Objective To analyze reasons of postoperat iv e relapse of inguinal hernia and to explore the clinical significance of laparos copic transabdominal preperitoneal (TAPP) repair for recurrent hernia. Methods We retrospectively analyzed clinical data of 24 cases of recurr ent inguinal hernia treated by laparoscopic TAPP repair from June 1998 to Octobe r 2003 in this hospital. There were 11 cases of direct hernia and 13 cases of in direct hernia. Results Operations were completed successfully in all the 24 cases without conversions to open surgery. The operation time was 47~128 min (mean, 69 min), and the postoperative hospital stay, 2~5 days (mean, 3 days). Urinary retention happened in 6 cases after the operation, in which a F oley urethral catheter was indwelled for 1~3 days. There were no complications s uch as wound infection, scrotal hematoma or pneumatosis. Follow-up checkups were made for 2~66 months (mean, 27 months) in all the 24 cases. No recurrence was o bserved. Conclusions Laparoscopic TAPP repair for recurrent in guinal hernia has advantages of minimal invasion and few complications, being a safe and feasible option for treating recurrent inguinal hernia.

Objective To summarize our experience on the treatment for severe vascular injuries in the operation of great saphenous varicose vein. Methods The clinical data of 4 cases (5 lower limbs) from December 2004 to April 2009 of severe vascular injuries were retrospectively analyzed. For the lower limbs in which from the end of femoral artery to the upper part of posterior tibial artery were stripped, reconstruction operation using blood vessel prothesis was performed, above knee amputation was performed because of limb gangrene. For three limbs in which 10 cm to 15 cm superficial femoral artery were stripped, reconstruction operation using autologous saphenous vein were performed, above knee amputation was performed for one limb 5 days after the operation. For the limb in which 2 cm superficial femoral vein were cut, reconstruction operation using autologous saphenous vein were performed. Results No cases died perioperatively,for four limbs of injuried artery, ampution were performed for two limbs(50% ) ;two limbs (50%) were saved. The patient of injuried superficial femoral vein recovered. Conclusions Severe vascular injuries can be prevented and its incidence reduced by improving the awareness for iatrogenic vascular injuries,accurate operation; once the vascular injury occurred, prompt and rational measures must be adopted.

Objective: To determine the value of intercostal video mediastinoscopy (VMS) in clinical application. Methods: The clinical data of 126 patients treated with intercostal VMS were summarized retrospectively. Of them, 8 patients with suspected malignant pleural effusion underwent intercostal VMS pleural biopsy and talc poudrage pleurodesis, 118 patients with palmar hyperhidrosis underwent bilateral intercostal VMS sympathectomy. Results: Definitive pathologic diagnosis has been made through VMS pleural biopsy in pleural effusion group, and the efficiency of talc pleurodesis was 100%(8/8). In 118 patients with palmar hyperhidrosis, the symptom of hands sweating disappeared completely after operation. Both hands became dry with an increasing skin temperature of 1 5℃～3 0℃ immediately after operation. No recurrence was recorded during the follow up. No mortality and morbidity were reported in this group. Conclusion: Comparing with VATS, intercostal VMS is easier to operate and less invasive. It is an effective and alternative procedure in the treatment of malignant pleural effusion and palmar hyperhidrosis.

Objective To investigate the effects of changing the arteriovenous pressure difference on the survival area of reverse island flap in New Zealand white rabbits models.Methods The saphenous artery and saphenous vein of New Zealand rabbits were selected to design experimental models of reverse island flap.Experi mental rabbits were randomly divided into 4 groups:group A:control group (reserved pedicle integrity of superficial veins);group B:part anastomosis of saphenous artery group (the distal saphenous artery of the flap was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group C:part anastomosis of vein group (distal superficial veins was cut,then trimmed its original diameter to half and done end-to-end anastomosis);group D:ligated superficial veins group (pedicle superficial veins was ligated).After surgery,the flaps were measured by general observation.Blood distribution at different times of the flaps was detected by radionuclide scans.Survival area of the flap was measured to compare the survival rate of flap.Distribution of blood vessels and the state of blood cells were observed by Histological examination.Results The flap survival rate was (82.27-± 11.71)％ in group B,showing significant differences when compared with that group A (47.70-± 11.18)％,group C (47.70 ± 11.18)％ and group D (47.70 ± 11.18)％ (P ＜ 0.05).Radionuclide scans showed that the radioactive material in group B could be seen clearly,the radioactive material in groups A,C and D were a transient existence.Ten days postoperatively,histological observation showed that group B had more capillary regeneration and blood cells remain compared with other groups.Conclusion Increase the blood supply can increase the survival area of the reverse island flap,and simply promote the venous drainage can not effectively improve the survival rate of the flap.

ObjectiveTo improve the understanding of chronic myelomonocytic leukemia associated with Sweet' s syndrome.MethodsRetrospective analysis of a case of chronic myelomonocytic leukemia associated with skin herpes was reported. Skin biopsy was performed. DA and CAG regiment were administrated.ResultsSweet's syndrome was diagnosed by skin biopsy.Corticosteroids therapy alone was not effective. Complete remission was achieved by CAG regiment and skin rash has been effectively controlled.Three months later Sweet' s syndrome relapsed and chronic myelomonocytic leukemia developed into acute myelomonocytic leukemia. ConclusionChronic myelomonocytic leukemia associated with Sweet's syndrome is rare but implies a quick progression to acute myelomonocytic leukemia.

Objective To explore the effects of low-dose X-ray irradiation effects on ischemic flap survival and its possible mechanism.Methods From June, 2014 to December, 2014, 80 SD rats were include in the study, the rats were randomly divided into 2 groups: the experimental group A and control group B.There were 40 rats in each group.The ischemic flaps with the size of 9 cm × 3 cm were designed on the back of the rats.The pedicle of the flaps was near to the tail.A sterile biological isolating membrane was placed under the flap to block the blood supply between muscular layer and flaps.The flaps were intermittently sutured into their original position.The group A was immediately received single and local irradiation of 0.2 Gy after surgery, The group B was not treated.On days 1 to 14 after operation,general observation,HE staining and the western blot of the flaps were performed to calculate the survival vate of the flaps, observe neovascularization and determin the content of VEGF and MMP-9, respectively.Results On the third, seventh and fourteenth days, survival rates of the flaps in the experimental group [(66.46 ± 4.37)％, (44.30 ± 3.86)％, (32.20 ± 4.22)％, respectively] were higher than the control group [(43.15 ± 5.03)％, (27.71 ± 3.20)％, (16.40 ± 5.34)％, respectively] after inspection, there were statistically significant differences between these indices (P ＜ 0.01), HE staining of the flaps in the experimental group were seen in the fibroblast infiltration and neovascularization were higher than that of control group, and experimental group within the lumen of blood vessels were arranged in order, the groups were visible tissue edema obviously control, neovascularization in small numbers, the lumen was irregular.On the third and seventh days, MVD rates of the flaps in the experimental group (85.54 ± 6.12, 44.32 ± 3.56, respectively) were higher than the control group (49.35 ± 4.75,18.75 ± 2.89,respectively) after inspection, there were statistically significant differences between these indices (P ＜ 0.01).VEGF and MMP-9 protein content in the flap for the seventh day in the experimental group were significantly higher than that of the control group.Conclusion Low-dose X-ray irradiation can promote the survival rate of ischemic flap, the mechanism may be related to the expression of VEGF and MMP-9 increased and promoted angiogenesis of the flaps after low-dose X-ray irradiation.

A new proposed data mining technique, support vector machine (SVM), is used to predict the degree of malignancy in brain glioma. Based on statistical learning theory, SVM realizes the principle of data dependent structure risk minimization, so it can depress the overfitting with better generalization performance, since the prediction in medical diagnosis often deals with a small sample. SVM based rule induction algorithm is implemented in comparison with other data mining techniques such as artificial neural networks, rule induction algorithm and fuzzy rule extraction algorithm based on fuzzy max-min neural networks (FRE-FMMNN) proposed recently. Computation results by 10 fold cross validation method show that SVM can get higher prediction accuracy than artificial neural networks and FRE-FMMNN, which implies SVM can get higher accuracy and more reliability. On the whole data sets, SVM gets one rule with the classification accuracy of 89.29%, while FRE-FMMNN gets two rules of 84. 64%, in which the rule got by SVM is of quantity relation and contains more information than the two rules by FRE-FMMNN. All the above show SVM is a potential algorithm for the medical diagnosis such as the prediction of the degree of malignancy in brain glioma.
Algorithms ; Artificial Intelligence ; Brain Neoplasms ; pathology ; Diagnosis, Computer-Assisted ; methods ; Female ; Glioma ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Models, Statistical ; Neural Networks (Computer) ; Predictive Value of Tests

According to the current evidence-based medicine researches, the eastern and western countries have reached a consensus that D2 operation is a standardized procedure for advanced gastric cancer.However, the postoperative five-year survival rate is still not satisfactory. Professor Gong Jianping of Tongji Hospital, Tongji Medical Gollege of Huazhong University of Science and Technology proposed a theory of membrane anatomy (the third element of surgical anatomy) and the concept of cancer leakage—an epoch-making concept in surgical anatomy. The Department of Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University was honored to be selected as one of the first domestic replication units of 3D laparoscopic radical gastrectomy under membrane anatomy. Professor Gong Jianping has visited our hospital several times for surgical demonstration, explanation of membrane anatomy theory and replication training. Through the understanding of membrane anatomy theory, we found that 3D laparoscopic radical gastrectomy guided by membrane anatomy can achieve good results, e.g less bleeding, complete resection, complete lymph node dissection and avoidance of side damage, meanwhile the operation is simple and safe. At the same time, it can avoid the shedding of cancer cells, so as to reduce the iatrogenic leakage of cancer and improve the efficacy of radical gastrectomy. In addition, the standardized procedure of laparoscopic radical gastrectomy makes it scientific, reproducible and easy to be popularized.

In-stent restenosis is the major problem of percutaneous coronary interventions. Drug-eluting stent became a landmark in the treatment of coronary disease. Curcumin could be used for drug-eluting stent due to its antithrombogenity and antiproliferative properties. In this paper, 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assays were performed to decide the optimal concentration of curcumin for inhibiting the proliferation of vascular smooth muscle cells (VSMC). The result disclosed that more than 80% of VSMC were inhibited when the concentration of curcumin ranged from 2.5 microg/ml to 10 microg/ml (P < 0.05, compared to ethanol). Three weight percent curcumin-loaded films (3wt%, 5wt%, 8wt%) were prepared using a biodegradable polymer (poly (lactic acid-co-glycol acid), PLGA) as the carrier of curcumin. The release of lactate dehydrogenase (LDH) was used to evaluate the immediate toxicity of the curcumin-loaded PLGA films, and the three concentration curcumin-loaded films were revealed to be of no acute toxicity to the smooth muscle cells. The results of Alamar Blue test indicated that the curcumin-loaded films had better antiproliferation effect than did the 316 stainless steel (SS). Therefore, these films may be used for stent coating to inhibit the in-stent restenosis induced by VSMC proliferation.
Angioplasty, Balloon, Coronary ; Animals ; Carotid Arteries ; cytology ; Cell Proliferation ; drug effects ; Cells, Cultured ; Coated Materials, Biocompatible ; pharmacology ; Coronary Restenosis ; prevention & control ; Curcumin ; pharmacology ; Drug-Eluting Stents ; Lactic Acid ; pharmacology ; Muscle, Smooth, Vascular ; cytology ; Polyglycolic Acid ; pharmacology ; Rats