Influencing factors of small intestinal ischemia in elderly patients with incarcerated hernia / 中华外科杂志

Objective: To investigate the factors influencing small intestinal ischemia in elderly patients with incarcerated hernia. Methods: The clinical data of 105 elderly patients admitted for surgical procedures of incarcerated hernia at Department of General Surgery, Huadong Hospital between January 2014 and December 2021 were retrospectively analyzed. There were 60 males and 45 females, aged (86.1±4.3) years (range: 80 to 96 years). They were divided into normal group (n=55) and ischemic group (n=50) according to intraoperative intestinal canal condition. The t test, χ2 test and Fisher's exact probability method were used for the univariate analysis of the factors that influence intestinal ischemia in patients, and Logistic regression was used for multifactorial analysis. Results: In all patients, 18 patients (17.1%) had irreversible intestinal ischemia with bowel resection. Six patients died within 30 days, 3 cases from severe abdominal infection, 2 cases from postoperative exacerbation of underlying cardiac disease, and 1 case from respiratory failure due to severe pulmonary infection. The results of the univariate analysis showed that there were differences in gender, history of intussusception, duration of previous hernia, white blood cell count, neutrophil percentage, C-reactive protein, type of incarcerated hernia, and preoperative intestinal obstruction between the two groups (all P<0.05). The Logistic regression results showed that the short time to the previous hernia (OR=0.892, 95%CI 0.872 to 0.962, P=0.003), high C-reactive protein (OR=1.022, 95%CI 1.007 to 1.037, P=0.003), non-indirect incarcerated hernia (OR=10.571, 95%CI 3.711 to 30.114, P<0.01) and preoperative intestinal obstruction (OR=6.438, 95%CI 1.762 to 23.522, P=0.005) were independent risk factors for the development of intestinal ischemia in elderly patients with incarcerated hernia. Conclusions: The short duration of the previous hernia, the high values of C-reactive proteins, the non-indirect incarcerated hernia, and the preoperative bowel obstruction are influencing factors for bowel ischemia in elderly patients with incarcerated hernia. A timely operation is necessary to reduce the incidence of intestinal necrosis and improve the prognosis.

Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China / 中华外科杂志

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

The progression of intervention cell death in kidney diseases / 医学研究生学报

Precise regulation of cell death and survival is essential for proper maintenance of organismal homeostasis, development, and immune system. Kidney diseases, especially acute histology changings linked ischemia-reperfusion injury, are among illnesses that are profoundly affected by improper regulation or execution of cell death pathways. Given the truth that improper regulation of cell death participates in a common pathway of various pathologies, specific therapeutic strategies that aim at the regulation are promising. In current review, we reviewed the most common pathway on cell death in renal injury, also described several potential therapy strategies that may influence the prognosis of kidney diseases，such as targeting receptor interacting protein 1 kinase.

Psychological influence of mini-invasive Carisolv III gel for caries removal in primary teeth / 医学研究生学报

Objective　Mini-invasive Carisolv is an aid to treat dental caries for patients with dental phobia. The article was to investigate the level of pain in caries removal using mini-invasive Carisolv III gel and mechanical methods with four psychological indicators.　Methods　We collected 120 primary molar tooth caries of 60 children treated in our hospital. Two primary molar tooth caries of each child were respectively treated with Carisolv III gel (Group A) and mechanical method (Group B) for caries removal. Psychological indicators including the visual analog scale (VAS), the Frank1 behavior rating scale (Frank1), the Kuttner law (Kuttner), and the Houpt behavior rating scale (Houpt) were used to assess the level of pain, degree of cooperation, pain tolerance and comfort. The clinical efficiency after six months and treatment time were compared between the two groups.　Results　There was no statistically significant difference before treatment between the two groups using the four psychological indicators (P>0.05) , while significant differences were found during and after the treatment between the two groups (P0.05). In the mechanical group, there were statistically significant differences before and during treatment or before and after treatment using the four psychological indicators (P<0.05). The treatment time in Carisolv III gel group was longer than in mechanical group (P=0.001). There was no statistical difference between the two groups in filling examination after six months (P=0.082).　Conclusion　Carisolv III gel for caries removal can effectively avoid pain, improve comfort and decrease fear in children, which can be promoted in clinical application.

Basic principles and repair material selection of abdominal wall defect after breast reconstruction for breast cancer surgery / 中国实用外科杂志

Autologous breast reconstruction after radical resection of breast cancer has been widely used in clinic.Some surgical methods of autologous breast reconstruction may cause abdominal wall defect to a certain extent.The abdominal wall defect leads to the loss of normal function,which leads to a series of serious pathophysiological changes.At present,transverse rectus abdominis myocutaneous flap(TRAM) and deep inferior epigastric artery perforator flap(DIEP) are commonly used for breast reconstruction.According to the different types of abdominal wall defect after breast autoreconstruction for breast cancer surgery,the corresponding surgical repair scheme should be formulated on the basis of strictly following the basic principles of abdominal wall repair.At the same time,appropriate materials for repairing abdominal wall defect are selected according to the different extent of abdominal wall defect.The posterior sheath and peritoneum of rectus abdominis are usually intact after breast reconstruction,and the anterior sheath of rectus abdominis may be retained.The different layers of abdominal wall can be repaired by surgical methods,and the application of repair materials is emphasized.

Clinical analysis on the technique of transverse fascia reinforcement with biological mesh in young inguinal hernia patients / 中国实用外科杂志

OBJECTIVE: To analyze the application value of biological mesh in inguinal hernia patients aged from 18 to44 years old. METHODS: The clinical data of 127 patients with inguinal hernia admitted from January 2013 to December 2018 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. Through the abdominal transverse fascia reinforcement with biological mesh(tTRB), it was to observe indicators during perioperative and followup periods, to explore the application value and treatment experience of biological mesh in young patients with inguinal hernia. RESULTS: All the 127 cases were successfully completed. There were obvious pain in 3 cases and scrotal edema in 3 cases. No other patients were found to have obvious discomfort. All patients had no complications such as recurrence, chronic pain and infection after 3 to 12 months of follow-up. CONCLUSION: The rational use of biological mesh to repair young and middle-aged patients with inguinal hernia is effective. The advantage is that the effect of mesh minimize the impact on long-term quality of life in young patients. At the same time, the risk of postoperative infection and chronic pain is effectively reduced by reinforcement of transverse fascia with biological mesh, which is worthy of further study.

Characteristics of inguinal hernia in adolescents in China and the problems deserving attention in diagnosis and treatment / 中国实用外科杂志

There is no authoritative definition of adolescents in the world which is generally believed that the age ranges from 10 to 19. At present, there are few surveys on the prevalence of inguinal hernia among adolescents at home and abroad. Adolescents are in the process of vigorous growth and development, and the diagnosis and treatment of inguinal hernia is special. There is still much controversy in the treatment of inguinal hernia. In view of the special group of inguinal hernia patients, adolescents should formulate corresponding treatment plan according to their specific characteristics. Detailed preoperative evaluation should be done to find out if there were any special cases(such as hydrocele of testis and cryptorchidism). According to preoperative evaluation, reasonable surgical methods and repairing materials should be selected, carefully operate during surgery, and protect spermatic cord vessels and vas deferens to the maximum extent to avoid adverse complications. Tissue repair or patch reinforcement should be considered according to the degree of posterior inguinal canal defect.

Topology optimization on the configuration of titanium reconstruction plate for bridging mandibular angle defect / 医用生物力学

Objective To provide an optimization method and a basic configuration for the configuration design of mandibular defect-repair implant. Methods A topology optimization computation based on density method was adopted to make topology optimization on reconstruction titanium plate for repairing mandibular defect. Results The effects of volume fraction F and penalization factor p on the optimized configuration were compared and analyzed, respectively, and the optimum parameters were chosen to be F=0.65 and p=3.5. Using this set of parameters, optimized computation was performed on the mandibular defect-repair implant, and the three opening configuration was proved to be the basic optimization configuration. The result also showed that unilateral molar clenching had more significant effect on stress distributions in the implant as compared to incisal clenching. Conclusions A set of parameters suitable for optimizing configuration of mandibular defect-repair implant, as well as the basic configuration of optimized titanium plate were obtained, which could provide references for the design of mandibular defect-repair implant in clinic.

Clinical research of 24-hour double-probe pH-metry in the laryngopharyngeal reflux diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the clinical value of 24 h double-probe pH-metry for the diagnosis and treatment of laryngopharyngeal reflux (LPR).</p><p><b>METHODS</b>According to the pH-metry results (whether the reflux events record in the upper esophagus is more than 6.9), patients of refractory pharyngolaryngitis were divided into LPR and control groups (each of 17 cases). All patients treated with anti-acid therapy and conventional pharyngo-laryngitis therapy. Correlation between pH-metry and the reflux symptom index (RSI), the reflux symptom index (RFI) were analyzed. Changes of the RSI and RFI in different group were calculated in post-treatment.</p><p><b>RESULTS</b>In the LPR group, the median reflux events of the upright time were higher than the supine time (Z = -3.62, P < 0.01), but the difference was not discovered in the control group (Z = -0.60, P > 0.05). There was no statistical difference between RSI, RSI and RFS with pH-metry, and with moderate concordance (k were 0.47, 0.53, P < 0.01, respectively). Compared to pre-treatment, the RSI and RFI were decreased both in LPR group and control group, Amplitude decreased in LPR group significantly higher than the control groups, with statistical difference (t were 3.74, 3.01, P < 0.01, respectively).</p><p><b>CONCLUSION</b>The 24 h double-probe pH-metry is significant for the anti-acid therapy of LPR.</p>

Analysis of urinary storage symptoms following transurethral resection of the prostate / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the lower urinary tract symptoms (LUTS), especially those in the urinary storage phase, following transurethral resection of the prostate (TURP), and to improve the postoperative management and patients' quality of life after TURP.</p><p><b>METHODS</b>A total of 86 patients with benign prostate hyperplasia (BPH) underwent TURP, and were interviewed on urinary symptoms at 1, 3, 7, 15 and 30 days after removal of the catheter. The patients were divided into two groups according to whether they had preoperative detrusor instability and/or compliance of the bladder (Group A) or not (Group B), and observed for the changes in IPSS scores and urinary storage symptoms after removal of the catheter.</p><p><b>RESULTS</b>Complete follow-ups were achieved in 71 cases, 28 with detrusor instability and/or compliance of the bladder and the other 43 without. Their IPSS scores on the 1st, 3rd, 7th, 15th and 30th day after removal of the catheter were 8.1 +/- 2.5, 7.2 +/- 3.1, 6.3 +/- 3.8, 5.3 +/- 4.2 and 2.4 +/- 3.4, respectively, with statistically significant differences between the 7th and the 1st as well as the 30th and the 15th day (P < 0.05), but not between the 1st and the3rd nor the 15th and the 7th day (P > 0.05). On the 1st day, the cardinal symptoms in the urinary storage phase were urinary frequency, urgency and incontinence; the scores on IPSS and urinary storage symptoms were 10.4 +/- 3.3 and 9.3 +/- 3.8 in Group A and 6.2 +/- 2.8 and 5.2 +/- 2.7 in Group B, with significant differences between the two groups (P < 0.05). After treatment with tolterodine and alpha-adrenoreceptor inhibitor, neither IPSS scores nor the scores on urinary storage symptoms showed any significant differences between Groups A and B on the 15th and 30th day (P > 0.05).</p><p><b>CONCLUSION</b>The lower urinary tract symptoms following TURP, especially those in the urinary storage phase, are correlated with preoperative bladder function, and getting improved gradually after surgery.</p>

Needlescopic thoracic sympathectomy for palmar hyperhidrosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of needlescopic thoracic sympathectomy for palmar hyperhidrosis.</p><p><b>METHODS</b>From March 2004 to April 2005, 62 patients, including 23 men and 39 women with a mean age of 23 years (ranged from 12 to 53 years), underwent bilateral needlescopic thoracic sympathectomy. Among all the patients 8 cases had accompanied axillary hyperhidrosis. The degree of palmar sweating was moderate in 16 cases and severe in 46 cases. The sympathetic chain on the body of the second and third ribs in all patients was cauterized and divided; the chain on the fourth rib in those with axillary hyperhidrosis was also severed. Intraoperative changes in palmar temperature and blood flow were recorded.</p><p><b>RESULTS</b>Sympathectomies were successful, and dry limbs were immediately achieved in all patients after surgery. There were no mortality or life-threatening complication, however 1 patient developed moderate pneumothorax which resolved soon after chest drainage. After all procedures, palmar blood perfusion increased significantly and mean palmar temperature elevated by 2.4 degrees C. The mean operative duration was 65 min, and the mean postoperative hospital stay was 1.2 days. No recurrence of palmar hyperhidrosis occurred after a mean follow-up of 6.3 months (ranged from 1 to 13 months). Compensatory sweating was found in 26 patients, but the symptoms were mostly tolerable and required no further treatment.</p><p><b>CONCLUSION</b>Needlescopic thoracic sympathectomy is a safe and effective technique for palmar hyperhidrosis, which is less invasive than conventional video-assisted thoracic surgery.</p>

Effect of valsartan on Tribble 3 gene expression in rats with experimental diabetic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>Tribbles, a protein family controlling mitogen-activated protein kinase cascades, might contribute to the remodeling process in dilated cardiomyopathy. We investigated the gene expression of Tribble 3 (TRB(3)), cardiac function and collagen changes in rats with diabetic cardiomyopathy (DCM) and the modulating effects of valsartan on them.</p><p><b>METHODS</b>Male Wistar rats were fed with high cholesterol diet throughout the study period, streptozocin (30 mg/kg, i.p) was given at the 28th day, valsartan (30 mg.kg(-1).d(-1), n = 13) or placebo (n = 11) was administered at the 35th day to rats with fasting blood glucose > or = 11.1 mmol/L per gavage for another 12 weeks. Control rats (n = 8) were fed with regular chow. Fasting blood glucose was monitored throughout the study, left ventricular function was determined by echocardiography, myocardial collagen content quantified after Masson-staining and myocardial mRNA expression of TRB(3) detected by quantification real-time RT-PCR at the end of study.</p><p><b>RESULTS</b>Cardiac function was significantly improved (EF: 74% +/- 10% vs. 66% +/- 7%, P < 0.05), myocardial collagen content decreased (13.23 +/- 3.14 vs. 16.92 +/- 3.18, P < 0.05) in rats with DCM treated with valsartan. Moreover, TRB(3) mRNA was significantly increased in rats with DCM compared to control rats (0.0198 +/- 0.0082 vs. 0.1108 +/- 0.0933, P < 0.05) and the increase could be significantly attenuated by valsartan (0.0367 +/- 0.0234, P < 0.05 vs. DCM). A significant positive correlation was observed between myocardial TRB(3) mRNA and myocardial collagen content (r = 0.67, P < 0.05) and between TRB(3) mRNA and fasting blood glucose (r = 0.69, P < 0.05) in rats with DCM.</p><p><b>CONCLUSION</b>Our results show for the first time that myocardial TRB(3) mRNA is upregulated in rats with DCM and which could be down-regulated by valsartan.</p>

The role of glucose/TSP-1/TGFbeta1 signal pathways in diabetic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>Hyperglycemia could upregulate transforming growth factor-beta (TGFbeta(1)) via thrombospondin (TSP-1) and induce fibrotic renal disease in the rat in vivo and myocardial fibrosis was related to cardiac dysfunction in diabetic patients. We explored the role of glucose/TSP-1/TGFbeta(1) signal pathways in the development of diabetic cardiomyopathy (DCM).</p><p><b>METHODS</b>Male Wistar rats were fed with high cholesterol diet for 17 weeks, streptozocin (30 mg/kg, i.p) was given at the 28th day, rats with fasting blood glucose > or = 11.1 mmol/L by the end of the 5th week were assigned to DCM group (n = 11). Control rats (n = 8) were fed with regular chow. Fasting blood glucose (FBG) was monitored throughout the study. After hemodynamic measurements by the end of the study, myocardial collagen content was quantified in Masson-stained samples and the mRNA expressions of TSP-1 and TGFbeta(1) were detected by quantification real-time RT-PCR. The protein levels of TSP-1, active and latent TGFbeta(1) were detected by Western blot.</p><p><b>RESULTS</b>Compared with control group, cardiac function was decreased as shown by significantly reduced left ventricular systolic pressure, dp/dt(max) and dp/dt(min), while the myocardial collagen content was significantly increased in the DCM group (11.01 +/- 3.05 vs. 16.92 +/- 3.18, P < 0.01). The myocardial mRNA expressions of TSP-1, TGFbeta(1) and protein expressions of TSP-1, active and latent TGFbeta(1) in the DCM group were also significantly higher than those of the control group. Moreover, myocardial collagen was positively correlated to FBG (r = 0.746, P < 0.01); mRNA expressions of TSP-1 and TGFbeta(1), protein expressions of TSP-1 and active TGFbeta(1) were positively correlated to FBG and myocardial collagen (P < 0.05). However, there were no correlations between the protein expression of latent TGFbeta(1) and FBG and myocardial collagen.</p><p><b>CONCLUSION</b>The pathway of glucose/TSP-1/TGFbeta(1) might play an important role in myocardial interstitial fibrosis of DCM. It may be the basis of novel therapeutic approaches for ameliorating DCM.</p>

The study of magnetic resonance sialography in diagnosing parotid diseases / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the feasibility of diagnosing parotid disease with magnetic resonance sialography (MRS) and to select the optimal scanning sequence.</p><p><b>METHODS</b>Twenty-three patients with parotid gland disease and 5 normal adults received sialography using magnetic resonance imaging technique and several sequences (including IR-FSE, FSE, SS-IR-FSE, SS-FSE) were used. After first scanning, the patients were scanned respectively 3 and 10 minutes after buccal application of vitamin C. And MR images of duct obtained. The images of parotid duct system were analysed and evaluated according to their displaying effects. Qualitative diagnosis was made based on MRI and those diagnosis were compared with pathological diagnosis after operation.</p><p><b>RESULTS</b>Images of MR sialography clearly displayed the main duct and its branches of parotid gland and the pathological changes of duct, such as narrow, expanded, stoppage. Of the scanning sequences, IR-FSE was superior to others in manifesting the parotid gland duct (P < 0.05). The performance of images after being given vitamin C did not significantly improve the displaying effect. The accurate rate of qualitative diagnosis was 95.6%.</p><p><b>CONCLUSIONS</b>MR sialography can clearly display the parotid ducts and their pathological changes. The accurate rate of qualitative diagnosis of parotid disease was higher than that X-ray sialography.</p>

Development and Application of Hospital ADR Monitoring System Based on Electronic Medical Records / 中国药房

OBJECTIVE:To improve the quality and efficiency of hospital monitoring on the adverse drug reaction(ADR). METHODS:Hospital ADR monitoring system was developed based on the hospital ADR monitoring procedure in Jinzhou First People's Hospital by using Brower/Server system structure and ASP.NET2.0 and SQL SERVER 2005 database technique and sharing the database of hospital electronic medical records.RESULTS & CONCLUSIONS:Through the establishment of hospital ADR monitoring network,the responsibility of medical personnel in ADR work has been established,and their ability in identifying and judging ADR have been improved,and both the quality and quantity of ADR reporting have been improved.