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The expansive soil slope is mainly characterized by the decline of slope integrity caused by shallow expansive soil cracking and the destruction of internal soil structure, which seriously affects the overall stability of expansive soil slope. To study the effect of the combination of geogrid reinforcement and slope vegetation on inhibiting the development of expansive soil cracks, six groups of test models were made. The natural dry-wet cycle was simulated, and the crack image was binarized by using image processing technology. The crack characteristic parameters such as crack ratio, crack width, and crack length were extracted, and the effect of various reinforcement methods on inhibiting the development of cracks was comprehensively evaluated. The basic situation of the development of crack indexes in each group with the development of multiple dry-wet cycles was obtained, and the fluctuation changes of crack indexes in different stages were different under different reinforcement methods and dry-wet cycles. At the same time, the influence of different reinforcement methods on the crack development of expansive soil is obtained. It is considered that planting vetiver grass + geogrid backpacking has a good effect on inhibiting the crack development of expansive soil.
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Abdominal incisional hernia is caused by poor healing of myofascial layer of abdominal wall and abdominal visceral organs protruding through the defect after abdominal surgery. The incidence of abdominal incisional hernia is 5.0%?20.0%, even higher after hepato-biliary and pancreatic surgery. Although great progress has been made in the methods of abdominal incision closure, hernia repair technology and materials, the overall incidence, repair effect and prognosis of abdominal incisional hernia are still not significantly improved. The incisional hernias after hepatobiliary and pancreatic surgery are relatively more complex, and the difficult problems of surgical repair are more prominent, including effectively controlling basic diseases, choosing a better surgical method, reasonably using a variety of abdominal wall defect closure and reconstruction techniques, and reducing the risk of postoperative complications. Relevant guidelines for abdominal incisional hernia repair and abdominal closure have been issued and updated all over the world. In order to improve the treatment of incisional hernia after hepatobiliary and pancreatic surgery and improve the prognosis of patients, the authors summarize the difficulties and new progress in the repair of incisional hernia after hepatobiliary and pancreatic surgery.
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Objective:To investigate the application value of obliquus externus abdominis pedicle flap graft technique in repair of giant abdominal incisional hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 14 patients with giant abdominal incisional hernia who were admitted to Affiliated Hangzhou First People′s Hospital of Zhejiang University School of Medicine from June 2015 to June 2018 were collected. There were 5 males and 9 females, aged (67±10)years, with a range from 45 to 80 years. All the 14 patients underwent repair of abdominal wall defect and functional reconstruction with obliquus externus abdominis pedicle flap graft technique. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) hernia-related quality of life; (4) follow-up. Follow-up using outpatient examination was performed at postoperative 1 and 12 months, and once a year thereafter to detect the recurrence of incisional hernia or abdominal bulging up to June 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired sample t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages. Results:(1) Surgical situations: all the 14 patients underwent repair of abdominal wall defect and functional reconstruction with unilateral obliquus externus abdominis pedicle flap graft technique successfully, and reinforced repair with mesh. All the meshes were standard polypropylene meshes which were placed in the retro muscular or preperitoneal space. The operation time, volume of intraoperative bleeding, mesh size of the 14 patients were (153±34)minutes, (119±59)mL, (450±156)cm 2, respectively. (2) Postoperative situations: the duration of hospital stay of the 14 patients were (14±3)days. Of the 14 patients, 1 had type Ⅲ seroma and was cured after conservative treatment. There were no complications such as ischaemia and necrosis of external oblique muscle flap, incision dehiscence, infection of operation site, intestinal obstruction or intestinal fistula observed in the 14 patients. (3) Hernia-related quality of life: the score of hernia-related quality of life of the 14 patients before operation and at postoperative 12 months were 38±8 and 77±15 respectively, showing a significant difference ( t=12.729, P<0.05). (4) Follow-up: 14 patients were followed up for 12-48 months, with a median follow-up of 16 month. During the follow-up, none of the 14 patients had recurrence of incisional hernia or abdominal wall bulging. Conclusion:Obliquus externus abdominis pedicle flap graft technique can be used for repair of giant abdominal incisional hernia, which will lead to less surgical complications and improve hernia-related quality of life of patients.
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Direct suture repair with mesh reinforcement is the main surgical procedure in ventral hernia repair. The best place for mesh implantation is retromuscular space which means sublay. The most commonly used techniques are open sublay and laparoscopic IPOM repair. But open sublay repair may cause more trauma to the abdominal wall and result in more infections. Laparoscopic IPOM repair carries an increased risk in bowel injury, mesh-related complications and postoperative pain. Germany surgeon Reinpold developed a new technique defined as "MILOS concept" by combining the advantages of open sublay and laparoscopic IPOM repair. This technique uses mini or less incision hybrid with endoscopic technique to accomplish minimally invasive sublay repair. The MILOS operation has the advantages of less operative trauma, fewer postoperative complications, low recurrence rate and high economic efficiency. "MILOS concept" has been applied with several modifications by using endoscopic technique (EMILOS and eTEP) or robotic surgery. This new minimal invasive ventral hernia repair technique is accepted and applied in clinical practice by most surgeons worldwide. Several literatures already reported that this procedure had very good surgical outcomes, and confirmed its value in further popularization.
Subject(s)
Humans , Hernia, Ventral , General Surgery , Herniorrhaphy , Laparoscopy , Postoperative Complications , Surgical MeshABSTRACT
OBJECTIVE: Effects of human chorionic gonadotropin combined with clomiphene on serum E2, FSH, LH and PRL levels in patients with polycystic ovarian syndrome were analyzed. METHODS: 90 patients with polycystic ovarian syndrome treated from January 2015 to March 2016 were randomly and evenly divided into control group and observation group. Patients in the control group were only treated with clomiphene. On the basis of the treatment in control group, human chorionic gonadotropin was added in the treatment of observation group. The changes of E2, FSH, LH, PRL levels were compared between two groups before and after the treatment. Clinical curative effects of patients in the two groups was evaluated. Adverse reactions during treatment in two groups were observed and recorded. The incidence of adverse reactions was calculated. RESULTS: Serum E2, FSH, LH and PRL levels in the two groups decreased significantly after treatment compared with that before treatment. The difference is statistical significant (P < 0.05). After the treatment, E2, FSH, LH and PRL levels in the observation group were lower than that in the control group and the difference is statistical significant (P < 0.05). Total effective rate was 64.44% in the control group and 93.33% in the observation group. There were statistically significant difference in clinical curative effects in the two groups (P < 0.05). Different degrees of adverse reactions were found in both groups during treatment, such as nausea, vomiting, anorexia, liver dysfunction. There were 2 cases of nausea, 2 cases of vomiting, 3 cases of anorexia and 1 case of liver dysfunction from the 45 patients in control group. The total incidence of adverse reactions was 17.78% (8/45). There were 1 case of nausea, 1 case of vomiting, 1 case of anorexia and no liver dysfunction from the 45 patients in observation group. The total incidence of adverse reactions was 6.67% (3/45). The total incidence of adverse reactions in the observation group was significantly higher than that in the control group and the difference was not statistically significant (P > 0.05). CONCLUSION: Combined use of human chorionic gonadotropin can significantly reduce serum E2, FSH, LH and PRL levels, improve clinical curative effects and reduce the incidence of adverse reactions. Human chorionic gonadotropin has high application value on the treatment of polycystic ovary syndrome.
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Objective To introduce a new appointment registration way in the outpatient department.Methods A WeChat appointment registration platform based on HIS was established with smart phone and WeChat public platform,which was gifted with the functions of online registration and payment and etc.The processes including preliminary diagnosis and return visit,cancelling appointment,treatment of appointment breaking,and the limitations during the appointment could be accomplished by the appointment registration.Results The platform realized appointment registration,information feedback and etc.Conclusion The appointment registration based on WeChat public platform contributes to satisfying the patient,enhancing medical service and distributing medical resources rationally.
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Big data of electronic health records ( EHR) are faced with the challenge of both information security and privacy protection in theInternet+ era. The bottleneck of information technology in centralized and relational databases-covered EHR was described, application of block chain technology in decentralization, privacy protec-tion and gene sequencing was elaborated in order to usher in new ideas for the construction of EHR.
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In recent years,combined therapy based on radical resection has promoted the prognosis of gastric cancer,but the rate rate of post-surgery recurrence is still high,which is the main cause of death.It helps us take out better treatment for gastric cancer to analyze correlation factors of gastric cancer recurrence after radical resection.It is needed to reviewed the literatures about correlation factors analysis of gastric cancer recurrence after radical resection in recent years.
