Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation.MethodsUnder general anesthesia,32 patients(42 sides)with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007.ResultsAll of operations were successfully performed.The operative time was 60-120 minutes,the blood loss was 20-60 ml,and the length of postoperative hospitalization was 3 days.All cases were followed up for 8 to 18 months and found no recurrence.ConclusionLaparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible,reliable and effective,offering a low recurrence rate,while its price is higher than tension-free herniorrhaphy by traditional method.

Objective To measure the expression of CD80 and CD86 in renal tissue of lupus nephritis (LN) and explore its mechanism in the development of LN.Methods Forty-nine patients with active LN and 9 patients with minor glomerular abnormalities tissues as controls were studied.The expression of CD80, and CD86 in renal tissues was detected by immunohistochemical methods.Results CD86 was expressed extensively in glomerulus, periglomerular area, tubular epithelial cells and peritubular interstitium, while CD80 was expressed only in tubular epithelial cells and peritubular interstitium.Moreover, the percentage of CD+80 and CD+86 cells in tubular epithelial cells and peritubular interstitium showed a tendency to increase with tubulointerstitial damage.The expression of CD80 and CD86 in renal tissue correlated with the systemic lupus erythematosus (SLE) disease activity index score, the degree of proteinuria, creatinine clearance and anti- dsDNA antibody.Conclusions This study shows that increased CD80 and CD86 expression with the progression of tubulointerstitial lesion might play an important role in the development of lupus nephropathy, and the tubulointerstitial expression of CD80 and CD86 could potentially serve as a surrogate marker of SLE disease activity.The co-stimulatory molecules CDg, and CD86 might play an important role in the pathogenesis of LN.

Gynecology and obstetrics is a theoretical and practical subject. It is an important goal for the medical students to develop the clinical thinking ability and operating skills and apply them in the diagnosis and treatment of disease. To overcome the limited teaching resources, the rare clinical skills opportunities caused by doctor-patient relationship tension, virtual patient (VP) combined with clinical teaching was applied in clinical teaching, which can reproduce the real, and bring the students to the role of the clinician , enrich the content of the obstetrics and Gynecology clinical teaching. Along with the reform the teaching faculty with high quality was established, their clinical teaching experiences and innovative thinking were improved significantly. The results were evaluated by means of clinical comprehensive ability test. The present study aimed to establish virtual patients of OBGYN (virtual patient, VP) learning to promote learning of basic knowledge, clinic skills, and thinking ability.

Objective:To evaluate the sedative effect of remimazolam for induction of general anesthesia in elderly patients.Methods:One hundred patients of both sexes, aged 65-75 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective general anesthesia requiring tracheal intubation, were divided into 4 groups ( n=25 each) using a random number table method: propofol group (group P) and three different doses of remimazolam groups (group R1, group R2 and group R3). In group P, general anesthesia was induced with propofol 1.5 mg/kg intravenously injected over 30 s, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when bispectral index (BIS) value ≤ 60, and endotracheal intubation was performed.In R1, R2 and R3 groups, general anesthesia was induced with 0.2, 0.3 and 0.4 mg/kg of remimazolam intravenously injected over 30 s, respectively, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when BIS value ≤ 60, and endotracheal intubation was performed.When the BIS value was > 60 during the induction of anesthesia, propofol 0.5 mg/kg was intravenously injected per time for rescue sedation in group P, and remimazolam 0.05 mg/kg was intravenously injected per time for rescue sedation until the BIS value ≤ 60, with the interval between the two injections > 1 min in R1, R2, and R3 groups.The onset time of propofol or remazolam was recorded.The occurrence of hypertension, hypotension, bradycardia, hypoxemia, injection pain and rescue sedation during the induction of anesthesia was recorded.The occurrence of intraoperative awareness was recorded during follow-up at 1 day after surgery. Results:Compared with group P, the rate of rescue sedation was significantly increased in group R1, the incidence of hypoxemia was significantly reduced in R1 and R2 groups, the onset time was significantly prolonged, and the incidence of hypotension, bradycardia and injection pain was decreased in R1, R2 and R3 groups ( P<0.05). Compared with group R1, the rate of rescue sedation was significantly decreased in R2 and R3 groups ( P<0.05). Compared with R1 and R2 groups, the incidence of hypoxemia was significantly increased in group R3 ( P<0.05). There was no significant difference in the incidence of hypotension, hypoxemia and injection pain among R1 group, R2 group and R3 group ( P>0.05). No hypertension and intraoperative awareness was found in the four groups. Conclusion:Remimazolam can be safely and effectively used for sedation during induction of general anesthesia in elderly patients, and the optimal dose is 0.3 mg/kg.

Objective To explore the clinical value of resistance index(RI)of prostatic capsular artery in predicting or screening of prostate cancer(PCa)by comparing prostatic capsular artery RI with the serum total prostatic specific antigen(TPSA),fPSA/tPSA ratio and prostatic specific antigen dernsity(PSAD).Methods RI of prostate capsular artery,serum TPSA,of fPSA/tPSA ratio and PSAD were measured with colour Doppler ultrasonography in this subset of 203 patients who had undergone transrectal ultrasound guided prostate puncture biopsy.The patients were divided into two groups [PCa and benign prostatic hyperplasia(BPH)group] for comparative study.Results Of them,the level of TPSA were between 4 and 10 ng/ml(grey area)in 34 cases,accounts for 16.75%of the total subjects.All the others were outside the grey area.ROC curve analysis showed that the area under the curve(AUC)of RI of the capsular artery was 0.77,which was close to 0.84 and 0.86 of TPSA and PSAD.It indicated a similar value in predicting or screening PCa; while the AUC of fPSA/tPSA ratio was only 0.49,which had little clinical value.The fPSA/tPSA ratio and the mean value of PSAD in the grey area had significant differences(t=2.78,3.94,P＜0.02)between the two groups.However,the fPSA/tPSA ratio had no statistical significance in the high value area outside the grey area(t=0.873,P ＞ 0.05).And the mean value of RI of prostatic capsular artery had significant differences between the two groups both in the grey area and in the high value area outside the grey area(t=4.56,5.10,P ＜ 0.001).Conclusions RI of prostatic capsular artery can be steadily used to predict or screen PCa.It is not affected by the gray area of TPSA and is of great value in clinical practice.

Objective: To evaluate the mid-term outcomes of patients with chronic infected total hip arthroplasty (THA) after partial single-stage revision. Methods: From July 2000 to October 2013, a total of 31 patients (18 males and 13 females, mean age 54 years, mean BMI 24.7 kg/m²) with chronic infected THA underwent partial single-stage revision in our hospital were retrospectively analyzed in the present study. According to the fixation type and the material of the prosthesis, selective revision of the acetabular cup or femoral stem was performed by preoperative imaging and intraoperative evaluation. The characteristics of procedure included changing femoral head and liner components, aggressive soft tissue debridement, retention of the well-fixed femoral stem or acetabular cup, thorough exposed component brushing, adequate surgical area soaking by iodine and vancomycin powder used in medullary space. Pre- and post-operative outcomes were evaluated with the Harris hip score. The frequency of infection recurrence was recorded and the failure treatment of infection was defined as recurrence of infection in the same hip. Results: Acetabular cups were revised in 22 patients and femoral stems in nine patients. The average follow-up was 7.2±2.6 years (4.8-15.1 years). There were 4 (13%) failures during the study period at an average of 15 months (9-21 months) after partial single-stage revision. Two cases of them had grade A incision healing and another two cases had grade B incision healing. Of the 31 patients, a total of 27 (87%) patients had satisfactory outcomes with grade A incision healing and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score was improved from 45.2±5.4 pre-operatively to 70.1±4.3 at one year post-operatively. The Harris hip score at 2 years and 5 years after surgery were 75.3±5.1 and 73.2±5.3, respectively. Conclusion In treating chronic infected THA, partial single-stage revision can be conducted fairly effective in eradication of infection and achieving acceptable functional outcomes while reducing surgical injury, which indicated that this is an attractive alternation in selected patients.

Objective: To explore the safety and strategy of thoracic endovascular aortic repair (TEVAR) combining coronary artery bypass grafting (CABG) as one-stop performance in treating the patients with coronary artery disease (CAD) and thoracic aorta disease. Methods: A total of 20 patients received one-stop treatment of TEVAR combining CABG in our hospital from 2009-04 to 2016-01 were retrospectively analyzed. There were 18 male and the mean age of patients was (65.2±8.5, 51-82) years. The performance strategy and peri-operative management were studied. Results: There were 1/20 patient received 2 stents implantation in thoracic aorta and 19 received 1 stent in thoracic aorta those including 1 case with endovascular repair of abdominal aortic aneurysm, 1 with right iliac artery stent implantation and 1 with carotid endarterectomy at meanwhile. The average number of coronary artery bypass branch was (2.4±0.94, 1-4) and 10 (50%) patients received internal mammary artery grafting. The average in-hospital time in all 20 patients was (22.4±11.6, 8-58) days. There were 6 (30%) patients received blood transfusion; 1 (5%) having low cardiac output syndrome received extracorporeal membrane oxygenation (ECMO), then received the second thoracotomy for hemostasis due to excessive pleural effusion; 2 (10%) patients died at 30 days post-operation. 1 patient lost contact and 17 received clinical or telephone follow-up visit at the average of (13.4+13.6, 1-49) months; 2 patients died for cerebral hemorrhage at 12 and 49 months post-operation, the rest 15 had disappeared symptoms and improved quality of life, no operation related death occurred. Conclusion: TEVAR combining CABG as one-stop performance presented good mid-term effect in treating the patients with CAD and thoracic aorta disease; in otherwise, the operative time and risk might be increased by two step performance.

Objective To present clinical effects of debridement, antibiotics, irrigation and retention of implant (DAIR) with integrated antibiotics application in treating periprosthetic joint infection (PJI) occurred within 3 months after primary surgery. Methods We retrospectively analyzed patients who received DAIR between January 2011 and October 2015. A total of 49 pa?tients with a mean age of 62.38±14.56 years (range, 26-82 years) were included in this study, including 29 males and 20 females. There are 27 knees and 22 hips. Twenty?three patients has sinus tract. Failure was defined as subsequent surgical intervention for infection after the index procedure; persistent fistula, drainage, or excessive joint pain at the last follow?up; death related to the PJI; chronic suppression with antibiotics. Results There were 18 (36.7%) culture negative cases and 31 (63.3%) culture positive cases, including 28.6% (14/49) methicillin?sensitive staphylococcus aureus, 4% (2/49) methicillin?resistant staphylococcus aure?us, 2% (1/49) methicillin?resistant staphylococcus epidermidis, 2%(1/49) mixed infection with fungus and so on. Within the 68.34± 14.02 months (range, 39-94 months) follow?up duration, the Knee Society Score (KSS) score was improved from 38.37 ± 12.39 points (range, 18-62 points) pre?operatively to 82.26±10.50 points (range, 49-96 points) post?operatively (t=-17.09, P<0.001). KSS function score was improved from 42.19±10.14 points (range, 26-67 points) pre?operatively to 75.22±11.60 points (range, 41-90 points) post?operatively (t=-12.53, P<0.001). Harris hip score was improved from 47.41±8.39 points (range, 32-58 points) pre?operatively to 86.41±6.07 points (range, 71-96 points) post?operatively (t=-23.38, P<0.001). There were 6 patients receiving sub?sequent surgical intervention as failure. The mean duration from the index surgery to failure was 5.75±3.00 months (range, 1.5-10 months). Conclusion The present protocol of DAIR for dealing with early?stage PJI, which is less than 3 months after primary TKA or THA, is fairly effective.

Objective:To investigate the risk factors for bleeding and thrombosis during extracorporeal membrane oxygenation (ECMO) therapy in critically ill patients and determine the best predictors of coagulation-related complications.Methods:A retrospective analysis was performed on patients who received ECMO for respiratory or circulatory failure at Xiangya Hospital of Central South University from January 2020 to December 2022. The outcome was whether bleeding or thrombosis occurred from 24 h after ECMO insertion to before weaning. The differences in demographic characteristics, weaning conditions, prognosis, routine blood tests, organ function, coagulation and blood product transfusion of each group were compared. Logistic regression analysis was used to evaluate the risk factors for bleeding and thrombosis, and ROC curve evaluation was used to assess their capacity to predict complications.Results:A total of 61 patients with ECMO were enrolled, with 21 cases of bleeding and 14 cases of thrombosis during ECMO. Compared with the nonbleeding group, the activated partial thromboplastin time, thromboplastin time (TT), and transfusions of frozen plasma and red blood cells were higher in the bleeding group (all P<0.05). Compared with the nonthrombotic group, the increase in body weight, D-dimer (DD), fibrinogen degradation product (FDP), and improvement of arterial oxygen partial pressure (ΔPO 2) within 24 h were significantly higher in the thrombotic group (all P<0.05). Logistic regression analysis revealed that TT ( OR=1.039, 95% CI: 1.006~1.072, P=0.018) and frozen plasma transfusion volume ( OR=1.046, 95% CI: 1.010-1.083, P=0.012) were risk factors for bleeding events. FDP ( OR=1.030, 95% CI: 1.009-1.051, P=0.005), DD ( OR=1.181, 95% CI: 1.044-1.336, P=0.008), and ΔPO 2 ( OR=1.007, 95% CI: 1.002-1.012, P=0.006) were risk factors for thrombosis. According to ROC curve analysis, the AUCs of TT, frozen plasma transfusion, and combined indexes for predicting bleeding were 0.712, 0.690, and 0.816, respectively. The combined indices had a cut-off value of 0.273, a sensitivity of 75.61%, and a specificity of 80.00%. The AUCs of FDP, DD, ΔPO 2, and combined FDP with ΔPO 2 for predicting thrombosis were 0.778, 0.748, 0.786, and 0.868, respectively. The cut-off value of the combined index was 0.157, the sensitivity was 68.09%, and the specificity was 92.86%. Conclusions:TT combined with frozen plasma transfusion volume predicted bleeding optimally, while FDP plus ΔPO 2 predicted thrombotic events better during ECMO treatment in critically ill patients.

Objective:To explore the screening scheme of gastric cancer in large-scale natural population in Wuxi.Methods:From December 2016 to December 2019, 105 865 residents of 19 communities (villages) in six streets of Xinwu District, Wuxi were randomly enrolled in this study by random number table. A household epidemiological questionnaire survey was conducted among 50 063 target population subjects (aged 40-69), and then, respondents were divided into four categories, category Ⅰ: HP (-), PG (-); category Ⅱ: HP (+ ), PG (-); category Ⅲ: HP (+ ), PG (+ ); category Ⅳ: HP (-), PG (+ )according to the serological Helicobacter pylori ( HP) antibodies and pepsinogen (PG) test results. People in category Ⅲ and Ⅳ were all selected into group C and group D respectively, then individuals 3 times of group D were randomly selected from category Ⅰ to assign to group A, and individuals 3 times of group C from category Ⅱwere assigned to group B in the same way. Remaining individuals in category Ⅰ and Ⅱ who had first-degree family history of gastric cancer were also included in group A and group B, respectively. Endoscopic and pathological examination were performed on the above enrolled subjects for high grade intraepithelialneoplasia (HGIN), early gastric cancer and gastric cancer. Results:Of the 50 063 target subjects, 31 508 questionnaires were finally collected, with a participation rate of 62.9%. A total of 19 745 people were tested for serology, and the participation rate was 39.4% (19 745/50 063). Serological results showed that there were 11 152 people (56.48%) in category Ⅰ, 8 170 (41.38%) in category Ⅱ, 124 (0.63%) in category Ⅲ, and 299 (1.51%) in category Ⅳ. According to the exclusion criteria and principle of voluntariness, 3 400 individuals were candidates to undergo gastroscopy. Finally, a total of 2 389 people came to the hospital for gastroscopy, 1 263 in group A, 814 in group B, 86 in group C and 226 in group D, with an overall response rate of 70.3% (2 389/3 400), target population participation rate of 4.8% (389/50 063), and the overall population participation rate of 2.3% (2 389/105 865). In the 2 389 cases, there were 32 cases (1.34%) of HGIN and gastric cancer by gastroscopy and biopsy pathology, among which 1 case (3.125%) aged 40-49, 9 (28.125%) aged 50-59, and 22 (68.750%) aged 60-69. Among the 32 cases, 25 cases (78.13%)were pathologically confirmed as having HGIN or early gastric cancer by endoscopic submucosal dissection or surgical operation. By eliminating 810 people (including 3 gastric cancer) without first-degree family history with gastric cancer in group Ⅰ and Ⅱ, and increasing the gastroscopy screening age to 50 years (exluding 214 people aged 40-49, including 1 gastric cancer), the number of people who should undergo gastroscopy could be reduced from 2 389 to 1 365, and 28 cases of HGIN or gastric cancer were still detected, including 22 HGIN or early gastric cancer.Conclusion:Gastroscopy after the screening with epidemiological, serological tests, age and first-degree relative with gastric cancer family history is suitable for gastric cancer screening in Wuxi. Based on Chinese national conditions, a new community gastric cancer screening program is recommended in Wuxi considering cost-effectiveness, which includes those over 50 years old, serological PG (+ ) and first-degree relatives with family history of gastric cancer.