Objective To explore the effect of transabdominal preperitoneal prosthetic(TAPP) repair combined with intraperitoneal onlay mesh(IPOM) on laparoscopic repair of inguinal hernia.Methods From January to December 2006,laparoscopic hernioplasty was performed on 30 adult patients with inguinal hernia.The hernia area was divided into two parts by the subperitoneal vessel across the area.The medial part was repaired by TAPP using polypropylene patch,and the lateral part was repaired by IPOM with Proceed patch.During to operation,an incision was made on the peritoneum along the subperitoneal vessel,and then the peritoneum was separated medially to expose an operative area(7.5 cm?6.5 cm),which was an avascular area with loose connective tissues and few vital nerves.Results All the operations were accomplished under epidural anesthesia.The operative time was 30-40 min(mean 35 min) for unilateral hernia,and 50-60 min(mean 55 min) for bilateral ones.The amount of blood loss during the operation was 1-5 ml.The patients could walk on the second day after the operation.They were discharged from the hospital 3-4 days after the operation,and were back to work in 2 weeks.During a 2-12-month follow-up(mean,9 months),no adhesive intestinal obstruction and local or systemic complications was observed.Conclusions The combined technique of IPOM and TAPP is a minimal invasive method with confirmed efficacy.By using this easily mastered method,the operative time is reduced,and the patients can recover quickly.

Objective To evaluate mid-term clinical effects of laparoscopic intraperitoneal onlay mesh herniorrhaphy (IPOM) for adult inguinal hernia. Methods A retrospective analysis was made on 546 cases of inguinal hernia treated by IPOM (603 sides) between June 2002 to December 2004. We closed the hernia sac by the lift-insert method following with the implantation of the Prolene mesh with the help of a stapler. Results The operation was successfully completed in all the cases, except for 2 cases of conversions to open surgery because of difficulties in covering the defects. There were no intraoperative complications, and 5 cases of postoperative seroma which subsided after physical therapy. The operative time was 25~40 min (mean, 31 min), and the hospital stay was 36~72 h (mean, 46 h). Follow-up observations for 18~48 months (mean, 28 months) found 6 cases of recurrence, with the recurrence time at 30~45 months (mean,38.2 months). The racurrence rate was 0.995%. Conclusions Laparoscopic intraperitoneal onlay mesh herniorrhaphy a minimally invasive method with reliable outcomes, low recurrence rate, and rapid recovery.

AIM: To investigate the effect of Ginkgo Biloba Extract on coronary blood flow in patients with coronary artery disease(CAD). METHODS: Ninety CAD patients confirmed by cardioangiography were randomly assigned to Ginkgo Biloba Extract Injection group(n=45) and control groups(n=45).Before and after intravenous administration,the distal left anterior descending coronary artery(LAD) flow was measured by transthoracic Doppler echocardiography. RESULTS: Ginkgo Biloba Extract Injection treatment demonstrated significant improvement in diastolic peak velocity,systolic peak velocity and diastolic time velocity integral(P0.05). CONCLUSION: CAD patients in the treatment of Ginkgo Biloa Extract lead to the increase in LAD blood flow.

Objectives: To clarify the diagnostic value of sTFR and its compound parameters sTFR/SF, sTFR/logSF in the differential diagnosis of IDA, ACD and CDID. Methods: Forty nine anemia patients were classified into IDA, ACD and CDID by clinical presentations and the laboratory results. The serum concentration of sTFR was detected by ELISA. The difference of sTFR, sTFR/SF, sTFR/logSF and routine parameters in the three groups and the correlation among sTFR and routine parameters were analyzed. Using ROC curve, the diagnostic value of these parameters in the differential diagnosis of the three diseases were compared. Results: The serum concentration of sTFR in the IDA, ACD and CDID were (50.8?8.2)nmol/L, (33.5?6.9)nmol/L and (22.7?9.9)nmol/L,respectively. The differences among three groups were significant( P

Objective To retrospectively analyze clinical manifestations of autonomic nervous system (ANS) and skin sympathetic response (SSR) in Lambert-Eaton myasthenic syndrome (LEMS).Methods Fifty-three LEMS patients' medical records were reviewed and information regarding clinical symptoms and signs of ANS and SSR testing results were collected.Results ( 1 ) The most common initial symptom of LEMS was weakness of lower extremities ( n =41 ) and the most common symptom of ANS dysfunction was constipation ( n =25 ) and dry-mouth ( n =23),which could be occurred before the onset of the legs (n =7).(2) In symptoms of ANS,cardiovascular system dysfunction was found in 4 patients include one of ingone of bradycardia,one of postural hypotension and 2 of tachycardia- Secretory glands dysfunction was found in 34 patients:23 dry-mouth,6 dry-eyes,and 8 patients sweating dysfunctions.Twenty-eight patients complained of alimentary dysfunction including constipation and diarrhea.Bladder dysfunction was found in 2 patients,who complained of urinary incontinence.Seven male patients complained of sexual dysfunction.Abnormal skin scratch test was found in 17 patients.(3) SSR was performed in 33 patients and 18 found abnormal.Conclusions ANS manifestations are common and prominent in LEMS patients.SSR abnormality is also common in LEMS.More electrophysiology tests are needed in LEMS patients.

Objective To explore the relationship between cervical spondylotic radiculopathy (CSR) and carpal tunnel syndrome (CTS) by investigating their electrophysiological characteristics and the incidence of CSR root injury and root injury complicating with CTS.Methods One hundred and twenty-four cases of CSR diagnosed in Peking Union Medical College Hospital from September 2013 to February 2014 by electromyography (EMG) were recruited.According to the results of EMG,patients were divided into root injury and root injury complicating with CTS groups.The distal motor latency (DML),motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),sensory nerve action potential (SNAP),compound muscle action potential (CMAP) and spontaneous potential (SP) were compared between the two groups.Results There were 81 (65.3％) cases with root injury,11 cases with double sides injury and 29 cases with normal EMG among these 124 patients.The CMAP,DML,MCV,SCV and SNAP were normal in 76 cases,CMAP lowered 5％-12％ in 3 cases,DML extended 3％ and 9％ in 2 cases.There were 14 cases (11.3％) with concomitant CTS (female 10 cases and male 4 cases,double sides CTS 10 cases).Among the 14 cases with concomitant CTS,there were 9 cases with simply sensory nerve conduction abnormality,SCV slowing down 26％-47％,SNAP reducing 58％-86％ or normal,while other 5 cases with motor conduction abnormality as well as sensory nerve conduction abnormality,CMAP reducing 21％-78％,DML extending 27％-39％ in 3 cases,MCV slowing down 32％ and 40％ in 2 cases.Five cases had spontaneous electricity position movement in the abductor pollicis brevis.The incidence of root injury complicating with CTS in C6 (27.4％,9/33),C7 (26.9％,7/26) and C8 (5/7) showed statistically significant difference (x2 =5.96,P ＜ 0.01).Conclusions There is a high incidence of root injury and CTS in CSR patients,indicating a possible double crush between CSR and CTS.

Objective To assess the effectiveness of pedicled iliac periosteal flap graft for treatment of old femoral neck fracture in adolescents.Methods Between June,2005 and December,2013,15 patients (15 hips) of old femoral neck fracture in adolescents treated with vascular pedicled iliac periosteal.There were 11 males and 4 females with an average age of 15.8(range 12 to 18) years.Based on the location of fracture,there was 5 cases of subcapital,8 cases of transcervical and 2 cases of basal.6 cases were treated with lower limb traction,3 cases with internal fixation and 6 just without any treatment.The average duration from injury to the second operation was 4.8 (range 1 to 19) months.There were 2 cases of femoral head necrosis after femoral neck fracture.Open reduction,pedicled iliac periosteal flap grafting and cannulate screw fixation were performed.Results All incisions healed by first intention.All patients were followed up 12 to 90 months (mean,46 months).The HHS was increased from (48.7 ± 8.3) pre-operation to (91.3 ± 6.1) at last followed-up,indicating a significant difference between before and after operation (P ＜ 0.01).One patient underwent total hip arthroplasty at 10 months after operation because of fracture nonunion and femoral head necrosis.Fracture healed successfully in 14 cases and the average time of fracture healing was 4 (range 3 to 6) months.Certain extent of remodelling and bulge of the head were observed in 2 cases of collapsed heads.Conclusion Pedicled iliac periosteal flap graft can provide good osteogenesis and vascular reconstruction for femoral head and promote fracture healing in treatment for old femoral neck fracture in adolescents.

Objective To discuss the feasibility of positioning the acetabular center,fixing acetabular implant correctly and reconstructing hip rotation center according to Harris fossa and the remaining anatomical markers of acetabular notch in revision hip arthroplasty.Methods Twenty-eight patients underwent revision hip arthroplasty from April 2007 to June 2009.Based on Paprosky type,3 cases with type Ⅰ were treated with biological fixed acetabular component;8 cases with ⅡA and ⅡB were reconstructed with using of morselized bone grafting and large diameter cemented acetabular prosthesis;17 cases with type ⅡC,ⅢA and ⅢB were treated with using of morselized bone grafting and fixation of acetabular reinforcement ring.Among them,5 patients with massive bone loss in acetabular wall were reconstructed with the use of the structural and morselized bone grafting.The center of the original acetabulum was believed to be in the lunate cartilage surface which was closed to Harris fossa.During the operation,the center was located in the site which was 25-28 mm above in line with perpendicular bisector of acetabular notch connecting line.The acetabular center was the point of positioning acetabular prosthesis (Ⅰ type) or making new acetabulum by impaction bone grafting.Acetabular reinforcement ring (Ⅱ,Ⅲ type) was fixed in accordance with proper transverse angle and anteversion angle.The vertical distance from hip rotation center to teardrop connection and the horizontal distance from hip rotation center to teardrop were measured on preoperative and postoperative radiograph.And the outcomes of reconstruction of rotation center were evaluated.Results The vertical distance was changed from (14.22±3.39) mm preoperatively to (32.64±4.51) mm postoperatively.The difference was statistically significant (t=3.65,P＜ 0.05).The horizontal distance was changed from (25.13±3.46)mm preoperatively to (32.87±4.73) mm postoperatively.The difference was statistically significant (t=2.72,P＜0.05).Conclusion Using residual Harris fossa and acetabular notch as the anatomical markers in revision hip arthroplasty,the restoration of the anatomical hip center has shown to be favorable.

Objective To determine whether peripheral nerve ultrasound can differentiate CharcotMarie-Tooth type 1 (CMT1) from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Methods Eighteen patients with CIDP,13 patients with CMT1 and 16 healthy controls were recruited prospectively from Peking Union Medical College Hospital between January 2014 and July 2015 for this study.Ultrasonographic tests were performed via nerve tracing from wrist to axilla on median and ulnar nerve with a 10 MHz linear array probe.The cross sectional areas (CSAs) were measured at 10 defined sites of the nerves,respectively.Results CSAs (mm2) at all sites of median nerve were significantly increased in CMT1 than in CIDP (10.5 ±5.3 vs7.8 ±2.4,10.9 ±3.6 vs 6.8 ±1.9,11.5 ±5.0 vs7.3 ±1.8,13.5 ± 4.4vs7.2±2.5,16.0±4.5vs7.2±2.1,17.1±5.1vs7.0±2.8,21.0±4.5vs9.5±4.8,24.3±6.9 vs 9.5 ±4.3,23.9 ±6.0 vs 10.2 ±4.3,22.4 ±6.7 vs 9.8 ±2.1;t=2.141,4.766,2.935,4.858,6.715,6.602,7.148,7.100,8.078,6.498,respectively,all P ＜ 0.05).CSAs (mm2) at all sites of ulnar nerve were significantly increased in CMT1 than in CIDP (7.9 ± 1.8 vs 4.0 ± 1.3,8.9 ± 2.0 vs 4.9 ± 1.3,13.5±1.9 vs6.5±2.4,15.0±4.3 vs 6.5 ±1.5,15.8 ±4.4 vs 6.8 ±3.3,11.6±2.3 vs6.9± 3.1,10.2±3.2vs7.6±2.8,14.0±3.0vs6.6±2.1,19.2±3.7vs7.6±4.4,18.1±3.6vs6.3± 2.5;t =7.652,7.414,9.194,6.893,6.443,4.766,2.561,7.897,8.113,11.554,respectively,all P ＜ 0.05).CSAs at 8 sites of median nerve and 8 sites of ulnar nerve were significantly increased in CIDP than in healthy controls.Receiver operation characteristic curve analysis revealed that CSA was suited for differentiating CMT1 from CIDP,and the area under curve in 8 sites of median nerve and 9 sites in ulnar nerve was more than 0.9.Conclusions CSAs measured at different sites by peripheral nerve ultrasound in CMT1 were significantly increased than in CIDP.Measurement of CSAs by peripheral nerve ultrasound can be used for differentiating CMTI from CIDP.

Advanced gastric cancer without distant metastasis remains a potentially curable disease, but the prognosis is poor in this condition because of the high unresectability rate at presentation and the high recurrence rate after radical surgery. Administration of neoadjuvant chemotherapy has several potential benefits for advanced gastric cancer. This treatment can decrease tumor stage and improve R0 resection rate. Neoadjuvant chemotherapy has higher patient tolerability and a higher rate of chemotherapy completion than adjuvant chemotherapy. In vivo drug sensitivity tests can also be conducted to avoid unnecessary surgeries. Although high-intensi-ty chemotherapy results in a high overall response rate, a few advanced gastric patients can achieve a pathologically complete re-sponse. However, no standardized treatment has been achieved. This article introduces five cases of advanced gastric cancer treated with neoadjuvant chemotherapy in the Affiliated Tumor Hospital of Guangxi Medical University. The five cases achieved a pathological complete response. This article also aims to explore the clinicopathological characteristics of these patients, proper cooperative treat-ment practices, and prognostic factors for the benefit of future patients.