Objective To study a novel method of laparoscopic treatment for indirect inguinal hernia in children. Methods Forty-eight children with indirect inguinal hernia (right: 31 cases, left: 13 cases, bilateral: 4 cases) were treated by one port laparoscopic surgery. Among those with unilateral hernia, contralateral latent hernia was found in 5 children. All the patients underwent high ligation of internal annulus under laparoscope. Results The duration of operation was 7～14 min (mean, 9 min). The mean postoperative hospital stay was 24 h. Skin sutures were not required. Follow-up for 3～15 months (mean, 9 5 months) revealed no recurrence. Conclusions One port laparoscopic high ligation of internal annulus is effective, minimally invasive and simple.

Objective To compare and observe the effect and side effect of two different kinds of simulation mode for nasopharyngeal carcinoma conventional radiotherapy. Methods 147 cases were randomly divided into the study group (74 cases, CT simulation) and the control group (73 cases, X-ray radiography simulation). In the study group three-dimensional treatment planning system (IPS) was used to draw target volume and organ at risk, and then beam eye view (BEV) function was utilized to design treatment plan and subsequent plan modulation. In the control group X-ray simulation radiography was used. Two groups of plan design and subsequent plan modulation mode were exactly the same, and the radiotherapy were performed on the same accelerator. Results For these two groups, there were 5-59 months follow-up. The recent therapeutic effect of nasopharyngeal carcinoma primary site and cervical lymph node metastasis was regular,and no statistical significance (P >0.05). For the study group 3-year local recurrence rate was 5.4 % (4/74) while the control group was 16.4 %(12/73), and there was obvious statistical significance between two groups. About one year and three year accumulated survival rate, the study group was 98.5 %, 77.4 %, and for the control group was 92.9 %, 64.7 %. Two groups survival curves were examined by Log-rank test: the survival curves showed statistical significance between two groups(P <0.05). In control group, stage II and III radiotheray reaction of oralis mucosa was significantly increased compared with that of the study group (P < 0.05). There were two cases radioactivity cerebral palsy and one case optic nerve damage in the control group, but no serious dermatosis, soft tissue fibrosis and radioactivity posterior cranial nerve damage. Conclusion The CT simulation which is applied to nasopharyngeal carcinoma conventional radiotheraphy could improve therapeutic effect and reduce cancer recurrence and radiation side effect.

Objective By using cardiac ischemia reperfusion model, the muscarinic receptor path way of cardiac signal conduction in both young and aged myocardium was studied. The aim was to study the pathogenesis of ischemia reperfusion injury in aged myocardium. Methods 20 dogs (15～20 kg) were randomly divided into two groups: group A (young, 3～4 years old, n=10), group B (old, 7～8 years old, n=10). All dogs underwent 60 minutes of global ischemia and 30 minutes of reperfusion under cardiopulmonary bypass (CPB). A tunnel was inserted through the left ventricular apex, to measure the LVEDP、+dp/dt、-dp/dt and ECG. . Myocardial specimens were collected at the beginning of reperfusion, 30 min after reperfusion and 60 min after reperfusion. Myocardium was prepared or studied of density of muscarinic receptor, G protein level, cGMP, guanylate cyclase activity, value of NO, protein level of eNOS, mRNA level of iNOS and eNOS. Results (1) Group B had higher LVEDP but lower +dp/dt max and -dp/dt max than group A in each stage. After CPB, the LVEDP showed no difference between pre and post surgery in two groups, while +dp/dt max and -dp/dt max were decreased in both groups, more significantly in group B. (2) At 30 min and 60 min after reperfusion, the density of M receptor was significantly increased in group B than that in group A. (3) There was no significant difference in Gs pre and post surgery in group A. Compared with group B, the level of Gi decreased significantly after the reperfusion in group A. There were decreasing in Gs and Gi after reperfusion in group B, more greater in the former. The ratio of Gi/Gs in group B was much higher than that in group A. (4) Compared with group A, the mRNA level of eNOS and protein level of eNOS decreased more significantly in group B during each stage of reperfusion. After ischemia reperfusion, the mRNA level of iNOS, NO, cGMP and guanylate cyclase activity were obviously increased in group B than that in group A.Conclusion (1) After the cardiac surgery in elder model, the M receptor path way increased significantly, which is negatively correlated with cardiac function, hence promote the ischemia reperfusion injury in elder myocardium. (2) In the ischemia reperfusion injury in elder myocardium, higher vagotonic does more harm to the old myocardium through NO and NO cGMP pathway.

Objective To evaluate the efficacy of puerarin for prevention of brain injury in the patients undergoing open heart surgery under cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅲ patients of both sexes,aged 50-64 yr,weighing 50-75 kg,scheduled for elective cardiac valve replacement under general anesthesia,were randomly divided into 2 groups (n =15 each) using a random number table:control group(group C) and puerarin group (group P).Puerarin 400 mg was infused intravenously over 30 min immediately at skin incision in group P and the equal volume of 5％ glucose-sodium chloride injection was given in group C.Before induction of anesthesia (T0),at 30 min of CPB (T1),immediately after aortic unclamping (T2),and at 6,12 and 24 h after termination of CPB (T3.5),blood samples were collected from the jugular venous bulb for determination of the plasma concentration of neuron-specific enolase (NSE) and S-100 β protein.P300 eventrelated potential latency and amplitude were determined and cognitive function was assessed by Mini-Mental State Examination (MMSE) score at 1 day before surgery and 7 days after surgery.The patients were diagnosed as having post-operative cognitive dysfunction when MMSE score before surgery-MMSE score after surgery ≥ 2,or when M MSE score≤ 24.Results Compared with group C,the concentrations of plasma NSE and S-100 β protein were significantly decreased at T15,and P300 event-related potential latency was shortened,P300 event-related potential amplitude was increased,and the incidence of postoperative cognitive dysfunction was decreased at 7 days after operation in group P.Conclusion Puerarin can prevent the brain injury in the patients undergoing open heart surgery under CPB.

Objective To investigate the regulatory effects and possible mechanisms of autophagy induction and bactericidal activity in muring bone marrow derived macrophages ( BMDMs) . Methods Murine BMDMs were isolated and cultured in vitro. Then standard strain of E. coli was used to infect BMDMs and cellular autophagy levels and AMPK activation were detected. We next modulated functions of AMPK by pretreating cells with the specific agonist or antagonist of AMPK. Then cellular AMPK activation, autophagy levels and bactericidal activity were observed after E. coli infection. Results In E. coli infected BMDMs,autophagy related molecules like LC3B and Beclin1 were upregu-lated,accompanied with elevated LC3Ⅱ/Ⅰratio. Phosphorylation of AMPK was also upregulated by E. coli treatment. Enhanced AMPK activi-ty by its agonist leads to increased cellular autophagy and bactericidal activity,whereas inhibition of AMPK by its suppressor downregulated autophagy and dampened bactericidal activity. Conclusion AMPK and its related signaling pathway is required for anti-bacterial response in macrophage,which is dependent on its function in upregulating autophagy related molecules and inducing autophagy.

Objective To compare the effects of different spleen-strengthening recipes on water-electrolyte metabolism and water transport in rat model of spleen-deficiency syndrome. Methods The male Wistar rats were randomly assigned into the normal group and spleen-deficiency model group. The rat model of spleen-deficiency was established by overstrain plus disordered diet method. On the 15th modeling day, the model rats were randomly assigned into model group , Buzhong Yiqi Tang(BYT) group, Si Junzi Tang(SJT) group, Shenling Baizhu San(SBS) group, and the rats except for the model group were treated with gastric gavage of the corresponding medicine in the dosage of 4.05 g·kg-1·d-1. Rats of normal group and model group were given equal volume of normal saline. The medication lasted for 14 days. On the 29th experimental day, we detected serum Na+ and K+, plasma antidiuretic hormone(ADH) and aldosterone(ALD), aquaporin 3(AQP3) in the small intestine and colon, and renal AQP2. Results Compared with the normal group, plasma ADH and ALD levels, serum Na+ level, renal AQP2 content in the model rats were increased significantly, serum K+ and AQP3 content of small intestine and colon mucosa was decreased significantly(P<0.01). Compared with the model group, plasma ADH and ALD levels, serum Na+ level, renal AQP2 content in the three medication groups were decreased significantly, serum K+level and AQP3 in the small intestine and descending colon mucosa was increased significantly(P<0.05 or P<0.01). Of the three medication groups, SBS group had lower ADH, ALD, Na+levels, and higher serum K+level and AQP3 in the small intestine and descending colon mucosa than BYT group and SJT group(P<0.01); SBS group and BYT group had lower renal AQP2 than SJT group(P<0.05 or P<0.01). Conclusion Rat model with spleen-deficiency syndrome has disordered water-electrolyte metabolism and abnormal water transport. The spleen-strengthening recipes, which have the actions of strengthening spleen, strengthening spleen to drain dampness, strengthening spleen to elevate yang, can improve the disorder of water metabolism to some degrees, and SBS has the best effect.

Objective To examine the chracteristics of distribution of the FGF R before and after the flap transplantation and the influence of exogenic bFGF on the distribution of FGF R. Method Caudally based random skin flaps were raised on the backs of Wistar rats,bFGF was instilled under flaps after closure.An immunohistochemical techniques stanining method was used. Results FGF receptors distributes in the stratum basal of epidermis,the vascular endothelial cells in the dermis and hypodermis,the fibroblasts and the epithelial cells of the hair follicle and the sweat gland.In compared with preoperation,the quantity of increased gradually from the 1st day to the fifth day after operation,and the peak value is on the fifth day,it then recovered to the pre operation level on the serventh day.After applying the exogenic bFGF,the positive immunoreactive cells in the experimental group,increased remarkably from the Ist day to the 3rd day after operation in contrast with the control group.The peak value is on the 3rd day which was two days earlier than that of the control group and the peak value of the experimental group is remarkably higher than that of the control group.Conclusion\ FGF R distributes in the stratum basal of epidermis,the vascular endothelial cells in the dermis and hypodermis,the fibroblasts,and the epithelial cells of the hair follicle and the sweat gland.In compaired with pre operation,the quantity of the positive immunoreactive cells of FGF R were increased gradually from the Ist day to fifth day after operation,and the peak value is on the fifth day.After applying the exogenic bFGF,the positive immunoreactive cells of FGF receptors were increased.\;[

Objective To evaluate the effectiveness of internet-based cognitive behavior therapy (CBT-I) on blood pressure in patients with hypertension comorbid with insomnia.Methods One hundred and six patients met the JNC-8 diagnostic criteria for hypertension and DSM-5 diagnostic criteria for insomnia were selected,and randomly assigned to CBT-I group (n=53) and regular treatment group (n=53).All the patients accepted relevant treatment for 8 consecutive weeks.Changes of systolic blood pressure (SBP),diastolic blood pressure (DBP),the sleep parameters and the anxiety and depression levels were observed between baseline and 8 weeks of follow-up.Results Compared with pre-treatment,SBP and DBP decreased significantly in both CBT-I group and regular treatment group (P＜0.01),the decrease was more significant in CBT-I group than in regular treatment group (P＜0.01).The sleep latency,sleep efficiency,bed time and rating anxiety scale were improved more significantly in CBT-I group than in regular treatment group (44.49 ± 22.75min vs.55.50 ± 34.96min;72.31％ ± 9.15％ vs.57.70％ ± 11.53％;302.65 ± 43.76min vs.262.70 ± 50.64min and 17.14 ± 6.45 vs.21.02 ± 6.64,respectively),the differences were of statistical significance (P＜0.05).In addition,no significant difference was found in the level of depression between CBT-I group and regular treatment group.Conclusion CBT-I can effectively shorten sleep latency,improve sleep efficiency,extend bed time and improve anxiety,meanwhile effectively lower the blood pressure of patients with hypertension comorbid with insomnia by optimizing sleep quality.

Objectives: The aim of the study was to evaluate the therapeutic effects of 6-mercaptopurine in the treatment of refractory childhood nephrotic syndrome (NS). Methods: According to the varieties of NS, 6-mercaptopurine (2 mg/kg body weight daily) combined with corticosteroid or 6-mercaptopurine (2 mg/kg body weight daily) alone after tapering of steroids were given to 28 consecutive children with primary NS in our hospital. Results: One month after the use of 6-mercaptopurine, proteinuria was decreased. The duration of improvement was 9～28 days, with mean duration of 17 days. Over-all effective rate was 85.7%. Among different varieties of NS, the best therapeutic effect was noted in steroid-dependent children; the better therapeutic effect in steroid-resistant children; and good therapeutic effect in frequently relapsing children. The effective rates were 100%, 84.6%, 81.8% respectively. All the pathological varieties of 28 children were confirmed by renal biopsy. The better therapeutic effects were noted in slight mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephrotic syndrome (MCNS). The less therapeutic effect was noted in membranoproliferative glomerulonephritis (MPGN). Their therapeutic effective rates were 92.9%, 80%, 66.7% respectively. Unfortunately, drug-induced aplastic anemia was seen in 2 cases. Slight gastrointestinal reactions were present in 6 cases. There were no side reaction on the gonad. Conclusions: The great difference in the therapeutic effects is related to the different pathologic varieties of NS. With regard to the treatment of refractory NS in children, the pathological varieties should be confirmed by renal biopsy as soon as possible. Based on the renal biopsy, 6-mercaptopurine can be considered in the treatment of MsPGN and MCNS. As a result, relapses could be reduced; the duration of remission could be prolonged, and the side reactions from steroid treatment could be avoided. The use of 6-mercaptopurine for the treatment of refractory NS is one of the effective therapy.

Objective To investegate the value of dual-source CT (DsCT) in the diagnosis of tetralogy of Fallot (TOF).Methods The measurement results of the main pulmonary artery( PA),left pulmonary artery (LPA),right pulmonary artery( RPA ),right entricular outflow tract(ROVT) of 42 cases with TOF by DsCT,echocardiography aud surgery were ret rospectively analyzed.Results Of the 42 cases,a total of 232 cardiac nomalies were found by surgery ( 145 intra cardiac anomalies,53 ventricular-aterial connection anomalies,34 external cardiac anomalies),DsCT and echocardiography found 204 cardiac nomalies (130 intra cardiac anomalies,12 ventricular-aterial connection anomalies,53 external cardiac anomalies),224 cardiac nomalies ( 145 intra cardiac anomalies,31 ventricular-aterial connection anomalies,48 external cardiac anomalies)respectively;and the diagnostic accuracy of DsCT and echocardiography was 88％ (204/232),97％ (224/232) respectively.There was not significant difference between DsCT and surgery ( P ＞ 0.05 ).There was significant difference between echocardiography and surgery in PA,LPA and RPA (P＜0.05),but not in ROVT and over-riding of the aorta (P＞0.05).There was not significant difference between DsCT and echocardiography ( P ＞ 0.05 ).Conclusion Echocardiography was superior to DsCT in intra cardiac anomalies,especially in the cardiac septal defects and heart valve diseases.DsCT had the advantages in external cardiac anomalies,particularly in assessing pulmonary artery.