive obstructive jaundice (12 cases), fever (6 cases) and weight loss (9 cases). Fifteen patients had extrapancreatic organ involvemnet, including allergic rhinitis, swelling of lymphoglandulae submaxillares, swelling of submaxillary gland, allergic asthma, rheumatoid arthritis, Sjogren syndrome, diabetes mellitus, primary sclerosing cholangitis and autoimmune hepatitis. Of these 17 cases, 11 cases presented with high serum globulin, 14 cases with high serum IgG, 13 cases with high serum γ-globulin, 13 cases with positive anti-nuclear antibody and 2 cases with positive anti-insulin IgG antibody. The abdominal imaging demonstrated that 15 patients had diffuse enlargement of the pancreas with diffuse or segmental narrowing of main pancreatic duct, narrowing of the intrapancreatic common bile duct, dilation of the proximal biliary duct and gallbladder enlargement. Focal enlargement of the pancreas was found in 2 cases. Thirteen cases were misdiagnosed as pancreatic carcinoma. Among them, 4 cases underwent pancreaticoduodenectomy and 7 cases underwent choledochojejunostomy. Two cases were misdiagnosed as end stage of cancer that lost therapeutic chance. Another 4 cases were misdiagnosed as chronic pancreatitis. Steroid therapy was administered in all patients with satisfactory response. All patients were followed-up for 15 months (ranged from 6 months to 45 months), and recurrence was found in 4 cases. Satisfactory response was found in patients treated with steroid for the second time. No pancreatic cancer was found in these patients in the follow up period. Conclusion The main causes of mis-diagnosis and mis-treatment of AIP may be contributed by difficulty in differentiating AIP from pancreatic carcinoma based on clinical manifestations and inadequate knowledge of AIP as well as insufficient attention to AIP in China.

Objective To investigate the diagnostic value of B-mode ultrasonography in detecting middle hepatic vein(MHV)in chronic liver disease patients.Methods 80 chronic liver disease patients were divided into 2 groups(chronic hepatitis and liver cirrhosis).Liver biopsies and the inner diameter(ID)of MHV was detected with B-mode ultrasonography.The ID of MHV was compared in the chronic hepatitis and liver cirrhosis groups,different liver fibrosis stages and compensation/non-compensation liver cirrhosis.The ability of ID of MHV in auxiliary diagnosis liver cirrhosis was analyzed with the receiver operating characteristic curve(ROC).Results The size of ID of MHV in liver cirrhosis(3.82±1.84)mm was smaller than that of chronic hepatitis(6.15±1.67)mm(P＜0.01).The size of ID of MHV in non-compensation liver cirrhosis(2.98±1.15)mm was smaller than that of compensation liver cirrhosis(4.42±2 20)mm(P＜0.05).There was midrange negative correlation with liver fibrosis stages and the ID of MHV(rs=-0.465,P＜0.01).The cutoff point of ID of MHV diagnosis liver cirrhosis was 4.7mm.The area under ROC(AUC)achieved 0.813(P＜0.01).The sensitivity(Se),specificity,(Sp),positive predictive value (PPV),negative predictive value(NPV)and Youden index were 67.5%,90.0%,88.0%,73.5% and 57.5%,respectively.Conclusion There is well clinical value with B-mode ultrasonography detecting ID of MHV for the auxiliary diagnosis of chronic liver disease.

Objective To retrospectively evaluate the role of consolidative repeat radiofrequency ablation (CRRFA) based on safety margin (SM) analyses in local tumor control for alpha-fetoprotein (AFP) negative hepatocellular carcinoma (HCC) patients who had been shown to have radiological complete ablation (CA) with radiofrequency ablation (RFA). Methods From July 2002 to July 2009,152 AFP negative HCC patients who were shown to have radiological CA with RFA therapy were retrospectively analyzed. Among them, 110 patients had a SM of less than 1 cm and the other 42 patients had a SM of 1cm or more. Among 110 patients with SM less than 1 cm, fifty nine patients accepted CRRFA within 6 months after the first RFA and 51 did not. From these patients, a narrow SM-CRRFA group (n=41) and a narrow SM-single RFA group (n=37) were enrolled respectively. The wide SM-single RFA group (n= 30) was enrolled from the 42 patients with a SM of 1 cm or more.The LTP (local tumor progression)-free survival rate of the 3 groups were compared with a log-rank test. Results One-, two-, three-, four-, and five-year LTP-free survival rates respectively were 97. 1%, 90.9%, 69.6%, 47.2%, and 33. 0% in the narrow SM-CRRFA patients. 85.9%, 66. 5%,43.5%, 15.8%, and 0. 0%, in the narrow SM-single RFA patients, and were 92.7%, 83.7%,59.3%, 36. 9%, and 9.2% in the wide SM-single RFA patients. There were statistically significant differences (χ2 = 14. 789, P= 0. 001) between the groups. Conclusions An ablation zone with an SM of 1 cm or greater was the most important factor for local control of AFP negative HCC ranging from 3 to 5 cm in diameter. For these patients with a SM of less than 1 cm, CRRFA improved the overall local control outcomes.

Radiofrequency ablation (RFA) has been recognized as a curative therapeutic modality for hepatocellular carcinoma (HCC) for its increasing efficacy in the recent more than ten years. However, RFA has not been generally carried out in our country and the efficacy still waits for improvement. This paper presents a systemic discussion on the technical measures to promote the efficacy of RFA for HCC from the surgeon's perspective, aiming to provide technical standard and reference for the further popularization and application of RFA in China. The 13 measures include clarification of the tumor location and extent, following the indications and contraindications of RFA, scientific application of pretreatments, selection of the best approach of RFA and of the reasonble guiding method for percutaneous RFA, selection of suitable RFA probe, adequate analgesia, sufficient ablative margin to guarantee pathological complete ablation,optimization of ablaiton strategy, active prevention, diagnosis and treatment of complications, correct evaluation of complete ablation, standadized follow-up and selection of RFA to treat the local tumor progression and intrahepatic occurrence.

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.