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Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.
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Objective:To observe the therapeutic effect of warm needling moxibustion for erectile dysfunction (ED). Methods:A total of 46 eligible ED patients were randomized into a treatment group (n=24) and a control group (n=22). The treatment group was intervened by warm needling moxibustion while the control group by conventional acupuncture treatment, for a total of 4 courses. The therapeutic effect was evaluated by the international index of erectile function 5 (IIEF-5). Results:After 4 courses of treatment, the overall effective rate was 91.3% in the treatment group (23 completed), versus 75.0% in the control group (20 completed), with a significant difference (P Conclusion:Warm needling moxibustion can produce a more significant efficacy than conventional acupuncture in the treatment of ED.
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Objective: To summarize and critically assess the evidence from randomized controlled trials (RCTs) of acupuncture in treating dry eye syndrome (DES) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Collaboration recommendations. Methods: A search of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Embase was made from their inception to August 2016, as well as Chinese, Japanese, and Korean databases. Two reviewers independently selected RCTs and assessed the methodological quality. Meta-analysis and the level of evidence were processed by RevMan 5.3 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: After selection, 8 trials were subjected to our systematic review. The methodological quality was low generally. The 3-10 weeks follow-up showed that acupuncture improved the tear film break-up time (BUT) (MD=1.33, 95%CI=1.01-1.66, 619 participants). The mean difference of Schirmer's test was 1.73 mm (95%CI=1.28-2.18, 618 participants) between the acupuncture group and the control group. The subjective variables exhibited no significant differences. Conclusion: The low methodological quality of the trials does not suggest drawing firm conclusions on the value of acupuncture therapy for DES. Acupuncture treatment may have some effects on the tear film BUT and Schirmer's test, but not on the subjective symptoms. Well-planned large-scale high-quality RCTs are needed to make it clear whether acupuncture is effective in treating DES.
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Objective To investigate whether inhibiting the expression of typeⅠ collagen gene is one of the mechanisms of action of electroacupuncture in improving knee osteoarthritis.Methods Forty male adult SD rats were randomized into normal, model, medication and electroacupuncture group, 10 rats each. A rat model of MIA-induced knee osteoarthritis was made by injecting monomer sodium iodoacetate (MIA) and driving rat movement. After model making, the medication group received an oral gavage of celecoxib dissolved in 10% DMSO and the electroacupuncture group, electroacupuncture at points Zusanli and Yanglingquan. Pain thresholds and the levels of cartilage expression of typeⅠ collagen mRNA were compared between various groups of rats before and after treatment.Results There was a statistically significant difference in pain threshold between the model, medication or electroacupuncture group of rats and the normal group after model making (P0.05). There was a statistically significant difference in the expression of typeⅠ collagen mRNA between the model, medication or electroacupuncture group of rats and the normal group (P0.05).Conclusion The mechanisms of actions of electroacupuncture and medication in treating knee osteoarthritis may be related to inhibiting the expression of typeⅠ collagen mRNA.
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Objective:To observe the therapeutic effects of acupuncture plus cupping therapy and Western medication alone for cervical radiculopathy. Methods: A total of 139 patients with cervical radiculopathy were randomly divided based on the random digital table into an acupuncture-cupping group (70 cases) and a Western medication group (69 cases). In the acupuncture-cupping group, Fengchi (GB 20) (bilateral), Dazhui (GV 14), Jianjing (GB 21) (bilateral) and Jiaji (EX-B 2) points of the neck [bilateral, midpoint between Fengchi (GB 20) and Dazhui (GV 14)] were punctured. After the arrival of the needling sensation, bilateral Fengchi (GB 20) and Jianjing (GB 21) were linked with electric stimulation and the rest acupoints were manipulated with the moderate needling technique. In the retaining of the needles, TDP lamp radiation was used. After acupuncture, the cupping therapy was applied to the local area. The treatment was given once every other day, 20 d for a course. After one course, the therapeutic effects were observed. The Western medication group was treated by oral administration of Meloxicam (Mobic), 7.5 mg, once a day, with water and liquid after meal. The therapeutic effects were observed after 20 d. Results:The total effective rate was 92.8% in the acupuncture-cupping group and 73.9% in the Western medication group, with a statistical difference between the two groups (P<0.05). After treatment, the scores of the clinical symptoms of the two groups were obviously declined (P<0.01), and the score of the clinical symptoms of the acupuncture-cupping group was better than that of the Western medication group, with a statistical difference (P<0.05). Conclusion:Acupuncture plus cupping therapy was more effective than administration of Meloxicam tablets alone in the treatment of cervical radiculopathy.
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To summarize the clinical experience of Prof. Yan Jun-bai in treating rheumatic arthritis (RA) with suppurative moxibustion and aim to guide acupuncture treatment for RA. Prof. Yan believes that contributing factors of RA include external contraction of pathogenic factors, obstructed flow of qi and blood, internal phlegm-turbidity (due to deficiency of healthy qi or improper diet), and obstruction or malnourishment of meridians. As a result, the treatment strategies are to warm yang, remove pathogenic factors, and tonify the liver, spleen and kidney. Suppurative moxibustion is a reliable therapy for RA.
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Objective To screen differentially expressed serum proteins by label-free quantitative proteomics in patients with atopic dermatitis,in order to discover serum protein markers for atopic dermatitis.Methods Serum samples were collected from 6 patients with atopic dermatitis and 6 healthy human controls.Then,the samples from the patients were pooled together,so with those from the controls.Proteins were extracted from the two joint serum samples followed by separation with one-dimensional sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE).Peptides were obtained by enzymolysis in protein gels,which were subsequently identified by high performance liquid chromatography tandem mass spectrometry.The Mascot software was used for database searching,and the Scaffold software for relatively quantitative analysis of proteins.Results Totally,76 proteins with a difference of greater than 1.5 folds were identified between the serum samples of patients with atopic dermatitis and controls.There were 50 up-regulated and 26 down-regulated serum proteins in the patients compared with the healthy controls.Among these differentially expressed proteins,26 were only detected in the sera of the patients,and 14 proteins in those of the controls.Conlusion Differences exist in the expression of serum proteins between atopic dermatitis patients and healthy people.
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Objective To evaluate medical chemistry adhesive in tension-free herniorrhaphy for inguinal hernia. Methods In this study, 100 patients with primary unilateral inguinal hernia were assigned to study group ( n = 50) and control group ( n = 50) during Jun. 2009 and Dec. 2009. Medical chemistry adhesive (n-butyl-2-cyanoacrylate, NBCA) was used in Lichtenstein tension-free hernia repair in study group and suture procedure was used in control group. Patient demographics, operation time,postoperative length of stay, visual analogue scale ( VAS ) score 24 hours after surgery, incidence of postoperative chronic pain and hematoma, recurrence rate, and other complications were compared between the two groups. Results The duration of follow-up ranged from 12 months to 18 months. There were no recurrences or wound infection in the two groups. In study group, no patient complained of chronic pain postoperatively, whereas in the control group, 6 patients ( 12% ) had a significant chronic pain. In study group, 2 patients (4%) had local hematoma after operation, whereas there were 8 ( 16% ) in the control group ( P ＜ 0. 05 ). There were no significant differences between the 2 groups in postoperative length of stay ( P ＞ 0. 05 ), but the operation time and postoperative VAS score in study group ( 38 ± 5 min and 2. 5 ± 0. 6)were lower than in the control group (42 ± 5 min and 2. 8 ± 0. 8 ), ( P ＜ 0. 05 ). Conclusions Application of medical chemistry adhesive in tension-free herniorrhaphy for inguinal hernia is associated with less postoperative pain, lower incidence of hematoma, less postoperative chronic pain and shorter operation time.
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Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.
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Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.
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Objective To investigate the effect ofpeptidoglycan from Staphylococcus aureus on the release of several chemokines including intedeukin 8 (IL-8), regulated upon activation, normal T cell expressed and secreted (RANTES), macrophage-derived chemokine (MDC) by normal human epidermal keratinocytes (KCs) and the role of Toll-like receptor 2 (TLR2) in this process. Methods KCs were derived from the foreskin of a healthy boy and propagated. After 2 - 4 passages, KCs were collected and treated with various concentrations (3, 10, 30 and 100 mg/L) of peptidoglycan for 24 hours or with peptidoglycan of 100 mg/L for varying durations (3, 6, 12, 36 hours). A fi'action of KCs were pretreated with functional grade purified anti-TLR2 monoclonal antibody before the treatment with peptidoglycan of 100 mg/L. After additional 12-hour culture following the treatment, enzyme linked immunosorbent assay was used to detect the level of IL-8, RANTES and MDC in culture supernatants of KCs. Results KCs spontaneously released IL-8 and RANTES. Peptidoglycan increased the production of IL-8 but decreased that of RANTES by KCs. The levels of IL-8 were 209.96 ± 10.31 ng/L, 250.28 ± 9.52 ng/L, 285.11 ± 10.28 ng/L, 359.40 ± 6.93 ng/L in KCs treated with peptidoglycan of 3, 10, 30, 100 mg/L, respectively, compared to 135.41 ± 14.37 ng/L in untreated KCs (all P < 0.05). On the contrary, a significant decrement was seen in the secretion of RANTES by KCs treated with peptidoglycan of 10, 30, 100 mg/L compared with untreated KCs (110.72 ± 8.51 ng/L, 90.50 ±2.45 ng/L, 49.89 ± 13.74 ng/L vs 149.94 ± 18.71 ng/L, all P < 0.05). The monoclonal antibody to TLR-2 could markedly suppress the promotion of IL-8 production by peptidoglycan, but had no obvious influence on the inhibition of RANTES production by peptidoglycan. MDC could not be detected in the culture super-natants of KCs with or without peptidoglycan stimulation. Conclusion Peptidoglycan could inhibit RANTES secretion but induce IL-8 production by KCs likely via TLR2.
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Objective To discuss the control of ascites, timing and skill of herniorrhaphy for the treatment of umbilical hernia with ascites. Methods The management of 21 patients of umbilical hernia with ascites were retrospectively analyzed. Preoperative small amount of ascites was managed with oral diuretics, medium amount of ascites was treated with combined oral and intravenous diuretics, refractory ascites was treated with paracentensis (3000 ml each time). In the meantime, intravenous albumin, dopamine and fluid therapy were administered. In relapsing ascites, repeated paracentensis in a time interval of 2-4 days was applied. It was time for surgery when abdominal wall tension ameliorated, abdominal circumference reduced and the hernia sac shrank. In case of ascites refractory to all preoperative management an intraoperative slow extraction of the ascites to the amount below 4000 mi is mandatory. Perioperative diuretic therapy is the key for a successful herniorrhaphy. There were 21 cases in our group, 19 cases underwent selective operation, 2 cases were treated with emergency operation; 20 cases by tension-free hernia repair, 1 case by suture herniorrhaphy. Results Surgery was successful in all patients, the mean operative time was 45 min (25-90 min). During the follow-up period from 2 to 52 months (meanly 23 months), only 1 case lost and the other 19 cases healed with no recurrence. 20 patients healed well with no hernia recurrence or complications. One case who was treated with suture hemiorrhaphy suffered from incisional infection, and died of hepatic failure 3 weeks after surgery. Conclusions Umbilical hernia with ascites is not an absolute surgical contraindication. By intensive management of the ascites in perioperative period and prudent selection of the timing of surgery, tension-free herniorrhaphy is a safe and effective treatment for umbilical hernia.
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Objective To study the effect of pioglitazone on the differentiation and function of rat osteoclast-like cells (OLC), and to probe the relationship between activated PPARγ2 and osteoclasts. Methods On day 1 of OLC formation from nonadherent bone marrow ceils (BMC) obtained from rats induced by M-CSF and receptor activator of NF-кB ligand (RANKL), 1, 5 and 10μmol/L pioglitazone hydrochloride was added. RT- PCR was performed to determine the mRNA expressions of PPARγ2 and receptor activator of NF-кB (RANK) on day 3, 5 and 7 during incubation, the number of tartrate-resistant acid phosphatase (TRAP)-positive cells,the number of bone resorption pits and the ratio of its area on dentin slice were counted, the activity of TRAP and the mean fluorescence intensity of integrin β3 (CD61) of OLC were also measured. Results (1) The effect on the differentiation of OLC: The addition of pioglitazone at the start of the culture period induced a dose-dependent decrease in TRAP-positive OLC and the activity of TRAP (P < 0.01 or P < 0.05) ; the mRNA expression of PPARγ2 was up-regulated by 5 and 10 μmol/L pioglitazone in the early stage of incubation and attenuated with thematuration of OLC on the contrary, however, the expression of RANK was down-regulated by 5 and 10 μmol/L piolitazone in every stage of incubation (P < 0.05 or P < 0.01), combined with decrease in TRAP-positive OLC from day 3 by 10 μmol/L pioglitazone. (2) The effect on the function of OLC: the number of bone resorption pits and the ratio of its area on dentin slice were decreased in groups of 5 and 10 μmol/L pioglitazone (P < 0.01 orP < 0.05), no obvious change was noted in the group with 1 μmol/L pioglitazone compared with the control group; the mean fluorescence intensity of CD61 were down-regulated in groups of 5 and 10 μmol/L pioglitazone (P < 0.05 or P <0.01). Conclusion Activation of PPARγ2 pathway by pioglitazone could partially inhibit differentiation and function of OLC derived from rat BMC.
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BACKGROUND: The rehabilitative intervention accelerates the recombination and reconstruction of cerebral structure and function and then promotes the amelioration of function.OBJECTIVE: To evaluate the influence of early and late rehabilitative interventions on the motor function and activities of daily living (ADL) with neurologic deficit score (NDS), Fugl-Meyer assessment (FMA) and modified Barthel index in patients with cerebral infarction.DESIGN: A randomized controlled trial.SETTING: Department of Neurology, Qilu Hospital of Shandong University; Department of Rehabilitation, Jinan Great Wall Hospital; Department of Neurology, the Third People' s Hospital of Heze.PARTICIPANTS: Totally 216 inpatients with cerebral infarction (125 males and 91 females, aged 60-75 years), who were selected from Qilu Hospital of Shandong University, Jinan Great Wall Hospital and the Third People's Hospital of Heze from December 2000 to December 2003, were randomly divided into early rehabilitation group (n=108) and late rehabilitation group (n=108) after admission.INTERVENTIONS: In the early rehabilitation group, the patients began to receive rehabilitation at 48 hours to 14 days after the stability of vital signs and absence of the progress of neurological signs. In the late rehabilitation group, the patients began to receive rehabilitation at 15-30 days after attack. They were trained with Bobath method and motor relearning program, once a day, 45 minutes for each time, and 6 times every week.Before and 30 days after the rehabilitative treatment, the rehabilitation was evaluated with modified Barthel index (100 points as normal, 0-20 as extremely severe functional defect, 25-45 as severe functional defect, 50 -70 as moderate functional defect, 75-95 as mild functional defect), FMA (total score was 100 points, including the highest scores of upper and lower limb movement were 66 and 34 points respectively) and NDS (the highest and lowest scores were 45 and 0 point, 0-15 as mild, 16-30 as moderate, 31-45as severe).ter treatment.RESULTS: All the 216 patients with cerebral infarction were involved in obviously lower than that before treatment in both groups (P ＜ 0.01), lower in the early rehabilitation group than in the late rehabilitation group score at 30 days after treatment was obviously higher than that before treat ment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [upper limb: (32.43±21.52), (26.69±19.79)dex: The modified Barthel index at 30 days after treatment was obviously higher than that before treatment in both groups (P ＜ 0.01), higher in the early rehabilitation group than in the late rehabilitation group [(54.23±30.33),(46.57±29.85) points, P ＜ 0.05].CONCLUSION: Both early and late rehabilitative interventions can obviously accelerate the recovery of neurological function, motor function and ADL, but the effect of early rehabilitative intervention is superior to that of the late one.