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 improve the diagnosis and surgical management of pulmonary aspergilloma.Methods Twenty-four patients underwent surgical treatment for pulmonary aspergilloma were enrolled in our study from April 2005 to May 2012 at the second hospital of Xiamen.The information of all cases was recorded.Results There were 18 males and 6 females in all subjects,and their age ranged from 22 to 67 year.The surgical outcome were 15 lobectomies,3 segmentectomies or wedge resections,1 right upper and middle lobectomy,1 radical debridement,4 pneumonectomy.Results There was no preoperative mortality.Seven cases (29.2％) developed complications in this series including 1 postoperative bleeding,1 bleeding during operation,2 pulmonary infection,1 bronchial fistula,1 pulmonary reexpansion insufficiency,1 wound infection.Conclusion Surgical resection of pulmonary lesion is the most effective method for pulmonary aspergilloma.Moreover strengthening the perioperative management could decrease the morbidity and mortality.

Objective To investigate the expression of membrane type 1 matrix metalloproteinase(MT1-MMP) in the esophageal carcinoma tissues and in normal periearcinomatous tissues and its clinical significance. Methods Immunohistochemistry was used to study the expression of MT1-MMP in esophageal carcinoma tissues and normal tissues in distance for 5-7 em from tumor. Results Among 54esophageal carcinoma specimens, the positive expression rate of MT1-MMP was 87.0%, while all of themwere expressed a small quantity in normal esophageal epithelial tissues, the expression in the esophageal carcinoma tissues was significantly higher than those in normal esophageal epithelial tissues (P ＜ 0.01 ).The degree of MT1-MMP expressions was associated with the depth of tumor invasion (P ＜ 0.01 ), the invasion of the lymph nodes(P ＜ 0.01 ) and the relapse and/or metastasis of the tumors for three years after surgery(P ＜0.01 ), and was also related to differentiation of tumor cells (P ＜ 0.01 ). Conclusions The expression of MT1-MMP in the esophageal carcinoma tissues is well associated with the depth of tumor invasion, the invasion of the lymph nodes, the differentiation of tumor cells and relapse and/or metastasis of the tumors for three years after surgery. MT1-MMP plays an important rote in the invasion and metastasis in the patients with esophageal carcinoma.

Objective To investigate the protective effect of ischemic postconditioning on lung injury in situ during lung ischemic reperfusion.Methods 24 SD rats were randomly divided into 3 groups,sham-operated group(S),ischemic-reperfusion group(I/R) and ischemic postconditioning group (IpostC).IpostC was established by several brief reperfusion-ischemia (30 s,5 cycles) before continuous reperfusion.AKT,p-AKT,p70S6K,p-p70S6K protein expression,apoptotic cells were tested by Western blotting and TUNEL,wet to dry weight ratio(W/D) in lung tissue were determined respectively.The lung pathological changes were also observed.Results Compared with S group,expression of Akt、p-Akt、p70S6K、p-p70S6K and the ratio of W/D,apoptotic index in lung tissue all markedly increased in I/R and IpostC group (P ＜ 0.05).Compared with I/R group,expression of Akt、p-Akt、p70S6K、p-p70S6K markedly increased in IpostC group(P ＜0.05),while the ratio of W/D and apoptotic index significantly reduced (P ＜ 0.05),the pathological injury in IpostC group also reduced significantly.Conclusion IpostC has a protective effect on lung ischemic reperfusion injury via PI3K/Akt pathway.

Objective To explore the effect of topical application of sodium hyaluronate on preventing perivascular adhesion of the vein grafts in rabbits. Methods Thirty-six male New Zealand white rabbits, aged 5 months, were randomly and equally divided into 2 groups: groups A and B. Arterial defect model was established by cutting about 1cm artery from the middle part of the dissected left common carotid artery. A section about 3cm was cut from the right external jugular vein, and the harvested vein was inverted and anastomosed end-to-end to the artery defect. After the anastomosis, the adventitia and two anastomoses of the grafted veins in group A were coated locally with 0.2ml sodium hyaluronate. The grafted veins were obtained 1, 2 and 4 weeks after the operation, with the perivascular adhesion of the vein grafts being examined macroscopically before the resection. HE staining and Masson staining were preformed for histological changes of grafted vein wall and the perivascular adhesion of the vein grafts. At 2, 4 weeks postoperation, the perivascular adhesions of the vein grafts were graded by the grading criteria of adhesion in macroscopic evaluation and histological evaluation. Result At 1, 2 and 4 weeks postoperatively, the macroscopic and histological observation found that the perivascular adhesions in group A were looser than those in group B. The macroscopic grade and histological grade were lower in group A than in group B, there was a significant difference between the two groups at 2 and 4 weeks postoperation (P<0.05). Conclusion Topical application of sodium hyaluronate can reduce the perivascular adhesion and is an ideal treatment strategy for preventing perivascular adhesion of vein grafts.

BACKGROUNDTo study the prognostic factors in patients with lung cancer after curative resection.

METHODSA retrospective study was conducted on 210 cases of clinicopathological survival data of lung cancer patients who underwent surgical resection from January 1987 to December 1999. Nine conventional prognostic factors were analyzed by COX model.

RESULTSThe overall 3-, 5- and 10-year survival rates were 37.4%, 30.1% and 23.5% respectively. Univariate analysis showed that regional lymph nodes status (N), primary tumor status (T), histological type of lung cancer, the type of operation and curability of surgical resection were significantly related to disease specific survival. Multivariate analysis showed that regional lymph nodes status, primary tumor status and curability of surgical resection were the three independent predictors of long term outcome. The hazard ratio of death was 2.42 for patients with N2-3 vs N0-1( P =0.000 1), 3.50 for patients with T2-4 vs T1( P =0.033 0) and 1.77 for patients with incomplete resection vs complete resection ( P =0.022 4).

CONCLUSIONSPrimary tumor status, regional lymph nodes status and curability of surgical resection are the three important prognostic factors of lung cancer. In order to improve long-term survival of lung cancer patients, it is very important to operate in the earlier stage of tumor, to extensively dissect intra-pulmonary and ipsilateral mediastinal lymph nodes and to avoid incomplete resection.

Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis.Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016.They were 52 men and 48 women,aged from 24 to 76 years (average,45 years).There were 14 femoral fractures,19 tibial plateau fractures,25 patella fractures,8 pilon fractures,22 tibiofibular shaft fractures,and 12 calcaneal fractures.Of them,21 were inflicted by wound infection.The preoperative and postoperative infection indexes,CRP,ESR,PCT and leukocyte count,were recorded.Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection.The optimal cut-off value was determined by the receiver operating characteristic curve.Results CRP showed a significant correlation with postoperative infection while other indexes did not.The optimal cut-off value was 25 mg/L at one day before operation.Conclusions Preoperative determination of CRP may predict the risk of postoperative infection.CRP ＞ 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.