Objective To investigate the value of Kugel patch for elderly patients with recurrent inguinal hernia.Methods From February 2004 to February 2007,37 elderly patients with recurrent inguinal hernia received surgical treatment in our hospital.The patients were divided into two groups according to the surgical methods.Twenty-one patients,including 17 cases of unilateral indirect inguinal hernia,1 bilateral indirect hernia,1 direct hernia,1 indirect hernia complicated with femoral hernia,and 1 indirect hernia complicated with direct hernia,received hernia repair with Kugel patch via the posterior approach.The other 16 patients,including 15 cases of unilateral indirect hernia and 1 case of direct hernia,were treated with TAPP.Results The operation time in the Kugel group was significantly shorter than that in the TAPP group [(23.2?5.8) min vs(40.5?5.2) min,t=-9.392,P=0.000].In the TAPP group,2 patients complained of surgical-site pain or tension,while no patient in the Kugel group had the symptoms(?2=0.869,P=0.351).The mean hospital stay in the Kugel group was shorter than that in the TAPP group [(5.7?0.7)d vs(6.3?0.8) d;t=-2.429,P=0.020].The patients were followed up for 3-36 months,none of them had recurrence.Conclusions As an new,non-tension,safe,and minimally invasive method,hernia repair using Kugel patch through the posterior approach is of great advantage to elderly patients.The method is worth being used widely.

OBJECTIVE To observe the efficiency of new low-temperature sterilization method using(hydrogen) peroxide gas plasma sterilization system.METHODS The hydrogen peroxide gas plasma sterilization system of STERRAD 100S was monitored for 157 sterilization cycles.RESULTS From them 134 cycles were(completed,) 23 cycles were(cancelled.) All cycles were completed with negative results either in biological culture or in chemical indicators.CONCLUSIONS The STERRAD Sterilization System involves the combined use of hydrogen peroxide and low-temperature gas plasma to sterilize most medical devices and materials rapidly and safely without leaving any toxic residues.As nursing develops,the new sterilization system is efficient and convenient.However,it also has own limitations.Therefore,it is desirable to fully understand the normal procedure of system according to the operation instruction.

Objective To explore the morbidity, risk factors and nursing of ventilator-associated pneumonia (VAP) in comprehensive ICU. Methods It was a retrospective survey. 98 mechanical ventilation (＞ 48 h) patients from Jan to Dec, 2009 in comprehensive ICU were reviewed using questionnaires to collect the clinical data. They were divided into the VAP and the non-VAP group. Several statistically significant risk factors were screened out with univarite analysis, then independent risk factors were determined with multiple Logistic regression. Results The morbidity of VAP was 35.7%. Univariate analysis showed that the level of APACHE Ⅱ score, duration of mechanical ventilation, whether primary lung disease, whether acid-suppressing agents, whether the semi-supine, whether accidental tube removal, oral care approach, whether attracted to subglottic were statistically significant risk factors of VAP. While multivariate Logistic regression analysis showed that the duration of mechanical ventilation, whether the semi- supine,whether attracted to subglottic were the major risk factors of VAP. Conclusions The occurrence of VAP is related with multiple factors. Application of comprehensive prevention strategies in accordance with these risk factors of VAP can reduce the morbidity of VAP effectively.

The metabolic syndrome leading to cerebrovascular disease attracts more and more attention by the medical circle,and its exact nosogenesis is not clear.There is no effective therapeutic method for this disease either.The author believes phlegm and blood stasis being the key factors for metaboric syndrome.Clinically,the author got good effects by treating the disease according to the different nosogenesis and stages of disease.

Objective To explore the puerperal mode of muliparas re-pregnancy, accumulate the clinical experience. Methods 490 multiparas' puerperal mode were analyzed as study group,and compared with 1600 prima-ry pregnancy at the same stage; compared the puerperal mode, the cesarean section rate and the rate of maerosoma. Results Re-pregnancy mtthiparas' vaginal delivery 385 examples, CS 105 examples,CS rate 21.4%, meanwhile the primary pregnancy's vaginal delivery 1200 examples,CS 400 examples,CS rate 25% ,no statistical difference(P>0.05). CS rate was directly proportional to the away time from last delivery. Conclusion CS rate had no remarkable difference between multiparas and primary pregnancy. Mainly CS indication is fetal distress, CS rate directly response to the time interval to last delivery. Macrosoma rate is high in muhiparas by well-fed. Multiparas had low CS rate with macrosoma.

Objective To compare the effectiveness of anterior cruciate ligament (ACL) reconstruction using Rigid-Fix for autogenous tendons fixation between by Ethibond excel polyester sutures combined with high-strength sutures and by Ethibond excel polyester sutures. Methods From October 2011 to August 2013, 48 cases of ACL rupture underwent ACL reconstruction using RigidFix for autogenous tendons fixation. Ethibond excel polyester sutures combined with high-strength sutures were used in 25 cases (observation group) and Ethibond excel polyester sutures were used in 23 cases (control group). There was no significant difference in gender, age, side, disease duration, and preoperative Lachman test, Lysholm score, and the International Knee Documentation Committee (IKDC) score be-tween the two groups ( >0.05). While the treatment and rehabilitation measures were identical. Result The opera-tion performed smoothly. Vessel, nerve and meniscus were not injured. No complication of donor site pain and myas-thenia of affected knee after operation. At 6 months and 2 years after operation, the Lachman test, the Lysholm score and the IKDC score were superior significantly to those before operation in both groups ( <0.05), but no significant difference was found ( >0.05). Conclusion Anterior cruciate ligament reconstruction by Ethibond excel polyester su-tures combined with high-strength sutures using RigidFix for autogenous tendons fixation presented satisfactory clinical results, whether using high-strength sutures during operation needs to be further study.

Objective To investigate the correlation between thrombelastogram (TEG)parameters and plasma D-dimer (D-D) and platelet aggregation rate (PAgT)in patients with acute cerebral infarction (ACI).Methods From January 2015 to Jan-uary 2016,120 patients with ACI (ACI group),and 60 healthy subjects (healthy group)were enrolled in the study.The TEG parameters were detected by thromboelastography,including blood coagulation time (R),blood clotting time (K),rate of blood clotting (αangle),coagulation comprehensive index (CI)and the maximum intensity of blood clotting (MA).Blood coagulation indexes also were detected,including prothrombin time (PT),fibrinogen (FIB,detected by automatic coagulation analyzer),plasma D-D (detected by colloidal gold method)and PAgT (detected by blood aggregation tester).Results R (5.36±0.95 min),K (2.34±0.98 min)and PT (11.88±1.67 s)in the ACI group were shorter than those in the healthy group (6.20±1.28 min,2.87±0.87 min,12.40±1.82 s),(t=4.962,3.547,1.911,all P<0.05).Theαangle (61.65± 7.84)degrees,CI (-0.21±1.11),MA (58.94±6.14 mm),D-D (0.34±0.08 mg/L),PAgT (66.9±6.8)% and FIB (4.41±0.96 g/L)in the ACI group were higher than those in the healthy group [(56.02 ± 6.94)degrees,(-1.50 ± 1.30),(53.86±7.85 mm),(0.24±0.06 mg/L),(55.4±7)%,(2.87±0.88 g/L)],(t=4.714,6.209,5.583,8.550, 10.592,7.039,all P<0.05).In ACI group,D-D,PAgt and the TEG parameters (αangle,CI,MA)were significantly nega-tively correlated (r=-0.481,-0.470,-0.504,-0.488,all P<0.05).D-D,PAgt and the TEG parameters (αangle,CI, MA)were significantly positively correlated (r=0.338,0.395,0.427,0.391,0.436,-0.482,all P<0.05).Conclusion TEG parameters can reflect the severity of ACI to some extent,and they were significantly correlated with plasma D-D and PAgt.

This article presented a series of cases using vascularized interpositional periosteal-connective tissue ( VIP-CT) flap with guide bone regeneration ( GBR) in peri-implant soft and hard tissue reconstuction at the esthet-ic zone of maxillary. Fifteen cases with bone and soft tissue defects underwent VIP-CT flap with GBR in the implant treatment. And the attached gingiva width was evaluated before treatment and six months and eighteen months after the operation. The width of attached gingival of six months and eighteen months after surgery was significantly dif-ferent from the preoperative value (P<0. 05). However, no statistically significant difference could be found at six months and eighteen months postoperative. The application of VIP-CT flap could increase the width of attached gin-giva around implants and the short-term effects were stable and favorable.

Breast malignant lymphoma refers to occur in the breast malignant tumor of the lymphoid tissue.Breast malignant lymphoma which belongs to outside of lymph tissue malignant tumor can be divided into two categories:one category is the secondary breast lymphoma (SBL),another kind is the primary malignant lymphoma of the breast (PBL).Because the rate of PBL was low and the difficulty of preoperative diagnosis,illness development is rapid and high malignant degree,we should improve the attention of clinicians.Based on the discussion of primary breast lymphoma pathological changes,histological types,clinical manifestations,this article focuses on the progress of diagnosis and treatment of the PBL.