Objective To investigate experience in adult inguinal hernia treated with the open preperitoneal herniorrhaphy.Methods Eight hundred and twenty-six cases were retrospectively analyzed from February 2004 to December 2011 in our hospital.The effect of operative methods and treatment were observed simultaneously.Results All the patients were cured completely without special complications; Followed up for 12 months,some negative factors such as incision infection,recurrence,special discomfort,and chronic pain have not been appeared.Conclusions The open preperitoneal herniorrhaphy under local anesthesia for adult inguinal hernia is safe,reliable and effective.

Objective To observe responses of brain evoked by somatic stimuli in healthy subjects with blood oxygenation level-dependent functional magnetic resonance imaging.Methods There were 30 healthy subjects in the study. Block design was used infunctional MR imaging. In experimental tasks somatic stimuli was executed to the hands of every subject at duration 1000 ms,interstimulus intervals 1000 ms.The professional software-SPM99 was performed to process the images.Results For healthy subjects to somatic stimuli, significant activation was observed in bilateral primary and secondary somatic cortex of precentral gyri and postcentral gyri, and temporallobes. Scattered activations could be seen in frontal lobes, supramarginal gyri and hemisphere of cerebella. There was more intensiveactivation in right hemisphere than that in left. There was no significant difference between the activation evoked by somatic stimuli of leftand right extremities. Conclusion somatic stimuli can evoke significant activations in bilateral primary and secondary somatic cortex.Temporal lobes and other brain areas join in the process of somatic stimuli.

Objective To investigate the morphological and immunophenotypic characteristics of phyllodes tumors (PT) and explore their significance in differential diagnosis and evaluation of prognosis.Methods 48 specimens with PT were observed under light microscope with HE and immunohistochemical staining (EnVision method).The antibodies including CD34,CD10,CD117,p53,and Ki-67 were used.10 cases of fibroadenoma were compared and the clinical data and follow-up results were analyzed retrospectively.Results All of 48 cases with PT presented as well-circumscribed masses with typically leaflike structures composed of double-layered epithelial component arranged in clefts and overgrowing hypercellular mesenchymal component.31 benign,12 borderline,and 5 malignant PT were diagnosed based on stromal overgrowth,cellular pleomorphism,mitosis,margins,and others.Focal necrosis was detected in 3 malignant cases and liposarcoma component existed in 1 case.Immunohistochemical staining showed that the positive rates of CD34 were 93.5 ％,58.3 ％,0 in benign,bordline,and malignant PT respectively,there were significant differences between each groups (P ＜ 0.05).The expression of CD10 were 25.8 ％,83.3 ％,80.0 ％,its expression in benign group was significantly different compared with bordline and malignant PT (P ＜ 0.05).p53 was expressed in three groups with no significant difference (P ＞ 0.05).CD117 and Ki-67 had high expression comparatively in malignant PT.All cases were treated surgically with a local recurrence rate of 22.9 ％.Conclusions Reasonable surgery pattern based on accurate histopathological diagnosis is crucial to reduce the local recurrence rate of PT.Immunohistochemistry examination in PT is helpful to the differential diagnosis and evaluation of prognosis.

Objective To build three-dimensional (3-D) finite element models for local advancement skin flap, by which the post-operative local strain and local stress of skin were figured out to assist in the design of skin flap in clinic. Methods The biomechanical parameters of human forehead skin were obtained in vitro from biomechanical experiments. The 3-D finite element model of local advancement skin flap was set up by MSC Marc/Mentat 2005 (3-D finite element software). Six models were built with the same flap but different skin defects, to simulate post-operative local strain of skin and local stress of skin in different models. Results Post-operative local stress of skin increased with the skin flaps stretching, but the relationship between increase and stretching did not meet the linear rule. Skin flap was able to stretch to 40 % of its initial length in theory if we did not consider blood supply of it. When the skin flap stretched over 40 % of its initial length, the maximal stress could exceed the yield limit. Conclusion It is an effective and workable way to simulate local advancement skin flap using 3-Dfinite element model and biomechanical parameters of human skin. The stretch ratio of local advancement skin flap should be not over 40% for safety.

Objective: To evaluate the effect of Shenfu Injection in treating vertigo of mild vertebrobasilar stenosis. Methods: From January 2005 to July 2008, 66 patients with the primary symptom of vertigo undergoing digital subtraction angiography (DSA) examination were diagnosed as mild vertebrobasilar stenosis (MVS) according to the North American symptomatic carotid endarterectomy trial (NASCET) criteria, and then randomly divided into Shenfu (SF) group (34 cases) and Danshen (DS) group (32 cases), the DS group acting as the control. Degrees of vertigo of the patients were evaluated by the screening version of the dizziness handicap inventory (DHI-S) and scoring system for the dizziness assessment rating scale (DARS) on the admitted day, the third and sixth day after treatment and discharged day respectively. The mean of blood ? ow velocity (Vm), resistance index (RI) of right and left vertebral arterys and basilar artery, hematocrit (Hmc) and fi brinogen (Fbg) level in serum were all examined on both the admitted and discharged days. Results: There was no signifi cant difference on the score of vertigo, the parameter of TCD and the index in serum between SF and DS groups at the admitted time. On the sixth day of treatment and the discharged day, the score of DHI-S and DARS in SF group were lower than those in DS group (P

Objective To investigate the correlation between the expression level of BLM and its clinical significance in leukemia.Methods 125 bone marrow specimens of inpatients and outpatients with leukemia were collected in Anhui provincial hospital from January 2011 to December 2011.125 leukemia patients were diagnosed and classified into acute leukemia (AL,n =66) and chronic myelogenous leukemia (CML,n =59) by Morphologic and Immunologic criteria,5 non-tumor individuals were included as control group.The BLM mRNA expressions were by reverse transcription-polymerase chain reaction(RT-PCR).The specimens were devided into groups according to the age,gender,leukemia type,peripheral blood leukocyte counts,hepatomegalia and(or) splenomegaly,fusion gene,chromosome karyotype,whether first visit and transplantation.The expression of BLM gene in each group and the correlation with above factors were retrospectively analysed.The statistical methods such as chi-square test,single factor variance analysis,t test and Pearson correlation test were mainly used.Results BLM mRNA was detected in leukemia.In bone marrow cells,the BLM gene expression was positive in 71 patients and negative in 54 patients.But none of 5 non-tumor bone marrow cells expressed BLM gene.The difference of BLM expression between patients and controls was statistically significant in two groups,i.e.peripheral blood leukocyte counts and fusion gene (x2 =14.730,22.399 ; P ＜ 0.05),but there is no statistical significant differences in other groups.The expressions of BLM mRNA in leukemia patients who had been treated with chemotherapy were lower than those newly diagnosed (0.1788 ± 0.1091 vs 0.3276 ± 0.2016 ; P ＜ 0.05).Moreover,BLM mRNA level in post-bone marrow transplant patients was lower than those not treated (0.1271 ± 0.1009 vs 0.2902 ±0.2034 ; P ＜ 0.05).Pearson correlation analysis showed that higher BLM mRNA expression positively correlated with fusion gene (r =0.357,P ＜ 0.01) and chromosome abnormality (r =0.279,P ＜ 0.05).Conclusion The BLM mRNA expression level of measurement can be used as judgment for leukemia patients disease severity and the index of prognosis,testing the level may provide a basis for clinical and curative effect judgment.

Objective:To explore the clinic and coronary disease lesion features in patients with acute coronary syn-drome (ACS) ≥ 75 years old and the outcomes of one-year follow up after percutaneous coronary intervention (PCI) .Methods :A total of 355 ACS patients ,who hospitalized in our hospital from Jan 2012 to Dec 2012 and re-ceived PCI ,were divided into ≥75 years group (n=205) and <75 years group (n=150) .Clinical and coronary dis-ease lesion characteristics and results of one-year follow up after PCI were compared between two groups .Results:Compared with < 75 years group , there were significant rise in incidence rates of hypertension (66.83% vs . 78.67% ) ,diabetes mellitus (28.29% vs .39.33% ) ,arrhythmia (17.07% vs .44.00% ) ,and percentage of type C lesions in coronary angiography (41.95% vs .56.00% ) in ≥75 years group , P<0.05~ <0.01 .There were no sig-nificant difference in incidence rates of adverse events during one-year follow up between two groups ( P>0.05 ) . Conclusion :Higher incidence rates of clinical complications and complex lesions are found in ≥75 years patients with acute coronary syndrome ;but no significant difference is found in one-year prognosis between the two groups .

Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population

Objectives Aiming at the current health management mode of chronic disease preven-tion and control as the focus of work, this paper was to evaluate the effect of chronic disease management-based education on clinical teaching and training in cardiovascular medicine. Methods Totally 54 students participating in internship training in Department of Cardiology, the Shanghai Ninth People’s Hospital be-tween July 2013 and Aug 2014 were enrolled. Twenty-eight students were taught by chronic disease man-agement-based method while twenty-six students were taught by traditional method. After the internship training in cardiology, final examination (theoretical exam, skill appraisal and case analysis) were compared between the two groups to assess the teaching efficacy. Questionnaire survey was employed to investigate student satisfaction with chronic disease management-based teaching method. Data were analyzed by SPSS 13.0 software. Quantitative data or enumeration data between two groups were compared by t-test or chi-square test respectively. Results There was no significant difference in the theoretical exam score between two groups (P=0.422). However, the scores of skill appraisal and case analysis in students taught by chronic disease management-based method were significantly higher than those in students taught by traditional method (P<0.05). Most students taught by chronic disease management-based method were satisfied with the novel teaching method. Conclusion In the course of clinical medicine education, the emphasis on the management of chronic diseases can not only significantly improve the quality of clinical teaching in car-diovascular medicine, but also lay the foundation for the implementation of the concept of chronic disease management.

Objective To establish a novel method for detecting circulating tumor cells (CTCs) in phripheral blood of lung cancer patients with high sensitivity and specificity.Methods Experimental study.42 cases of initial treatment patient who underwent resection and diagnosed to be non-small cell lung cancer by biopsy were studied,including 7 patients at stage Ⅰ,9 patients at stage Ⅱ,16 patients at stage Ⅲ and 10 patients at stage Ⅳ.As a control group,20 cases of healthy volunteers were selected.A series of experiments was conducted to determine the efficiency of tumor cells isolation,in which varied concentration (50,100,200,500,1000 cells) of A549 cells spiked into 2 ml peripheral blood drawn from healthy donors.The blood was removed of unwanted erythrocytes by lysis buffer,and made the rest of nucleated cells incubate with anti-EpCAM magnetic beads,then separated and enriched by a specific detector.All epithelia cells were retained on a slide because of a magnetic force and identified by H&E staining protocol.On the basis of cell recovery rate we calculated the sensitivity of tumor cells isolation.20 blood samples taken from healthy individuals were also detected to validate the specificity of this method.Samples of 42 patients with lung cancer were assayed for CTCs detection by above method.The correction of CTCs quantity with the patients' clinical features,for example,ages,gender,clinical stage,tumor size was analyzed in lung cancer patients by chi-square statistics.The correction of recovery cells with the spiked cells were assayed by linear correlation.Results The recovery rate was ranging from 68％ to 82％ by spiking varying numbers of A549 lung cancer cells into 2ml blood samples of healthy volunteers.Regression analysis of number of recovered vs.spiked A549 cells yielded a regression equation of Y =0.6419X + 8.8875.The number of CTCs detected has signification correlate with the cells spiked (R2 =0.9916,P ＜ 0.05),Eighteen of the 42 patients (43％) were found have CTCs in peripheral blood.The detection rate of lung cancer cells was 0 at stage Ⅰ,the detection rate of lung cancer cells was 11.1％ at stage Ⅱ,the detection rate of lung cancer cells was 62.5％ at stage Ⅲ and the detection rate of lung cancer cells was 70％ at stage Ⅳ.The positive rate of CTCs has no signification correlate with ages and gender of patients and tumor size (P ＞ 0.05),has signification with the clinical stage (P ＜ 0.05).None of the peripheral blood samples of the 20 healthy subjects analyzed was found to have CTCs.Conclusions This novel immunomagnetic separation technology is a sensitive and specific method,which provides a new tool allowing for feasible and specific detection of CTCs in lung cancer patients.The level of CTCs increases with the clinical stage and tumor size increased,which has important value to discover the early stage micrometastasis and redefine the clinical stage.But further multicenter and large sample clinical research are needed to confirm its clinical value.