Objective To compare tension-free repair and traditional hernia repair of inguinal hernia in the elderly patients. Methods During the period from 2000 to 2001,84 aged patients of scheduled for repair of inguinal hernia were randomized to tension-free repair or traditional hernia repair. The patients were followed up for two years. Results Tension-free repair of inguinal hernia was a simple procedure causing less trauma and operative time, fewer complications and recurrence. Conclusion Tension-free repair of inguinal hernia is superior to traditional hernia repair in the elderly patients.

Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio

Objective To detect the expression of aquaporin 1 in pancreas of rats with acute necrotizing pancreatitis (ANP) and to study the effect of Dachengqi decoction on it.MethodsOne hundred and sixty male SD rats were randomly divided into control group ( C group,n =32 ),ANP group ( n =32),Dexamethasone group (De group,n =32),Acetazolamide group (A group,n =32) and Dachengqi decoction group (DD group,n =32).ANP model was induced by retrograde injection of 5％ sodium taurocholate into the biliary and pancreatic duct.Rats in De group received dexamethasone (4 mg/kg) intravenously after ANP induction; while rats in A group received 1 ml acetazolamide via gastric lavage 2 h before ANP induction; rats in DD group received 2 ml Dachengqi decoction via gastric lavage 48,24,2h before ANP induction; rats in C group received laparotomy.Eight rats in each group were sacrificed at 3 h,6 h,12 h and 18h after induction of ANP models.Quantity of ascites and levels of serum amylases were measured.Pathological changes in pancreas tissue were detected by HE and electron microscope.Capillary permeability in pancreas tissue was detected by Evans Blue (EB) extravasations method.AQP1 expression in pancreas tissue was detected by real-time PCR and Western blotting.ResultsLevels of serum amylase in ANP group was significantly higher,and the pancreatic injuries were obvious ; the levels of serum amylase in De group and DD group was lower than that in ANP group,and the pancreatic injuries were attenuated.The levels of serum amylase in A group were higher than that in ANP group,and the pancreatic.injuries were more severe than that in ANP group.Six hours after ANP induction,the levels of EB in pancreas were (13.44 ±2.56),(126.35 ± 14.80),(86.31 ± 14.46),( 108.99 ± 15.07 ),(78.29 ± 16.85 ) mg/L In C group,ANP group,De group,A group and DD group,and the expression of AQP1 mRNA in pancreatic tissue was ( 170.07 ± 22.48 ) ％,( 83.93 ± 8.98 ) ％,( 117.09 ±10.70 ) ％,( 69.00 ± 8.98 ) ％,( 112.82 ± 11.79 ) ％ ; and the expression of AQP1 protein was 0.23 ± 0.06,0.10 ±0.02,0.32 ±0.03,0.13 ±0.02,0.45 ±0.04.The content of EB in ANP group was higher than that in C group,while the expression of AQP1 mRNA and protein in ANP group was significantly lower than that in C group (P ＜ 0.05 ).The content of EB in De group and DD group was significantly lower than that in ANP group,while the expression of AQP1 mRNA and protein was significantly higher than that in ANP group (P ＜ 0.05).ConclusionsAQP1 plays an important role in the pathogenesis of capillary endothelial barrier dysfunction in rats with ANP.Dachengqi Decoction can attenuate pancreatic injuries of rats by regulating the expression of AQP1.

Pre-eclampsia is a common complication of pregnancy that can result in serious consequences for mother and child health, but there are currently no established therapeutic options. Mesenchymal stem cell-derived exosomes (MSC-exos) are nanoparticles carrying bioactive substances such as proteins, lipids, and nucleic acids, and serve as a medium of intercellular communication. MSC-exos are involved in many important physiological processes, including immunological regulation, cell proliferation and migration, and angiogenesis, thereby play an important role in tissue repair and potentially clinical treatment strategies. In recent years, the treatment strategies of MSC-exos have become an emerging hot topic in the management of ischemic diseases, immune dysfunction, inflammatory diseases, and other fields. We review the advantages and challenges of MSC-exos as a new acellular therapy strategy as well as the feasibility of MSC-exos in managing preeclampsia, from its biological role in the important pathogenesis of preeclampsia, such as trophoblastic and endothelial cell dysfunction, immune imbalance at the maternal-fetal interface, and oxidative stress, and summarize the progress of animal experimental research in this field.

BACKGROUND:Lumbar decompression and fusion is the most effective surgical method to treat lumbar degenerative spondylolisthesis.In recent years,the sagittal balance of the spine has been widely considered the key factor to adjust the outcome of spinal surgery,and factors that can affect the sagittal balance of the spine indirectly affect the surgical effect and prognosis. OBJECTIVE:To summarize the risk factors that can affect the sagittal balance of the spine during decompression and fusion due to lumbar spondylolisthesis,and play a certain reference role in the surgical treatment of lumbar spondylolisthesis. METHODS:With"lumbar spondylolisthesis,the sagittal plane balance of the spine,surgical treatment,risk factors"as the Chinese search terms,and"lumbar spondylolisthesis,sagittal balance,risk factor"as the English search terms,PubMed,Springer,ScienceDirect,Wanfang,VIP and CNKI were searched respectively.The focus of the search was from January 2010 to January 2023,and a few classic long-term articles were included.Preliminary screening was conducted by reading the title and abstract.After excluding repetitive research in Chinese and English literature,low-quality journals and irrelevant literature,67 articles were finally included for review. RESULTS AND CONCLUSION:(1)Degenerative lumbar spondylolisthesis is an important factor causing spinal canal stenosis and lumbar instability,and is the main cause of low back pain and intermittent claudication.Lumbar decompression,fusion and internal fixation is an effective way to treat degenerative lumbar spondylolisthesis.(2)In the past,the treatment of degenerative lumbar spondylolisthesis with decompression,fusion and fixation focused on thorough exploration and release of nerve roots,reduction of spondylolisthesis and solid internal fixation,but less attention was paid to the balance of sagittal plane of the spine.(3)With the popularization of lumbar decompression,fusion and internal fixation,complications caused by the sagittal imbalance of the spine gradually increased,resulting in poor prognosis of patients and even increased risk of secondary surgery.(4)Previous studies have only discussed the correlation between lumbar sagittal plane parameters and spinal sagittal plane balance,but have not in-depth studied the relevant factors causing spinal sagittal plane imbalance.(5)Our results show that open lumbar fixation and fusion,complete reduction of spondylolisthesis,selection of thicker pedicle screws,selection of larger fusion cages,and autologous bone transplantation are beneficial factors for maintaining sagittal balance.The higher the number of fusion segments,the higher the level of fusion segments is,which is a risk factor for sagittal plane imbalance.

Objective:To compare the efficacy of reduction and in situ intervertebral fusion fixation in the treatment of degenerative lumbar spondylolisthesis.Methods:A total of 182 patients (92 males and 90 females) with L 4 degenerative lumbar spondylolisthesis of Meyerding's classification of grade I and grade II, aged (62.6±6.8) years (range, 57-73 years), who underwent posterior L 4, 5 internal fixation and interbody fusion in the Department of Spinal Surgery, the Second Hospital of Shanxi Medical University, were retrospectively analyzed from January 2019 to December 2022. There were 105 cases of I-degree spondylolisthesis and 77 cases of II-degree spondylolisthesis. According to the operation method, the patients were divided into reduction intervertebral fusion fixation (reduction group) and in situ intervertebral fusion fixation group (in situ group). Imaging parameters such as lumber lordosis (LL), pelvic incidence (PI)-LL, L 3, 4 intervertebral space heights, fusion segment angle, and sagittal vertical axis (SVA) were measured on the pre- and post-surgical lumbar spine lateral radiographs. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) of low back pain were recorded before and after surgery. The differences in clinical and imaging parameters were compared between reduction and in situ fusion group. Results:All 182 patients successfully completed the surgery and were followed up for 12.0±2.4 months (range, 9-15 months). The LL of the reduction group before surgery, immediately after surgery, and at the last follow-up were 46.9°±7.1°, 57.2°±5.9°, 55.6°±5.5°, respectively, with statistically significant differences ( F=87.61, P<0.001), with immediate and final follow-up being smaller than those in the in situ fixation group. The LL of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 47.8°±7.2°, 50.5°±7.0°, and 48.7°± 6.4°, respectively, with no statistically significant difference ( F=2.83, P=0.062). The immediate and final follow-up of LL in the reduction group was lower than those in the in situ fixation group ( P<0.05). The fusion segment angles of the reduction group before surgery, immediately after surgery, and at the last follow-up were 14.2°±5.1°, 23.2°±4.7°, 23.2°±4.7°, respectively, with statistically significant differences ( F=152.87, P<0.001), with immediate and final follow-up after surgery being greater than before surgery. The fusion segment angles of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 15.4°±5.9°, 18.2°±5.5°, and 17.4°±5.1°, respectively, with statistically significant differences ( F=4.69, P=0.009), with immediate and final follow-up being greater than before surgery. The fusion segment angulation in the reduction group was greater than that in the in situ fixation group at both the immediate and final follow-up ( P<0.05). The SVA of the reduction group before surgery, immediately after surgery, and at the last follow-up were 16.9±18.2 mm, 9.5±12.0 mm, and 8.7±11.3 mm, respectively, with statistically significant differences ( F=11.32, P<0.001), with immediate and final follow-up being smaller than before surgery. The SVA of immediately after surgery and at the last follow-up were both smaller than before surgery. The SVA of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 16.4±17.2 mm, 14.3±15.5 mm, and 13.8±15.0 mm, respectively, with no statistically significant difference ( F=0.57, P=0.576). The SVA of the reduction group at immediate and final follow-up was lower than that of the in situ fixation group ( P<0.05). Conclusion:Both reduction and in situ intervertebral fusion fixation can effectively relieve the clinical symptoms of patients. Fusion fixation after reduction can improve the angulation of fusion segments to form segmental kyphosis, which is more conducive to improving SVA.

OBJECTIVES: The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups. METHODS: Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups. RESULTS: Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint. CONCLUSIONS Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.

Objective:To monitor the blood pressure in pediatric patients with coarctation of the aorta (CoA) before and 8 years after surgery, and explore the mechanism of elevated blood pressure in pediatric patients with repaired CoA.Methods:A cohort of 23 pediatric patients who underwent CoA repair between January 2010 and October 2010 in Guangzhou Women and Children's Medical Center was studied. And 20 age-, sex-match patients with isolated ventricular septal defect (VSD) who underwent surgery at the same time, 20 age-, sex-match health patients with normal echocardiographic findings were included in the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), arm-leg SBP gradient, right carotid intima-media thickness (CIMT), serum transforming growth factor-β1 (TGF-β1) were monitored at baseline(1 day before surgery) and 8-year follow-up (8 years after surgery).Results:There were no differences in SBP and DBP among patients with CoA, patients with VSD and health children at baseline ( P>0.05). But at 8-year follow-up, 2 patients with CoA exhibited hypertension. Not only that, patients with CoA had higher SBP than patients with VSD and health children at 8-year follow-up ( P<0.05). Patients with CoA had higher arm-leg SBP gradient than patients with VSD and health children at baseline ( P<0.01). But there were no differences in arm-leg SBP among patients with CoA, patients with VSD and health children at 8-year follow-up ( P>0.05). Patients with CoA had increased CIMT and higher serum levels of TGF-β1 at baseline and 8-year follow-up ( P<0.05). The preoperative levels of CIMT and serum TGF-β1 in the patients with CoA were highly positively correlated with their levels at 8-year follow-up, respectively ( P<0.01). There was a strong correlation between the levels of CIMT and serum TGF-β1 in patients with CoA, both preoperatively and postoperatively ( P<0.01). The preoperative and postoperative levels of CIMT and serum TGF-β1 in the patients with CoA were highly positively correlated with SBP at 8-year follow-up, respectively( P<0.05). Conclusion:Although surgery can successfully cure the anatomical " stenosis" , patients with CoA have elevated systolic blood pressure than normal people and patients with simple congenital heart disease (such as VSD). And some of the patients with CoA suffer from hypertension at long-term follow-up, even they are normotensive preoperatively. It may be related to vascular remodeling, in which TGF-β signaling pathway may be involved. Monitoring CIMT and TGF-β1 in patients with CoA preoperatively may be significative for prediction for the levels of SBP postoperatively.

Objective:To investigate the correlation between gamma-glutamyl transferase/high-density lipoprotein cholesterol ratio (GHR), neutrophil/lymphocyte ratio (NLR) and coronary heart disease (CHD), and evaluated its pathogenic risk and predictive value for CHD.Methods:A total of 694 patients admitted to our hospital from December 2017 to December 2018 for suspected CHD and coronary angiography were selected. According to the results of coronary angiography,the patients were divided into CHD group ( n=527) and non-CHD group ( n=167). The clinical data of all patients were recorded. Gamma-glutamyl transferase (GGT), high-density lipoprotein cholesterol (HDL-C) and other biochemical indicators were recorded. Neutrophils, lymphocyte count and other hematological indicators were recorded. GHR, NLR and Gensini scores of the patients were calculated. Clinical data and GHR, NLR and other indicators were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of GHR, NLR in CHD, and to determine the optimal cut-off value; Logstic regression analysis was used to investigate the risk factors of CHD.Spearman correlation analysis was used to analyze the correlation between serum OPN, OPG and Gensini score in patients with CHD. Results:The GHR and NLR were 32.59(21.05, 48.24) and 3.53(2.18, 8.46) significantly higher in the CHD group than in the non-CHD group 16.56(10.07, 25.21) and 2.20(1.45, 3.28) respectively, with statistically significant differences ( Z=11.094, 9.055, P<0.05). ROC curve analysis showed that the AUC of NLR and MLR in diagnosing CHD was 0.785 and 0.732( P<0.05). When the critical values of GHR and NLR respectively were 19.805 and 2.678, respectively, the diagnostic efficiency of CHD was the highest, and the sensitivity and specificity were 79.30%, 62.90% and 63.80%, 68.30%, and the AUC of GGT in diagnosing CHD was 0.628. When the critical value was 19.500, the sensitivity and specificity were 80.50% and 39.50%, respectively,the AUC of GHR was greater than that of GGT ( Z=12.973, P<0.05). Multivariate Logistic regression analysis showed that Smoking ( OR=2.887, 95% CI:1.850-4.505, P<0.05), hypertension ( OR=2.009, 95% CI: 1.311-3.080, P<0.05), fasting plasma glucose ( OR=1.109, 95% CI:1.034-1.189, P<0.05), age ≥60 years ( OR=1.567, 95% CI:1.179-2.415, P<0.05), NLR ≥2.687 ( OR=3.152, 95% CI:2.066-4.808, P<0.05) and GHR ≥19.805 ( OR=4.768, 95% CI:3.131-7.262, P<0.05) was an independent risk factor for CHD. After gradually adjustment for risk factors such as smoking, hypertensive, fasting plasma glucose, age ≥60 years and NLR ≥2.687, GHR ≥19.805 was still an independent risk factor for coronary heart disease(OR and 95% CI were 4.620 (3.049-7.000), 4.768 (3.131-7.262), 6.567 (4.408-9.810), 4.768 (3.131-7.262), 4.768 (3.131-7.262), respectively; all P<0.001). Spearman correlation analysis showed that GHR and NLR were positively correlated with Gensini score ( r=0.312, 0.394; all P<0.05). Conclusion:GHR and NLR were positively correlated with the severity of coronary artery disease, which is of significance in the diagnosis of coronary heart disease. NLR ≥2.687 and GHR ≥19.805 were independent risk factors for CHD. GHR was superior to GGT and HDL-C alone in the diagnosis of CHD,and has certain clinical application value