The Impact of Double Fixation with Titanium Tack and N-Butyl Cyanoacrylate Glue (NBCG) Mesh Fixation versus NBCG Fixation Only in Totally Extra-Peritoneal Hernioplasty with 3-Dimensional Configured Polyester Mesh: A Comparative Study

PURPOSE: Our aim is to compare 3-dimensional mesh fixation using titanium tacks combine with n-butyl cyanoacrylate glue (NBCG) (COMBINE group) versus NBCG only (NBCG group) in totally extraperitoneal inguinal hernioplasty (TEP). METHODS: This is a retrospectively study of patients diagnosed with unilateral inguinal hernia and underwent TEP with 3-dimensional configured polyester mesh fixation using titanium tacks combine NBCG or NBCG only at the University of Hong Kong-Shenzhen Hospital with data prospectively collected. Operative details and outcomes were compared including: operating time, size of defect, total hospital cost, post-operative pain scores and recurrence. RESULTS: From 08.2013 to 03.2016 a total of 219 patients were included. There was no significant difference between COMBINE group and NBCG group in mean age (52.5 years versus 48.2 years), mean size of defects (2.4 cm versus 2.6 cm), and operating time (121 mins versus 111 mins). There were significant differences between COMBINE group and NBCG group in total hospital cost (3035 USD versus 2022 USD), post-operative pain score on day 2 to day 4 (VAS: 1.4 versus 1.0, 1.0 versus 0.4, 0.5 versus 0.2). There was one recurrence in COMBINE group (p=0.276) with overall recurrence of 0.46%. CONCLUSION: Patients with inguinal hernia underwent TEP with 3-dimensional configured polyester mesh with NBCG fixation only having comparative surgical outcome to COMBINE group. A recurrence of 0.46% can be achieved with this combination. Tacks fixation may cause more post-operative pain and increase hospital cost. Use of N-butyl cyanoacrylate glue in TEP is safe and effective in our clinical series.

Effects of pretreatment with nicorandil on PDCD4/NF-κB/TNF-α pathway in coronary microembolization / 中华急诊医学杂志

Objective To investigate the role of nicorandil pretreatment on protecting myocardium after coronary microembolization (CME) and on the PDCD4/NF-κB/TNF-α signaling pathway in miniature pigs. Methods Fifteen Bama miniature pigs were randomly(random number) divided into the sham operation group (sham group), microembolization group (CME group) and CME plus nicorandil group, with 5 pigs in each group. The CME model was constructed by injecting polyethylene microspheres via microcatheter into the left anterior descending artery, and pigs in the sham group were injected with the same amount of saline. Pigs in the CME plus nicorandil group were injected intravenously with nicorandil (150 μg/kg) via ear vein 30 min before CME. Cardiac function indexes were measured using cardiac ultrasonography. The expression of PDCD4 and TNF-α mRNA in myocardium were detected by fluorescence quantitative PCR, and the protein expression of PDCD4 and TNF-α in myocardium were detected by Western blotting. NF-κB activation was evaluated by electrophoretic mobility shift assay. Results (1) Cardiac function was significantly lower and the level of serum cTnI was significantly higher in the CME group compared with the sham group. CME reduced myocardial systolic dysfunction and left ventricular dilatation. The CME plus nicorandil group showed improved CME-induced cardiac function and reduced serum cTnI level when compared with the CME Group (P < 0.05). (2) Compared with the CME group, the CME plus nicorandil group showed lower PDCD4 and TNF-α expression and NF-κB activity as well as improved cardiac function (P < 0.05). Conclusions The pretreatment of nicorandil effectively reduced the myocardial damage caused by CME, mainly through inhibiting the PDCD4/NF-κB/TNF-α pathway in cardiomyocytes.

Minimally Invasive Approach to Supra-pubic and Non-Midline Lower Abdominal Ventral Hernia: An Extended Indication of TAPE Technique

Repair of lower abdominal incisional hernia is always a surgical challenge. TAPE technique has been described for the repair of supra-pubic midline incisional hernia with satisfactory outcome. Its indication can be extended for treatment of non-midline lower abdominal hernia. Peritoneal incision is created just below the hernia defect with pre-peritoneal dissection to expose supra-pubic preperitoneal space with Cooper's ligament exposed. Non-adhesive mesh then placed over preperitoneal space and partially intra-peritoneally, and cover the whole extra-peritoneal space prepared to ensure enough overlapping. Mesh is fixed by tackers for intra-peritoneal part, most inferior fixation points were at peritoneal incision line. Extra-peritoneal part of meshes is fixed at the safety zone and covered up by the peritoneal flap to avoid mesh migration. Fixation of the meshes at the lateral aspects were facilitated by the peritoneal flap and subsequent fibrosis and adhesion to the extra-peritoneal structures in cases of lateral lower abdominal hernia. Repair of midline and lateral lower abdominal incisional hernia with this novel modified technique with prosthetic mesh is safe and effective. A larger case series and longer follow-up is required for validation of this technique.

Research on the Relationship between the Deferment of the Promotion of MRI Manifestation by Gd-BOPTA of HCC and Expression of PCNA,PTEN / 中国医学影像学杂志

Purpose:To discuss the function of Gd-BOPTA on the deferment of manifestation of MRI,which bring influence to the immune mensuration of antigen PCNA,PTEN.Materials and Methods:Scanning with MRI on the 35 patients with pathologically verified HCC the image were analyzed concretely.Pathologic diagnose was made with Edmondson pathologic classification standard,and it was expressed with index of PCNA and PTEN of immune quantitative analysis.Results: HCC was negatively related to the index of PCNA,and most patients with high index were lightly or not deferred enhanced(13/16),Patients with low index were evidently enhanced ( 10/19).The degree of HCC deferred enhancing was positively related to the expression of PTEN.Most HCCs( 15/17) with negative PTEN were lightly or not deferred enhanced,while positive patients of PTEN were mostly enhanced obviously(11/18).Conclusion: Deferment of Gd-BOPTA can be used to basically estimate the tincture of tumor biology,therefore,the enhanced degree of which,the PCNA,PTEN,can offer great help in choosing the therapuetic method and estimating the outcome of the the therapy.

Distribution and Drug-resistance of Stenotrophomonas maltophilia / 中华医院感染学杂志

OBJECTIVE To get knowledge of the distribution and drug-resistance of Stenotrophomonas maltophilia in our hospital and improve the level of diagnosis and treatment.METHODS The automatic drug sensitive test and the paper spreads medicine sensitive test were carried on to 162 strains of S.(maltophilia) with the index of the VITEK system.RESULTS In all clinical samples,S. maltophilia isolated from phlegm was the most(90%),then was from secretion and swab.The majority of 162 strains were multidrug resistant.But to the(trimethoprim)-sulfamethoxazole and ciprofloxacin,the drug resistance was low((20.4%) and 22.2%,respectively).CONCLUSIONS S.maltophilia is the prevalent pathogen of nosocomial infection in ICU.And most of it are(isolated) from phlegm.So use antibiotics correctly,(reduce) invasive examinations or treatments and strengthen drug-resistant monitoring,are helpful to prevent and control S.maltophilia nosocomial infection.

Expression of PTEN and Caspase-3 and their clinicopathological significance in primary gastric malignant lymphoma / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the expression of PTEN and Caspase-3 in malignant lymphoma of the stomach and explore their role in progression of primary gastric malignant lymphoma.</p><p><b>METHODS</b>Formalin-fixed paraffin embedded tissues from 56 cases of primary gastric malignant lymphoma and their adjacent non-tumor mucosa were evaluated for PTEN and Caspase-3 protein expression by streptavidin-biotin-complex (SABC) immunohistochemistry. Their expression was compared with clinical tumor parameters with the relationship between PTEN and Caspase-3 expression concerned as well.</p><p><b>RESULTS</b>The positive rate of PTEN expression in primary gastric lymphomas (50.0%, 28/56) was significantly lower than that in adjacent non-tumor gastric mucosa (96.4%, 27/28) (P < 0.05). Meanwhile, 43 of 56 (76.8%) gastric lymphomas indicated Caspase-3 expression, less than that in adjacent non-tumor mucosa (93.5%, 29/31) (P < 0.05). The expression of PTEN was negatively correlated with invasion and lymph node metastasis of gastric lymphoma (P < 0.05), while the Caspase-3 expression was negatively associated with the latter one (P < 0.05). Additionally, the PTEN expression was positively correlated with Caspase-3 expression in the primary gastric malignant lymphoma (P < 0.05).</p><p><b>CONCLUSIONS</b>The down-regulated expression of PTEN and Caspase-3 played an important role in progression of primary malignant gastric lymphoma. PTEN, as a molecular marker of pathobiological behaviors of tumor, contributes to tumor progression by increasing cell mobility and angiogenesis, as well as decreasing cell adhesion and apoptosis.</p>

Effects of mutation and expression of PTEN gene mRNA on tumorigenesis and progression of epithelial ovarian cancer / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the mutation and expression of tumor suppressor gene-PTEN mRNA and explore their roles in tumorigenesis and progression of ovarian cancer.</p><p><b>METHODS</b>Mutated exon 5 of PTEN gene was examined in normal ovary (n=5), ovarian cyst (n=5), ovarian borderline tumor (n=9), epithelial ovarian cancer (n=60), and ovarian cancer cell line (n=1) by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP). mRNA expression of PTEN gene was evaluated in corresponding tissues and cell line by reverse transcription polymerase chain reaction (RT-PCR). The mutation and mRNA expression of PTEN gene were compared with clinicopathological features of ovarian cancer.</p><p><b>RESULTS</b>Mutated exon 5 of PTEN gene was detected only in 5 (7.1%) cases of epithelial ovarian cancer. mRNA expression level of PTEN gene in ovarian borderline tumor or ovarian cancer was lower than that in normal ovary or ovarian cyst (P < 0.05). The level of PTEN gene mRNA expression was negatively correlated with clinicopathological staging of ovarian cancer, whereas positively correlated with histological differentiation (P < 0.05). mRNA expression level of PTEN gene in ovarian endometrioid cancer was significantly lower than that in ovarian serous or mucinous cancer (P < 0.05).</p><p><b>CONCLUSIONS</b>Mutation of PTEN gene occurs in ovarian cancer. Down-regulated expression of PTEN is probably an important molecular event in tumorigenesis of ovarian cancer. Abnormal expression of PTEN gene is involved in progression of ovarian cancer. Reduced expression of PTEN gene is closely associated with tumorigenesis and pathobiological behaviors of ovarian endometrioid cancer.</p>

The Diagnostic Value of Spiral CT (CT Arterial Portography and CT Hepatic Arteriography) for Hepatic Carcinoma / 实用放射学杂志

Objective To evaluate the diagnostic value of spiral CT [CT arterial portography (CTAP) and CT hepatic arteriography(CTHA)] for hepatic carcinoma. Methods The CTAP and CTHA manifestations in 21 patients with hepatocelluar carcinoma were analyzed and compared with those in three-phase enhanced CT . Results The detection rate of three-phase enhanced CT was 72.4% , CTAP and CTHA was 96.1% and 88.2% respectively. The detection rate of combination CTAP and CTHA was 98.7% . They could reveal tumors of 0.5 cm in diameter . Both CTAP and CTHA gave false-positive findings , such as perfusion defects in 22.3% of CTAP and non-pathologic enhancement in 30.2% of CTHA .Conclusion With the use of spiral CT technique , the quantity of contrast material administrated in CTAP and CTHA can be considerably reduced . And the quality of CT images significantly improved . The detection rate of CTAP and CTHA is higher than that of three-phase enhanced CT . Simultaneous use of both procedures may decrease the false-positive rate.