It has long been one significant focus in the field of surgery to reduce postoperative incisional complications.Recently,incisional negative pressure wound therapy (iNPWT),which was designed to reduce the incidence of incisional complications,has gradually been applied for primary incision closure.This article reviews the relevant basic and clinical studies to elucidate the mechanism of iNPWT and its clinical safety and efficacy,and answers some fundamental questions regarding clinical application of iNPWT.

Objective To study the effect of quality ciecle on improving nurses application ablitiy in operating monitors. Methods Quality circle group was established in the department of general surgery and the circulation of plan-do-check-action was used in the groups for continuous quality control of ECG monitor application.The satisfaction of nurses with ECG monitor management and consuming time of ECG monitor installation were compared between pre-and post-enforcement of quality control circulation. Results After use of quality control circulation,the nurses were more satisfied with the maintenance of ECG monitoring and they knew better about their right storage and disposition and where the monitors were(all P<0.001).Conclusion The quality circle may effectively regulate ECG monitor management,improve applying proficiency of nurses and effectively improve work efficiency,so it is worth clinically applying.

Objective To retrospectively analyze the importance of preoperative ultrasound and D-dimer determination for patients with traumatic fractures so as to evaluate the value of vascular color Doppler ultrasound in diagnosing of vein thrombosis and the correlation between D-dimer level and lower extremity vein thrombosis. Methods The study involved 1000 in-patients with multiple traumatic fractures, femoral fractures, tibial fractures or tibiofibular fractures admitted from March 2008 to April 2009 who were prepared for open reduction surgery. There were 568 males and 432 females, at age range of 20-90 years ( average 54.8 years). Vein D-dimer was examined in the morning on the second day after admission. Vascular color Doppler ultrasound was performed on the lower extremity one day before operation (after the swelling faded away, about 4-10 days after fracture). Results The vascular color Doppler ultrasound on the lower extremity showed vein thrombosis of the lower extremity in 64 patients (6.4%) including 26 patients with iliac- femoral vein thrombosis, 10 with popliteal-tibial vein thrombosis and 28 with gastrocnemius or soleus muscle vein thrombosis. On the second day after operation, out of 736 patients (73.6%) with D-dimer above normal (324 μg/L), 56 patients (7.6%) developed thrombosis afterwards;of 264 patients (26.4%) with normal D-dimer, eight patients (3.03%) developed thrombsis. Incidence of thrombosis in patients with D-dimer above 650 μg/L was higher than that in patients with D-dimer below 650 μg/L (P＜0. 01). Conclusions Preoperative lower extremity vein Doppler ultrasound in traumatic fracture patients can lower the risk of fatal lung thrombosis caused by existing deep vein thrombosis.D-dimer above normal level indicates tendency of thorombosis. However, normal D-dimer still have the possibility to develop thrombosis, which deserves attention.

Objective To investigate the feasibility and safety of transumbilical laparoscopic single-port choledocholithotomy in the treatment of common bile duct stones. Methods The clinical data of four patients who underwent transumbilical laparoscopic single-port choledocholithotomy at Shengjing Hospital of China Medical University from January to June, 2010 were retrospectively analyzed. The operation method and postoperative effects were reviewed. Results All the operations were successfully carried out. The mean operation time was 100 minutes and the mean blood loss was 62. 5 ml. All patients were cured without the occurrence ofcomplications except for one patient who had a peritoneal infection and was cured after surgical drainage. Conclusion Transumbilical laparoscopic single-port choledocholithotomy is safe and feasible, but indications should be strictly followed.

Objective To investigate the clinical efficacy of transumbilical single-incision retrograde laparoscopic cholecystectomy.Me,otis The clinical data of 979 patients with gallbladder diseases who were admitted to the Shengjing Hospital of China Medical University from May 2009 to December 2012 were retrospectively analyzed.The numbers of patients who were admitted in the year of 2009,2010,2011 and 2012 were 51,265,374,289,respectively.The preoperative preparation of transumbilical single-incision retrograde laparoscopic cholecystectomy was similar to that of traditional multi-portal laparoscopic surgery.During the operation,the umbilical incision was selected.After the body and bottom of the gallbladder was dissociated,the cystic duct of gallbladder was dissociated and straightened,which was vertical to the common bile duct.After clipping the proximal part of the cystic duct of gallbladder with 2 hem-o-lock clips,the cystic duct was cut off with the ultrasonic knife,and then the gallbladder was removed.Postoperative nursing was also similar to that of traditional laparoscopic cholecystectomy.Patients were followed up via phone call or out-patient examination till March 2013.The wound infection,incisional hernia,incisional pain,cosmetic benefits were observed.Results No patient was converted to open surgery.Twenty patients were converted to multi-portal laparoscopic cholecystectomy because of severe inflammation (3 patients in 2009,5 in 2010,5 in 2011 and 7 in 2012).The mean operation time and volume of blood loss of the 959 patients were 48.5 minutes and (27 ± 25) mL.The operation time in 2009,2010,2011 and 2012 were 51.8 minutes,49.2 minutes,48.9 minutes and 46.7 minutes.The volumes of blood loss in 2009,2010,2011 and 2012 were 35.0 mL,32.1 mL,33.8 mL and 22.9 mL,respectively.The postoperative pain was slight.Forty-seven patients were administered antalgesics (5 in 2009,12 in 2010,18 in 2011 and 12 in 2012).In the 959 patients,umbilical swelling occurred in 4 patients,and was cured by disinfection treatment.Bile duct injury occurred in 3 patients from 2010 to 2011,timely repair wad done in 2 patients,and 1 was cured by drainage.The mean time of postoperative exhuast time and duration of hospital stay were 2.2 days and 4.2 days.A total of 924 patients were followed up for 1-3 months.The scar was hidden in the navel,and no incisional hernia occurred.Conclusion Transumbilical single-incision retrograde laparoscopic cholecystectomy is safe and effective with cosmetic benefits.

Objective To evaluate the safety and efficacy of infliximab (IFX) combined with conventional therapy in the treatment of Crohn's disease (CD) with incomplete intestinal obstruction.Methods From 2007 to 2013,22 cases of CD with incomplete intestinal obstruction were enrolled and were divided into IFX treatment group and conventional therapy group,each 11 cases.In conventional therapy group,patients were fasting or liquid food intake,received conventional therapy such as anti-infection and fluid supplement therapy to maintain water and electrolyte balance,long-term oral mesalazine,metacortandracin and imuran.In IFX treatment group,on the basis of conventional therapy patients received intravenous IFX 5 mg/kg at the 2nd,6th,14th,22nd and 30th week after admission.Regular blood test,liver function,erythrocyte sedimentation rate (ESR),C reaction protein (CRP) and CD active index (CDAI) of two groups were compared before and after treatment.Patients underwent endoscopy examination on admission day and the 30th week after treatment to evaluate the efficacy.The side effects were recorded during the period of treatment.The t test and Chi squaretest were used for comparison between groups.Results Compared with conventional therapy group,the average intestinal obstruction remission time of IFX treatment group shortened ((10.53±1.28) day vs (16.82±1.97) day) and the difference was statistically significant (t =2.985,P＜0.05).At the end of 30th week after treatment,clinical total effective rate of IFX treatment group and conventional therapy group was 9/11 and 7/11 (x2 ＝22.35,P＜0.05).Under endoscopy,total effective rate of these two groups was 7/11 and 5/11 (x2＝21.93,P＜0.05).At the end of 30th week after treatment,ESR,CRP and CDAI of IFX treatment group ((11.4±7.5) mm/1 h,(13.2±6.6) mg/L and 125.4±26.9) were all significantly lower than those on admission day ((31.3±5.7) mm/1 h,(45.3±7.6) mg/L and 240.5±35.2) (t=2.650,3.022,2.719,all P＜0.05).No serious side effects were observed in IFX treatment group and conventional therapy group during the treatment period.Conclusion For CD patients with incomplete intestinal obstruction,on the basis of conventional therapy,the addition of IFX could achieved better efficacy than conventional therapy alone.

Objective To investigate the mechanism of HSP70 that inhibits myocardial cell apoptosis in sepsis.Methods Myocardial cells in primary culture were randomly divided into control group,normal serum group,sepsis serum group,transported empty vector group and transported HSP70 group.The myocardial cells in transported HSP70 group have been transported by pcDNA3.1-HSP70 for 36 hours.The myocardial cells in every group have been cultured by respective serum for 2 hours and dyed by Hoechst 33258,and then calculate the rate of myocardial cells apoptosis.Using Western-blot to investigate the effect of overexpression of HSP70 on Caspase-3,8,9's activation and Bid's cracking.Results The rate of myocardial cells apoptosis after dealing in transported HSP70 group [ ( 12.48 ± 2.39 ) ％,( 23.96 ± 3.12 ) ％,( 25.40 ± 3.96) ％ ] is lower than in sepsis serum group [ ( 28.66 ± 2.24 ) ％,( 55.76 ± 5.69 ) ％,( 46.89±8.74)％,t =5.856,5.932,6.027,P ＜0.01,n =3] and lower than in transported empty vector group [(34.25±3.42)％,(50.71±6.38)％,(47.62+5.74)％,t =5.876,5.903,6.122,P ＜0.01,n =3],is higher than in control group,and in normal serum group(3.13％ ～ 6.75％ ,t =6.324,6.578,6.137,5.987,6.032,6.871,P ＜ 0.01,n =3 ).When Caspase-3,8,9 activating,the gray-scale of P11,P20 and P10 in transported HSP70 group( 12.5276 ± 2.1247,9.3481 ± 4.5423,16.1349 ± 6.0641 ) is lighter than that in sepsis serum group ( 27.1324 ± 2.1564,25.5643 ± 4.3018,36.5647 ± 6.7135,t =5.856,5.902,5.891,P ＜ 0.01,n =3 ) and lighter than in transported empty vector group (28.0314 ±2.0367,25.6413 ±4.1356,34.5648 ±5.9473,t =3.861,3.933,4.281,P ＜0.05,n =3),is deeper than in control group(8.0324 ± 1.5234,5.1246 ± 1.3274,2.0314 ±0.6423,t =3.286,3.867,4.031,P＜0.05,n =3) and in normal serum group(8.5649 ± 1.2136,6.0324 ± 1.0214,3.2146 ±0.1325,t =5.898,5.969,6.879,P ＜0.01,n =3).The gray-scale of tBid in transported HSP70 group( 12.0316 ±2.3641 ) is lighter than in sepsis serum group(27.0536 ± 5.3214),t =3.274 ( P ＜ 0.05,n =3 ) and lighter than in transported empty vector group(27.1034 ± 3.6741,t =3.301,P ＜ 0.05,n =3 ),is deeper than in control group ( 6.0347 ± 2.1304,t =5.924,P ＜ 0.01,n =3 ) and in normal serum group ( 7.3121± 1.3021,t =5.871,P ＜ 0.01,n =3 ).Conclusions HSP70 inhibit myocardial cells apoptosis in sepsis by intervened the death receptor pathway and mitochondrial pathway.

Objectives:To investigate the level of soluble intracellular adhesion molecule 1 (sICAM 1) concentrations in the serum and peritoneal fluid from the patients with or without endometriosis.To discuss the relationship within sICAM 1 and pelvic endometriosis. Methods:35 serum and 30 peritoneal fluid of patients with endometriosis (test group) and 26 serum and 4 peritoneal fluid without endometriosis (control group) were studied.Soluble intracellular adhesion molecule 1 levels were detected by an enzyme linked immunoassay(ELISA).The results were analysed by T test. Results: The serum concentration of sICAM 1 was significantly higher in test group than controll group. However,There was no significant difference in between two groups. Conclusions: These results suggest that sICAM 1 could play some role in the persistence of endometriotic lesions.

Objective To evaluate the standardization of Meta-analyses on nephropathy published in Chinese journals.Methods By searching in WANFANG,VIP,CNKI databases and Chinese Biomedical Literature Database(CBM) as well as related Chinese journals,eligible Meta-analyses were enrolled and analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement and the MOOSE (Meta-analysis of Observational Studies in Epidemiology) Checklist.Results A total of 217 Meta-analyses were enrolled with 166 on randomized controlled trials (RCT) and 51 on observational studies.Based on the PRSIMA Statement,of the 166 Meta-analyses on RCT,51.8％(86 papers) were found with the complete research hypothesis,13.9％ (23) with the literature screening flow chart,15.7％ (26) with the subgroup analysis,53.0％ (88) with the publication bias analysis and 28.3％ (47) with the sensitivity analysis.According to the MOOSE Checklist,of the 51 Meta-analyses on observational studies,only 9.8％ (5) had done the statistical stability calculation,54.9％ (28) with the outlook of application,45.1％ (23) with the limitation of the study,2.0％ (1) with the quantitative analysis on potential bias and 17.6％ (9) with the suggestion for future studies.Conclusions Unclear hypothesis,limited methodological description,lack of in-depth analysis on heterogeneity and bias are the common defects in Meta-analyses published in Chinese journals on nephrology.