Objective To assess the characteristics of abdominal hernia and summarize the therapeutic efficacy of mesh plug tension-free hernioplasty in elderly ventral hernia. Methods All 207 elderly patients with abdominal hernia who were admitted to our hospital during January 1999 to December 2001 and received the mesh plug tension-free hernioplasty were analyzed retrospectively. Results There were 405 patients receiving the mesh plug tension-free hernioplasty from 1999 to 2001, in whom 207 had elderly ventral hermia. Among the 207 elderly patients, 144 had inguinal oblique hernia, 38 direct hernia, 11 direct and indirect hernia, 6 sliding hernia, 6 incisional hernia, 1 femoral hernia, and 1 femoral and inguinal direct hernia. Postoperative complications were urinary retention(8 cases), hypoincisional hematoma(4), scrotal hydroceles(1), and incisional infection (1). One hundred eithty-seven patients were followed-up for 4-40 months and no recurrence was found. Conclusions The mesh plug tension-free hernioplasty is of advantages for elderly abdominal hernia, such as simpleness in performance and a good therapeutic effect. It is especially suitable for the elderly patients due to less trauma and low recurrence rate. It is also important to pay attention to the postoperative complications to the elderly.

Objective To investigate the effect of Dl-3-n-butylphthalide on acute cerebral infarction.Methods In Department of Neurology in the Fifth Hospital of Wuhan from March 2013 to June 2014,100 cases of patients with first onset of acute cerebral infarction were recruited.The participants were divided into 2 groups (control group and treatment group) randomly,with 50 participants in each group.Besides general treatment,the patients of treatment group received intravenous injection of Dl-3-n-butylphthalide in acute phase and orally took soft capsule of Dl-3-n-butylphthalide in recovery phase.All the patients were followed up for 24 weeks.Neurological function and general cognition were assessed separately by national institute of health stroke scale (NIHSS),and mini mental state examination (MMSE) was applied to assess overall cognitive function.Results NHISS score was gradually decreased and MMSE score was increased in both groups.As compared with the control group,NIHSS score and MMSE score were changed significantly in the treatment group.From first onset to 24 weeks after treatment,NHISS score was decreased by 30％ in the control group and 44％ in the treatment group;MMSE score was increased by 17％ in the control group and 32％ in the treatment group.Conclusion Sequential therapy with Dl-3-n-butylphthalide improves neurological function and general cognition faster and more significant for patients with acute cerebral infarction.

Objective To analyze the cognitive changes and influencing factors in patients with lacunar cerebral infarction after carotid artery intervention therapy. Methods Sixty lacunar cerebral infarction combined with carotid stenosis patients treated with artery intervention therapy (intervention therapy group) and 68 lacunar cerebral infarction without carotid stenosis patients treated with drug therapy (drug therapy group) were selected. The neuropsychological test was completed at entry and 1, 6, 12 months after entry, and the results were compared with 60 healthy controls (control group). The cognitive changes were observed. The neuropsychological test included mini mental state examination (MMSE), Montreal cognitive assessment scale (MoCA) and cognitive field test. Results There were statistical differences in other scores except the Stroop test C section and Wechsler adult intelligence scale (WAIS-RC) picture arrangement subtest at entry in intervention therapy group and drug therapy group compared with control group (P<0.05). There were no statistical differences in the all scores at entry between drug therapy group and intervention therapy group (P>0.05). In intervention therapy group, the MMSE scores, MoCA total score, Rey-Osterrieth complex figure test (ROCFT), auditory verb learning test (AVLT), and the WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function 12 months after entry were significantly better than those at entry, and there were statistical differences (P<0.05). MMSE score, MoCA total score, long-time delayed recall of ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, semantic category fluency test of performing function and digit span backwards subtest of WAIS-RC 6 months after entry were significantly better than those at entry:(27.8 ± 2.2) scores vs. (26.4 ± 1.9) scores, (20.7 ± 2.3) scores vs. (19.3 ± 2.0) scores, (12.4 ± 3.2) scores vs. (10.8 ± 2.6) scores, (54.3 ± 10.6) scores vs. (49.9 ± 10.9) scores, (12.4 ± 2.0) scores vs. (11.2 ± 2.8) scores, (12.9 ± 2.0) scores vs. (10.6 ± 2.6) scores, (17.5 ± 4.0) scores vs. (15.4 ± 3.4) scores and (4.0 ± 0.9) scores vs. (3.5 ± 0.9) scores, and there were statistical differences (P<0.05). In drug therapy group, there were no statistical differences in the all scores 1 and 6 months after entry, compared with that at entry (P>0.05);the MMSE score, MoCA total score, ROCFT, the immediate recall, long-time delayed recall and short delayed recall of AVLT, WAIS-RC picture arrangement subtest, verbal fluency test, WAIS-RC digit span backwards subtest of performing function and digit span backwards subtest of WAIS-RC 12 months after entry were significantly better than those at entry, and there were statistical differences (P<0.05). There were no statistical differences in all scores 12 months after entry between intervention therapy group and drug therapy group (P>0.05). In patients intervention therapy group, Logistic regression analysis showed that the MoCA score was related with age, hypertension and low education level (P<0.01 or<0.05), but was not related with smoking, diabetes and interventional treatment (P>0.05). Conclusions Cognitive impairment in patients with lacunar cerebral infarction and carotid stenosis is severe and extensive, but most cognition disorders can improve to normal level 12 months after artery intervention therapy.

Objective To investigate the correlation between posterior neck pain and lumbar epidural pressure (LEP)during percutaneous endoscopic lumbar discectomy (PELD).Methods A prospective study was performed on 86 patients undergoing PELD,46 males,40 females,aged 1 9-71 years,with ASA physical status of Ⅰ or Ⅱ.Each patient received lumbar epidural anesthesia.Lum-bar epidural pressure (LEP)was monitored continuously through a lumbar epidural catheter which was connected to a pressure transducer.LEP before the operation (LEPbase ),LEP at the time of pos-terior neck pain (LEPpain )and maximal LEP (LEPmax )were recorded.Results Thirty patients (34.9%)complained of posterior neck pain during the procedure.The lowest LEPmax was 31.0 mm Hg,and the highest LEPmax was 77.0 mm Hg.The LEPmax in patients with neck pain [(60.6± 8.8)mm Hg]was significantly higher than LEPmax in patients without neck pain [(50.7 ± 9.5 ) mm Hg](P <0.01 ).Patients with higher LEPmax had higher probabilities of having posterior neck pain (P <0.01).Conclusion Patients with higher LEPmax had higher probabilities of having posterior neck pain.

ObjectiveToanalyzetheclinicalandimagingcharacteristicsinpatientswithcarotidsteal syndrome ( CSS ) and to investigate its compensatory pathw ays, diagnosis, and treatment. Methods The medical history and imaging data of the patients with CSS were colected. Their vascular lesions, colateral circulation, treatment, and prognosis w ere analyzed. Results A total of 11 patients w ith CSS (8 males and 3 females, mean age 66.7 ±5.1 years) were enroled in the study. Their clinical manifestations were posterior circulation transient ischemic attack (TIA) ( n=9, 81.8%), posterior circulation infarction ( n=1, 9.1%), and anterior circulation TIA ( n=1, 9.1%). A total of 19 pathological arteries w ere found:12 (63.1%) w ith occlusion, 2 (10.5%) w ith subtotal occlusion, 4 (21.0%) w ith severe stenosis and 1 (5.2%) w ith artery dissection. Seven patients (63.6%) w ere bilateral internal carotid artery lesions, 3 (27.2%) w ere unilateral bilateral internal carotid artery lesions, and 1 (9.1%) w as bilateral common carotid artery occlusion. Eleven patients had primary col ateral circulation, including posterior communicating artery patency in 10 patients (90.9%) and anterior communicating artery patency in 1 patient (9.1%). Four patients (36.3%) had secondary col ateral circulation and 1 (9.1%) had tertiary col ateral circulation. Al patients w ere treated w ith medication on the basis of the management of risk factors. Three patients w ere treated w ith stenting and tw o were treated with carotid endarterectomy. No stroke occurred in al patients during folow -up til September 2014. Conclusions The vascular lesions of patients w ith CSS often occur in the extracranial segment of internal carotid artery. Usual y the compensatory blood is through the circle of Wil is. The presentation is ischemia in the stolen arteries. Its diagnosis needs to be examined by digital subtraction angiography. On the basis of medication therapy, some patients may be treated w ith surgery or endovascular intervention.

Objective: To observe the feasibility and clinical curative effect of anatomical reduction and fixation of lesser trochanter through posterior-lateral approach for the treatment of comminuted femoral intertrochanteric fractures in elderly patients. Methods: A total of 19 cases with comminuted femoral intertrochanteric fracture, aged 60 to 84 years were enrolled in this study.According to Evans-Jensen classification, 13 cases had type Ⅱ B and 6 cases had type Ⅲ femoral fracture.Through the posterior-lateral approach, the lesser trochanter was fully exposed, reduced and fixed by screw.The proximal and distal femur were well fixed with dynamic hip screw(DHS)or proximal femoral locking plate(PFLP). The lesser trochanter reduction was observed by intraoperative vision and postoperative X-ray.The function evaluation after hip surgery was performed by using Sanders hip function score. Results: All 19 patients obtained the anatomic reattachment in the lesser trochanter.All patients were followed up for an average of 18 months.After treatment, the Sanders hip function score were excellent in 7 patients(36.8%), fine in 12 cases(63.2%). And curative efficacy was good in all cases(100%). There was no significant difference in the curative effect between patients with different classification and gender. Conclusions Through the posterior-lateral approach, the surrounding structures of the lesser trochanter can be fully exposed, and the lesser trochanter can be anatomically repositioned.The posterior-lateral approach to anatomical reduction and fixation of lesser trochanter is an effective and feasible method for the treatment of comminuted intertrochanteric fracture in the elderly.

Objective To test the reliability and validity of Meaningful Life Measure-Chinese Revised (MLM-CR) in Chinese college students. Methods A total of 1035 college students were evaluated with MLM-CR, Satisfaction with Life Scale (SWLS), Purpose in Life (PIL) and Patient Health Questionnaire-2 (PHQ-2), and 120 of the students were examined with PIL-SF twice. Result All the items in MLM-CR had good discrimination indexes (r=0.753-0.838, P<0.001). Confirmatory factor analysis confirmed the hypothesized five-factor model of MLM-CR (χ2/df=3.4, GFI=0.946, AGFI=0.924, RMR=0.069, NFI=0.953, CFI=0.966, RMSEA=0.048). The total internal consistency reliability of MLM-CR was 0.942, and the alpha coefficients of the 5 dimensions ranged from 0.782 to 0.877;the total split-half reliability was 0.920, and the split-half reliability of the 5 dimensions ranged from 0.752 to 0.830;the total test-retest reliability was 0.871, and the test-retest reliability of the 5 dimensions ranged from 0.783 to 0.805. The criterion validity of MLM-CR in correlation with SWLS, PIL and PHQ-2 was 0.66, 0.755 and-0.388, respectively (P<0.01). The Average score of MLM-CR of the college students was 5.20 ± 0.90, and the scores were significantly higher in female students than in the male students (P<0.001). Conclusion MLM-CR has good psychometric properties for application in comprehensive evaluation of personal meaning in life.

Objective To analyze the basal conditions of 5 patients with cerebrovascular fibromuscular dysplasia (FMD),and explore the clinical presentation,imaging features,therapies and outcomes of cerebrovascular FMD.Methods Five patients with cerebrovascular FMD,admitted to our hospital from January 2012 to April 2013,were chosen in our study; their medical history and imaging features were collected,and their clinical presentation,imaging features,therapies and outcomes were retrospectively analyzed when combining with literature review.Results Five patients all presented with stroke,including four having hemiplegia as the initial symptom,and one having headache with nausea and vomiting as the main performance.One was diagnosed as having subarachnoid hemorrhage by CT scan,and four had different infarction lesions in lobes and basal ganglia on MRI.Artery dissection was discovered in all patients by cerebral digital substraction angiography,including two with right internal carotid artery dissection,one with right vertebral artery dissection combined with aneurysm in anterior communicating artery associated with "string-of-beads" appearance on C1 segment of right internal carotid artery and left vertebral artery,one with bilateral vertebral artery dissection,and the last one with bilateral internal carotid artery dissection and moyamoya disease-like vessels.No abnormality was discovered in two patients by renal artery angiography.The patient with anterior communicating artery aneurysm was treated with endovascular aneurysm embolization,having poor prognosis.In the remaining 4 patients with cerebral infarction,two were treated with carotid artery stenting,and the other 2 were only given antiplatelet therapy.No patient suffered cerebrovascular accidents during the 12-month follow-up.Conclusions Cerebrovascular FMD is a rare cause of young stroke,and patients with cerebrovascular FMD often manifest headache,neck bruit,carotid artery dissection and stroke.It is particularly important to make definitive diagnosis by performing cerebrovascular imaging examinations and give treatment accordingly.The long term outcome of FMD is not clear now.

Objective This study aims to investigate the diagnosis and treatment of external root resorption of adjacent teeth caused by impacted teeth via cone-beam computed tomography (CBCT). Methods A total of 19 teeth from 15 patients with uncertain external root resorption caused by an adjacent impacted tooth were examined from January 2011 to December 2011. All teeth with uncertain external root resorption were scanned by CBCT. Three dimensions reconstruction were the con-ducted to determine the location and extent of resorption. Results In all cases, CBCT identified the accurate location and extent of external root resorption caused by adjacent impacted teeth. Furthermore, the technique provided impacted teeth location in three dimensions, including the relation between the impacted teeth and surrounding vital structures. Conclusion CBCT can provide direct and accurate images of the location and extent of external root resorption, as well as the location of the adja-cent impacted teeth in three dimensions. Therefore, the proposed technique provides reliable information for clinical diagnosis and treatment.

Objective To test the reliability and validity of Meaningful Life Measure-Chinese Revised (MLM-CR) in Chinese college students. Methods A total of 1035 college students were evaluated with MLM-CR, Satisfaction with Life Scale (SWLS), Purpose in Life (PIL) and Patient Health Questionnaire-2 (PHQ-2), and 120 of the students were examined with PIL-SF twice. Result All the items in MLM-CR had good discrimination indexes (r=0.753-0.838, P<0.001). Confirmatory factor analysis confirmed the hypothesized five-factor model of MLM-CR (χ2/df=3.4, GFI=0.946, AGFI=0.924, RMR=0.069, NFI=0.953, CFI=0.966, RMSEA=0.048). The total internal consistency reliability of MLM-CR was 0.942, and the alpha coefficients of the 5 dimensions ranged from 0.782 to 0.877;the total split-half reliability was 0.920, and the split-half reliability of the 5 dimensions ranged from 0.752 to 0.830;the total test-retest reliability was 0.871, and the test-retest reliability of the 5 dimensions ranged from 0.783 to 0.805. The criterion validity of MLM-CR in correlation with SWLS, PIL and PHQ-2 was 0.66, 0.755 and-0.388, respectively (P<0.01). The Average score of MLM-CR of the college students was 5.20 ± 0.90, and the scores were significantly higher in female students than in the male students (P<0.001). Conclusion MLM-CR has good psychometric properties for application in comprehensive evaluation of personal meaning in life.