BACKGROUND:It remains controversial in term of therapeutic efficacy of self-fixating mesh and sutured mesh in inguinal hernia repair. OBJECTIVE:To compare the therapeutic effects of self-fixating mesh and sutured mesh in open inguinal hernia repair with Meta-analysis. METHODS:Comprehensive electronic search strategies were developed using the folowing electronic databases: Cochrane library, PubMed, EMBASE, Medline, Ovid, CNKI, Wanfang and FMJS. The Literature published before December 2014 was searched. Perspective randomized controled trials about comparing self-fixating mesh and sutured mesh in open inguinal hernia repair were included. A data-extraction sheet was developed based on the preset standards. The data from eligible studies were pooled through Meta-analysis. RESULTS AND CONCLUSION:Nine trials with a total of 2 100 inguinal hernia patients met the inclusion criteria, including 1 033 cases of self-fixing mesh and 1 067 cases of sutured mesh. The Meta-analysis showed that no significant differences were found between the two groups in the recurrence rate, seroma, hematoma, wound infection, pain, foreign body sensations (P > 0.05), but the duration of operation was less in the self-fixing mesh group than the sutured mesh group (P < 0.05). According to limited evidence, there are some findings as folows: self-fixating mesh is equivalent to sutured mesh in the therapeutic effects on open inguinal hernia repair. Because of the limits of samples and literature quality, more large-sample and high-quality trials are required to make a definite clinical evidence to use self-fixating mesh for groin hernia repair.

Objective To summarize key points of nursing the patients with hot-press injury in hands treated with artificial dermis.Method The nursing measures by summary included preoperative psychological counseling,raising the affected limbs in case of edema,keeping wounds clean,keeping the affected limbs immobilized,instructing them in functional exercise.Results All 10 cases were cured.Excellent results were obtained in hand function and shape.Conclusions Preoperative mental care can improve the patients’confidence and make them cooperative positively in treatment and postoperative rehabilitative exercises. Postoperative close observation of the disease conditions and good care to the wounds together with right instruction in hand function exercises are critical for the recovery of hand function.

Objective To investigate the dosimetric influence of dwell weight standard deviation (DWSD) and applicator displacement in cervical cancer patients treated with three-dimensional brachytherapy.Methods A total of 20 cervical cancer patients who had completed radical treatment were selected in this study.The Fletcher applicator (Nucletron#189.730) was used for these patients.A new plan,based on the former CT images and structures,was designed for each patient.In former and new plans,dwell weight was recorded,and DWSD was calculated.Two groups,low-DWSD (LDWSD,0.141-0.299) and high-DWSD (HDWSD,0.211-0.337),were set according to the DWSD size for the two plans.Dosimetric effects from ± 1 mm displacement of tandem applicator or ovoid applicator were simulated with Oncentra (R) Brachy V4.3 treatment planning system.D100,D90,and V150 for clinical target volume (CTV)and D0.1cc,D1cc,and D2cc for the bladder,rectum,and sigmoid were evaluated.Dosimetric comparisons were made between the LDWSD group and HDWSD group to study the dosimetric effects of DWSD and applicator displacement in cervical cancer patients.Results The dosimetric effects from applicator displacement increased with increasing DWSD.If there was a 1 mm displacement of tandem applicator or ovoid applicator,D100,D90,and V150 of CTV were 3.0％,23.8％,and 4.8％ higher or 0.5％,1.2％,and 5.2％ higher in the HDWSD group than in the LDWSD group;D0.1cc,D1cc,and D2cc of the bladder and rectum were significantly higher in the HDWSD group than in the LDWSD group,particularly for the sigmoid (up 44.0％,22.8％,and 16.8％) and (up 10.3％,14.4％,and 12.4％).Conclusions DWSD should be considered in plan evaluation for cervical cancer patients treated with three-dimensional brachytherapy.The dosimetric influence from applicator displacement can be decreased by reducing DWSD properly.

Objective To investigate the prevalence of nutritional risk,malnutrition(undemutrition),overweight/obesity,and application of nutritional support in hospitalized patients with endocrine disorders.Methods Adult patients in Department of Endocrine of Peking Union Medical College Hospital(PUMCH)from September to December 2008 were consecutively enrolled.Nutrional Risk Screening 2002(NRS2002)war per-formed on the next morning after admission and nutritional support evaluation was performed on the 14th day of ad-mission or on the discharge day.The relationship between nutritional risk and nutritional support Was analyzed.Nu-tritional risk was defined as NRS2002 score≥3,and body mass index(BMI)<18.5 ks/m2 defined as unclernut-rition.Results A total of 152 patients were enroled,and NBS2002 scoring was performed in all patients.The prevalence of undernutrition Was 7.9%and the nutritional risk was 27.6%.The prevalence of nutritional risk in the elderly inpotients(≥60 years old)was significantly higher than in younger patients(18-59 years old)(36.8%vs 20.2%,P=O.023).Nine patients(21.4%)with NRS2002≥3 received nutrition support,and 12patients(10.9%)with NRS2002<3 received nutritional support.The average PN:EN ratio was 1:3.2.Conclu-siom NRS2002 is afeasible nutritional risk screening tool for inpatients with endocrine disorders.A large propor-tion of inpotients were at nutritional risk or undemutrition in the Department of Endocrine of PUMCH. The application of nutritional support currently is somehow inappropriate.Evidence-based guidelines are required to improve this situation

Objective: To analyze the effect of rapid convalescence surgery on plasma radical prostatectomy in elderly patients with prostate hyperplasia. Methods: A total of 140 elderly patients with prostate hyperplasia who underwent plasma prostatectomy in our hospital from January 2016 to August 2017 were selected as subjects. Divide them into control group (70 cases) and observation group (70 cases) according to random number table method. Patients in the control group were given routine care. The observation group gave a nursing model based on the concept of rapid rehabilitation surgery on the basis of the control group. Compared the bladder irrigation time, postoperative hospitalization time, catheter removal time, anal exhaust time, first time out of bed time, complication rate, postoperative Numerical Rating Scale (NRS) pain score, bladder spasm symptom score and quality of life score between the two groups. Results: The bladder irrigation time, postoperative hospital stay, urinary catheter removal time, anal exhaust time and first time to get out of the observation group were (23.94±3.75) h, (3.49±0.46) d, (3.11±1.50) d, 6.23±3.07) h and (24.70±3.62) d, while the control group were (76.42±9.55) h, (7.06 ±0.44) d, (6.74±2.06) d, (17.41±3.48) h and (90.58±9.75) d, the above observation indexes of the observation group were significantly lower than the control group, the difference was statistically significant (t=11.918-52.998, P<0.01). The incidence of postoperative bladder spasm, bloating, hemorrhage, lung infection and urinary tract infection in the observation group were 1.429% (1/70), 2.857% (2/70), 0, 2.857% (2/70) and 7.143% (5/70), respectively, while the control group were 11.429% (8/70), 14.286% (10/70), 8.571% (6/70), 15.714% (11/70) and 24.143% (19/70), respectively. The incidence of the above complications in the observation group was significantly lower than that of the control group, the difference was statistically significant (χ²=4.275-8.499, P<0.05 or 0.01). The NRS pain score, quality of life score and bladder spasm score were observed in the observation group (31.48±3.60), (1.89±1.03), (2.25±0.47) points, while the control group were (36.20±4.22), (2.77±1.84), and (3.79±0.81) points, respectively. The above three scores in the observation group were significantly lower than those in the control group, the difference was statistically significant (t=7.119, 3.491, 13.756, P<0.01).The nursing satisfaction of patients in the observation group was 95.71% (67/70) which was significantly higher than 80.00% (56/70) of the control group, the difference was statistically significant (χ²=6.695, P<0.05). Conclusions Rapid rehabilitation surgery for patients with advanced prostatic hyperplasia with plasma prostatectomy can speed up the recovery process, relieve postoperative pain, reduce the incidence of postoperative complications, harmonious doctor-patient relationship, improve the quality of life of patients, it is worthy of extensive clinical promotion.

AIM: To investigate the effect of glycine on endotoxin and hypoxia-induced necrotizing exterocolitos (NEC) in rats. METHODS: In glycine+NEC group, twenty anesthetized and artificially ventilated rats received 1g/kg glycine (20%, iv). Five minutes later, the rats were treated with 2 mg/kg lipopolysaccharide (LPS). In control group (NS+NEC), twenty rats were treated with normal saline as a substitute for glycine. In all animals, FiO 2 was reduced after 90 min from 21% to 5% and ventilation continued until 180 min or death. At the end of the experiment, the samples of blood and intestine were obtained immediately. Serum TNF? was measured with ELISA, serum NO was determined by nitrate reductase. The histopathology of the necrotic lesions were categoried: grade Ⅰ, focal mild injury confined to villous tips; grade Ⅱ, partial loss of villi; grade Ⅲ, necrosis extending to submucosa; grade Ⅳ, transmural necrosis. RESULTS: The survival time [(159 25?22 78) min vs (138 75?19 05) min] was shorter in the NS+NEC group ( P

Objective To assess the safety and efficacy of hypertonic saline in traumatic hypovolemic shock with Meta-analysis.Methods Comprehensive electronic search strategies were developed using the following electronic databases:PubMed,EMBASE,Medline,Ovid、Clinical Trials,CNKI,Wan Fang,CBM and FMJS.The Literature published before August of 2017 was searched.The randomized controlled trials (RCTs) about hypertonic saline in traumatic hypovolemic shock were included.A data-extraction sheet was developed based on the preset standards.The data from eligible studies were pooled through Meta-analysis.Results 9 trials with a total of 1600 patients (741cases in observation group,859 cases in control group) met the inclusion criteria.The meta-analysis showed that the hypertonic saline group displayed remarkable increase in the systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group [MD =6.43,95％ CI(1.16,11.70),P ＜0.05],[MD =-5.99,95％ CI (-9.04,-2.95),P ＜0.05].The level of serum sodium [MD =7.94,95％ CI(7.39,8.50),P ＜0.05],serum chloride [MD =9.67,95 ％ CI(8.77,10.57),P ＜ 0.05] and osmolality [MD =18.11,95％ CI (10.73,25.49),P ＜ 0.05] in the hypertonic saline group was increased significantly but acceptable.No significant difference in mortality was found between the hypertonic saline group and the isotonic saline group [OR =0.88,95％ CI(0.69,1.11),P ＞ 0.05].Conclusions Available evidence shows that small volume hypertonic Sodium Chloride saline is safe and effective for resuscitation in patients with traumatic hemorrhagic shock.Since the quality of the inclued studes were not high,more high-quality,multicenter randomized controlled clinical studies need to provide better evidence for the above conclusion.

Objective: To evaluate the efficacy and side effects of tocilizumab for the treatment of systemic juvenile idiopathic arthritis. Method: In this prospective self case-control study, the children diagnosed with refractory systemic juvenile idiopathic arthritis admitted to Department of Rheumatism and Immunology of Children's Hospital Affiliated to Capital Institute of Pediatrics from December 2013 to June 2016 were enrolled and information before and after treatment of tocilizumab was analyzed. The tocilizumab was introvenously guttae in a dose of 8-12 mg/kg every 2 weeks. Complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were tested before and after the application of tocilizumab. Detailed clinical manifestations were recorded. All results were analyzed by χ² test and t test. Result: Forty patients with a median age of (6.6±3.7) years were enrolled, including 15 males and 25 females. All of the patients presented with fever and 38 patients got normal temperature 24-48 hours after treatment with tocilizumab. Symptoms disappeared in 13 and improved in 4 patients after treatment among the 17 patients who presented with arthritis. Within the 10 patients who manifested with rashes, 9 patients' rashes disappeared without relapse accompanied by the normalization of temperature after the treatment of tocilizumab. One patient got normal temperature but intermittently emerged rashes after symptoms of arthritis improved. In the 40 patients, 38 well tolerated tocilizumab while 2 showed rashes and chill which disappeared shortly after antianaphylaxis treatment. No severe treatment-related infection was found in any patients. According to the study, the white blood cell counts(×10⁹/L), CRP(mg/L) and ESR(mm/1h) tested 2 weeks after the treatment with tocilizumab were significantly lower than that before treatment(12.1±1.2 vs. 16.5±1.8, 47±8 vs. 67±9, 21±5 vs. 57±6, t=2.75, 3.98, 5.22, P=0.009, 0, 0, respectively). No significant changes were found in concentration of IL-6 and TNF-α (65(207) vs. 45(137) ng/L, and 14(6) vs. 17(19)ng/L, Z=-1.247 and-1.285, P=0.212 and 0.199 respectively). Conclusion Tocilizumab is a treatment with good efficacy and safety for refractory systemic juvenile idiopathic arthritis. Adverse effects would be found in some patients.

Objective:To improve the understanding of Takayasu′s arteritis (TA) and its diagnosis and treatment by analyzing and summarizing the clinical characteristics of TA in children at different ages.Methods:Clinical and follow-up data of 41 children with TA admitted in Children′s Hospital, Capital Institute of Pediatrics between January 2010 and May 2020 were retrospectively analyzed.Based on the cut-off age of 3 years, children with TA were divided into older group and younger group.Clinical characteristics, involvement of the coronary artery, blood pressure control and growth restriction between 2 groups were analyzed.Counting data were expressed as percentage and case, and compared by the Chi- square test. Results:Among the 17 children with TA in younger group, there were 8 males and 9 females.There were 6 males and 18 females in older group.The general type was most common in younger group, with 10 cases (58.8%). In older group, thoracic and abdominal aortic type was the most common, with 13 cases (54.2%). The most common clinical manifestation in younger group was fever, with 13 cases (76.5%). In older group, 19 patients (79.2%) had hypertension.Lower hemoglobin (Hb) was detected in younger group.Leukocyte count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) increased in all patients (100.0%). In older group, leukocyte count increased in 6 cases (25.0%), ESR increased in 13 cases (54.2%), and CRP increased in 11 cases (45.8%). The coronary artery and its branches (anterior descending branch and circumvolute branch) were the mostly affected in younger group, with 16 cases (94.1%). The subclavian artery was the most commonly involved in older group (15 cases, 62.5%). All TA children in younger group were in the active stage.Among them, 8 cases were treated with biological agents alone, 3 cases were treated with glucocorticoid alone, 5 cases were treated with the combination of glucocorticoid and biological agents, and 1 case was treated with glucocorticoid first, and then transferred to biological agents due to the poor effect.In older group, there were 18 active-stage patients (75.0%), and 2 refused treatment.Sixteen active patients and 6 inactive patients were treated with glucocorticoid, involving 19 cases treated with glucocorticoid combined with Cyclophosphamide, and 3 cases treated with glucocorticoid combined with biologics.There were 16 cases of coronary artery involvement in younger group and only 1 case in older group ( P<0.01). In younger group, 9 patients had growth restriction, while none was detected in older group ( P<0.01). The blood pressure of younger group was all controlled, which was not satisfactorily controlled in 16 cases of older age ( P<0.01). The incidence of general type and active stage in younger group was higher than that of older group without significant difference ( P>0.05). Conclusions:The clinical characteristics of TA vary at different ages.TA progresses more rapidly in younger children, which are more prone to the involvement of extensive vessels, the coronary arteries and other vessels, and the effects of drugs on growth and development should be well concerned.Older TA patients can be alleviated into the inactive phase by themselves, which is mainly characterized as the involvement of large vessels and hypertension sequelae.

OBJECTIVE： To provide reference for reducing the rate of outpatient/emergency intravenous infusion in paediatric and improving the safety of drug use in children. METHODS： The comprehensive intervention of outpatient/emergency intravenous infusion in paediatric by pharmacists of our hospital though multiple measures was introduced， such as education training， system construction and management， multi-party monitoring and intervention. Related data were selected before （Jan-Jun. 2018） and after intervention （Jul.-Dec. 2018） to evaluate intervention effects， involving paediatric outpatient/emergency intravenous infusion rate， antibiotics intravenous infusion rate， the rate of intravenous infusion prescription， total cost of antibiotics， TCM injection， adjunctive drugs and key monitoring drugs in infusion prescriptions. RESULTS： Through the comprehensive intervention of pharmacists， related indexes of outpatient/emergency intravenous infusion in paediatric were decreased greatly in our hospital. The rate of intravenous infusion， the rate of antibiotics intravenous infusion， the rate of intravenous infusion prescription and the rate of antibiotics intravenous infusion prescription were decreased from 19.52％， 15.46％， 20.29％， 11.20％ to 10.37％， 8.55％， 10.25％， 6.64％（P＜0.001）， respectively. Total cost of antibiotics， TCM injection， adjunctive drug and key monitoring drug were decreased respectively in infusion prescriptions （P＜0.001）. CONCLUSIONS： The comprehensive intervention measures taken by pharmacists in our hospital can reduce the rate of outpatient/emergency intravenous infusion in paediatric and the medical cost， and promote the safety of drug use in children.