Objective To compare the efficacy and complications of early transabdominal preperitoneal patch (TAPP) implantation and open tension-free repair in the treatment of adult inguinal hernia .Methods 84 adult patients with inguinal hernia were divided into two groups by random number table ,and 42 cases in each group .The control group was given Lichtenstein technique ,while the observation group underwent TAPP .The surgery situation, postoperative visual analogue scale (VAS) scores,postoperative morbidity and recurrence rate were compared between the two groups.Results The operative time,ambulation time,average length staying hospital and postoperative VAS scores of the observation group were (42.21 ±3.13) min,(1.13 ±0.21) d,(4.28 ±0.62) d and (2.28 ±0.22) points,which were significantly less than (65.72 ±3.62)min,(2.03 ±0.30)d,(7.87 ±0.83)d and (4.56 ±0.31) points of the control group(t=7.29,8.02,8.32,9.29,all P<0.05).The incidence rate of postoperative complica-tions and recurrence rate of the observation group were 11.90% and 2.38%,which were significantly lower than 26.19%and 16.66%of the control group(χ2 =12.52,14.39,all P<0.05).Conclusion The effect of TAPP in the treatment of adult inguinal hernia is remarkable ,and it is safe and minimally invasive ,which is easy to operate ,it has low recurrence rate ,rapid postoperative recovery and has better clinical value .

Objective To summarize and analyze characteristics and diagnostic value of ultrasonography in the diagnosis of 46 cases of gynecomastia sonographic image.Methods 46 cases of male breast lumps were tested by high frequency ultrasound probe The mammary glands position,thickness,border,shape,internal echo,the internal flow signals,with or without axillary lymph nodes were observed.Results There were 32 cases of unilateral disease, including 18 cases of left side,14 cases of right side,14 cases of bilateral disease.Sonographic indicated 28 cases of mammary gland tissue echo to see beneath the nipple with low echo,the boundary more clearly,more uniform internal echo;and 12 cases showed glandular tissue thickening,echogenic and showed cord -like,similar to the female gland hyperplasia sonogram;and 6 cases showed patchy irregularly echogenic area.Color Doppler performance was that the 33 cases showed glandular tissue without significant blood flow signals,10 cases showing 1 -2 strip -shaped blood flow to see in the glandular tissue,3 cases showing more abundant flow signals.Conclusion Ultrasonography has no pain,with higher diagnostic yield reproducible operation,so gynecomastia is the preferred method.

Objective To observe the ultrastructural changes in the midgut epithelium of Ixodes sinensis after infesting rabbits immunized with {Mr 105 000} purified tick antigen. MethodsNew Zealand rabbits were inoculated with {Mr 105 000} purified antigen by means of mutiple intradermal injection in foot pad, groin and back. Each immunized rabbit was infested by 30 female Ixodes sinensis. At 24 hours, 48 hours, 72 hours, 5 days and 8 days after infestation, three Ixodes sinensis in each group were observed for ultrastructural changes in the epithelium of their midgut. Results Histological examinations showed that with the time going, digestive cells of the ticks after infesting hosts became more and larger with dense and regularly arranged microvilli, enriched organella, distinct unit_membrane structure, and the appearance of tubli, small vacuole, numerous lipid droplets and hematin granules. These cells also developed a highly infolded basal lamina, forming a labyrinth system. The digestive cells of immunized group were however greatly damaged, whose number and volume were significantly different from control groups. From 24 to 48 hours after infestation, the midgut epithelium of Ixodes sinensis showed pathological changes with the basal lamina becoming thinner, looser and broken; digestive cells damaged and vacuolated; microvilli decreased, shortened and irregularly arranged; the mitochondria swollen and its crests reduced, shortened and even with myeloid changes; the rough endoplasmic reticulum dilated; lipid droplets and hematin granules decreased; phagocytic and pinocytic activity weakened; and basal labyrinth system vacuolated. From 72 hours to 8 days after infestation, cells were severely damaged, organella were denatured and necrotic, nuclei showed pyknosis and cells lysed. Conclusion The rabbits immunized with {Mr 105 000} purified ixodic protein have acquired the adoptive immunity against Ixodes sinensis; in the anti_tick immunity described above, the midgut of Ixodes sinensis is the major affected site.

OBJECTIVE: structure and biomechanics studies of posterior cruciate ligament (PCL) demonstrated that double-bundle hamstring graft has similar function to healthy PCL. semitendinosus and gracilis can stabilize knee joint by preventing anterior tibial displacement. Therefore, the aim of this paper is to evaluate the efficacy of construction a PCL using semitendinosus and gracilis bundles.METHODS: Nine patients who were underwent double bundle PCL reconstruction from March 2006 to December 2007, and received a more than 18 months follow-up, were collected, including 8 males and 1 female, aged 21-42 years. Four patients were suffered simple PCL injury,and the other 5 patients combined with meniscus injury. Two tunnels of 5 mm diameter was made in the femoral attachment site of PCL, one tunnel of 8.0 mm diameter was made in the tibial attachment site of PCL. The anterior bundle was reconstructed using semitendinosus tendon, and the posterior bundle was reconstructed using the gracilis tendon. We reserved the attachment of the semitendinosus and gracilis tendon outside of tibial tunnel, and tied a knot using tendens outside of femoral tunnels. No internal fixation was needed. Posterior drawer test was performed in 30.60 and 90 degrees of flexion of the knee joint, and Lysholm rating system was used to determine the function of the knee and the patient's level of activity. RESULTS: Nine patients were included in the final analysis. Prior to operation, posterior drawer test in 30, 60 and 90 degrees of flexion was positive in all 9 cases. However, at 18 months after operation, posterior drawer test in 30, 60 and 90 degrees was negative in 8 cases, only 1 patient had positive posterior drawer test in 30 degrees. The mean Lysholm score was 55 points (45-68points) prior to operation, which was 88 points (78-94 points) postoperatively. The excellent and good results were obtained in 89%.CONCLUSION: Double bundle reconstruction of the PCL mimics more closely to the natural behavior of the normal PCL, which can restore normal knee laxity across the full range of motion. However, the cases were limited, so the prostecdtive efficacy needs to be followed up.

Background: Although there are some Chinese herbal medicines in treatment of constipation, but no multi-center randomized controlled trials have been carried out to prove their effectiveness. Objective: To evaluate the safety and efficacy of Yunchang Capsule in treatment of functional constipation with deficiency of both qi and yin and internal accumulation of poisonous pathogenic factors syndrome, and to explore the clinical dosage. Design, setting, participants and interventions: A randomized, double-blinded controlled, multicenter trial was conducted. A total of 240 patients with functional constipation from West China Hospital of Sichuan University, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, the First Affiliated Hospital of Tianjing University of Traditional Chinese Medicine and Fujian Academy of Traditional Chinese Medicine were randomly divided into three groups: low dose group (80 cases), high dose group (80 cases) and control group (80 cases). Patients in the low dose group were treated with two pills (0.35 g/pill) of Yunchang Capsule and one pill of Yunchang Capsule simulant for three times daily; patients in the high dose group were treated with three pills (0.35 g/pill) of Yunchang Capsule for three times daily; and patients in the control group were treated with three pills (0.35 g/pill) of Biantong Capsule for three times daily. The therapeutic course was 14 days. Main outcome measures: Clinical symptoms, syndromes, and adverse effects were observed before and after the treatment, and blood, urine and stool tests, hepatorenal function and electrocardiogram were also examined. Results: Two cases were excluded, eleven cases were lost to follow-up, and there were 234 patients entered to intention-to-treat (ITT) analysis. After the treatment, the therapeutic effects were calculated by full analysis set (FAS) and per-protocol population set (PPS) analysis respectively. The effects on functional constipation in FAS showed the response rates in the low dose, high dose and control groups were 86.25% (69/80), 82.90% (63/76), and 70.52% (55/78) respectively, and PPS analysis showed the response rates were 85.71% (66/77), 83.56% (61/73), and 70.13% (54/77) respectively. There were no significant differences among the three groups (P>0.05). The effects on traditional Chinese medicine syndrome in FAS showed the response rates in the low dose, high dose and control groups were 78.75% (63/80), 69.74% (53/76), and 67.95% (53/78) respectively, and PPS analysis showed the response rates were 77.92% (60/77), 69.87%(51/73), and 67.53% (52/77) respectively. There were also no significant differences among the three groups (P>0.05). No severe adverse events were observed. Conclusion: Both low dose and high dose of Yunchang Capsule are effective and safe in treatment of functional constipation with deficiency of both qi and yin and internal accumulation of poisonous pathogenic factors syndrome.

Objective: To investigate the correlation between the expression of extracellular matrix metalloproteinase-inducible factor (CD147), matrix metalloproteinase-9 (MMP-9) and human epidermal growth factor receptor-2 (HER-2) in gastric cancer tissues and clinical pathology and prognosis. Methods: From June 2016 to June 2018, 80 gastric cancer specimens from the First People's Hospital of Taizhou were collected as observation group, and another 60 normal specimens of gastric mucosa adjacent to cancer were selected as control group.The expressions of CD147, MMP-9 and HER-2 were detected by SP immunohistochemical method.The positive rates of CD147, MMP-9 and HER-2 protein expression, the positive rates of CD147, MMP-9 and HER-2 protein expression in different pathological characteristics, and the positive rates of CD147, MMP-9 and HER-2 protein expression in different prognosis were compared between the two groups. Results: The positive rates of CD147 (73.75%), MMP-9 (76.25%) and HER-2 (42.50%) in the observation group were higher than those in the control group (21.67%, 25.00%, 5.00%), the differences were statistically significant (χ²=37.233, 36.288, 24.797, all P<0.05). There were no statisticallysignificant differences in the positive expression rates of CD147, MMP-9 and HER-2 protein among different gender, age, tumor diameter and differentiation (all P>0.05). The positive rates of CD147 (93.88%), MMP-9 (95.92%) and HER-2 (61.22%) with lymph node metastasis were higher than those without lymph node metastasis (41.94%, 45.16%, 12.90%), the differences were statistically significant (χ²=26.462, 27.012, 18.142, all P<0.05). The positive rates of CD147 (96.15%), MMP-9 (92.31%) and HER-2 (69.23%) in the death group were higher than those in the survival group (62.96%, 68.52%, 29.63%), the differences were statistically significant(χ²=9.987, 5.484, 11.263, all P<0.05). Conclusion High expression of CD147, MMP-9 and HER-2 proteins in gastric cancer tissues is closely related to invasion and metastasis, which can become a new prognostic marker and therapeutic target of gastric cancer.

Objective To compare the degree of coronary lesions in different types of heart failure with ischemic heart disease. Methods This retrospective analysis include 282 cases diagnosed as heart failure with ischemic heart disease in Zhengzhou People′s Hospital from January 2015 to May 2016. Based on LVEF and the level of BNP and NT-proBNP examination results ,282 cases were divided into HFmrEF(89 cases),HFrEF(109 cases) and HFpEF (84 cases). The clinical basic data ,cardiac color Doppler ultrasound and the difference of coronary artery lesions were compared. Results (1) HFpEF,HFmrEF and HFrEF groups gensini score were 30.45 ± 33.18,62.12 ± 41.25,86.72 ± 38.80. The differences are significant(P < 0.05). Pairwise comparison showed significant difference.(2)HFpEF,HFmrEF and HFrEF groups SYNTAX score were 11.77 ± 8.39,19.08 ± 8.39,26.41 ± 10.31. Compared with HFpEF group,the SYNTAX score of other groups are higher(P < 0.05). (3)The duration of disease ,LVEDD ,LVESD ,LVMI ,the number of vascular lesions was significantly higher in HFrEF group than those in other groups. (4) Multivariate correlation analysis suggested that SYNTAX scores were related to cardiac function classification,BNP,NT-proBNP and LVEF. Gensini integral is related to cardiac function classification ,BNP and NT-proBNP. Conclusions With the severity and complexity of coronary artery disease,the degree of heart failure is more serious. The complexity and severity of coronary artery disease is an important factor in heart failure in patients with ischemic heart disease.

OBJECTIVE: The aim of current work was to investigate the methodology and effect of dual U-shaped mucosal flap repair plus local dilatation for the treatment of nasopharyngeal atresia. METHOD: Nine patients with nasopharyngeal stenosis were treated with dual U-shaped flap to repair the wound of retropharyngeal and soft palate mucosa. and then dilated by implanting a silicone tube. RESULT: The silicone tube was removed 6 months after the operation. The transverse diameter of nasopharynx maintained at about 2.0 - 2.5 cm, and anteroposterior diameter at about 1.0 cm. All cases had good nasal patency except velopharyngeal insufficiency and nasal regurgitation of food. After a 2 years follow-up, all cases had a good result except one still had the nasal regurgitation of food. CONCLUSION U-shaped mucosal flap repair with local dilatation is an effective method for treatment of nasopharyngeal atresia.
Adult ; Dilatation ; Female ; Humans ; Male ; Middle Aged ; Mouth Mucosa ; transplantation ; Nasopharyngeal Diseases ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Young Adult

Objective To investigate the effect of overexpression of P2X4 gene on cell apoptosis in 6-OHDA (6-hydroxydopamine, 6-OHDA) induced PD rat model. Methods One hundred twenty male Wistar rats were randomly divided into 6 groups: 6-OHDA group, control group, objective RNA-P2X4 + 6-OHDA group, target gene RNA-P2X4 group, P2X4-NC + 6-OHDA group and negative virus P2X4-NC only group. Lentivirus or negative virus carrying the target gene and or 6-OHDA or the same amount of physiological saline were injected into the left substantia nigra of rats according to the groups. The number of dopaminergic neurons in substantia nigra was measured by immunofluorescence method.The expression levels of P2X4R,caspase-1 and NLRP3 in substantia nigra were detected by Western blot assay. Results Compared with P2X4-NC + 6-OHDA group, the expression of protein P2X4R (1.099 ± 0.05569 vs. 0.7821 ± 0.02008, P=0.0003 ), NLRP3 (0.9875 ± 0.01932 vs. 0.6645 ± 0.01747. P<0.0001), caspase-1 (0.9948 ± 0.01788 vs. 0.8276 ± 0.04543, P<0.0001) increased significantly in RNA-P2X4+6-OHDA group. Conclusion overexpression of P2X4 gene can increase the expression of NLPR3 and caspase-1 protein and promote apoptosis in PD rats.

Objective:Intravenous thrombolysis (IVT) in patients with acute ischemic stroke is strongly time-dependent.The purpose of this study was to investigate whether the transfer of ischemic stroke patients to hospital through emergency medical service (EMS) could shorten onset to needle time (ONT),onset to door time (ODT), door to imaging time(DIT), door to needle time(DNT) and improve the clinical outcomes of intravenous thrombolysis patients.Methods:We retrospectively collected the clinical and time data of acute ischemic stroke(AIS) patients who received IVT in the Affiliated Hospital of Qingdao University on Laoshan campus from September 2021 to August 2022 were retrospectively collected. Patients were divided into EMS group and Non-EMS group according to patients whether transferred by ambulance. The baseline characteristics, length of each period and differences in clinical outcome were compared. Good prognosis was defined as modified Rankin Scale score of 0-2 at 3-months.Results:A total of 175 patients aged (66.1 ±12.3) years were selected, including 63 females (36.0%) and 53 patients (30.3%) were transferred by EMS. Compared with the Non-EMS group, the patients in the EMS group were older, the baseline NIHSS score was higher, ODT and ONT were shorter (all P< 0.05), but there were no significant difference in DIT and DNT between the two groups. Binary Logistic regression model showed that after adjusting for age, sex, baseline NIHSS score, bridging therapy, history of atrial fibrillation, history of hypertension, the number of previous diseases and intracranial hemorrhage, EMS was independently associated with good prognosis of patients with acute ischemic stroke [odds ratio ( OR) 0.376, 95% confidence interval ( CI) 0.144~0.890, P=0.027). Conclusion:EMS could improve the clinical outcomes of acute stroke patients by shortening the ODT and ONT in patients with acute ischemic stroke.