Objective To explore the value of human epididymis protein 4(HE4),cancer antigen 125(CA125) and the risk of ovarian malignancy algorithm(ROMA) in the diagnosis of ovarian cancer.Methods Electrochemical luminescence and Enzymelinked immunosorbent assay (ELISA) were used to determine the levels of serum HE4,CA125 in 56 patients with ovarian carcinoma,73 cases of ovarian benign tumor and 50 health women,and the ROMA was calculated by HE4 and CA125 levels depending on the menopause state,drawing the receiver operating characteristics(ROC) curve and calculating the area under the curve(AUC).Results The average levels of the HE4,CA125 and the value of the ROMA were (345.33±605.03)pmol/L,(701.46±1 500.30) U/mL,(58.72±31.00) ％ in the ovarian carcinoma group,(53.84± 14.68)pmol/L,(44.25±45.81)U/mL,(10.80± 6.75) ％ in the ovarian benign tumor group,and (46.03±10.26)pmol/L,(17.39±10.64)U/mL,(6.92±3.85)％ in the health control group respectively,compared with the benign tumor group and the health control group,the ovarian carcinoma group were higher in HE4,CA125 and the ROMA value,and the difference were significantly (P＜0.05),whereas compared in the ovarian benign group and the health group,except the CA125 was higher in the benign group and the difference had statistical significance(P＜0.05),the HE4 level and the value of the ROMA had no statistical significance(P＞0.05).The sensitivities of the HE4,CA125 and ROMA were 71.43％,76.79 ％,89.28％,the specificities were 93.15 ％,53.42％,94.52 ％ and the ROC-AUCs were 0.930,0.809,0.937 respectively.When the specificity for the diagnosis of the ovarian carcinoma was 95.00％,the sensitivities of the HE4,CA125 and ROMA were 80.40％,53.60％,83.90％ respectively.Conclusion HE4 and CA125 combined detection to calculate the ROMA can elevate the sensitivity and specificity for the ovarian carcinoma diagnosis.

Objective To investigate the characteristics of PMP22 duplication mutation and the clinical variability of Charcot-Marie-Tooth disease type 1A (CMT1A) patients. Methods PMP22 duplication mutation analysis were performed in 45 cases diagnosed probably CMT by combination of improved allele-specific PCR-restriction enzyme digestion and short tandem repeat (STR) analysis based on laser-induced fluorescence detection in capillary electrophoresis. The clinical features of the positive cases were precisely analyzed. Results With the combined use of two methods, PMP22 duplication was detected in 21 cases, i.e. 10 CMT1 cases with typical presentations including weakness and atrophy in the distal limbs, and 11 atypical cases with special phenotypes including 1 case with mild dizziness, 1 case with hearing loss, 2 cases with recurrent limbs weakness, 2 cases with postural tremor in the upper limbs, 4 cases with cerebellar ataxia and 1 case with epilepsy. Conclusions The improved allele-specific PCR-restriction enzyme digestion provides the accurate, reliable and feasible method to detect PMP22 duplication, which is the most common cause of CMT. Comprehensive analysis of clinical, electrophysiological and pathological features of the CMT1A patients with positive PMP22 duplication indicate the high clinical variability of this disease.

OBJECTIVETo investigate the injuries of intestinal mitochondria induced by different doses of whole-body radiation in Tibet minipigs.

METHODSEighteen Tibet minipigs were randomized into 5 radiation groups (n=3) and a control group (n=3). The minipigs in the radiation groups were subject to a total body X-ray radiation at 2, 5, 8, 11, or 14 Gy, and 72 h after the exposure, the mRNA expressions of the intestinal mitochondrial genes were examined using RT-PCR. The changes in the respiratory chain complexes I-IV and the respiratory functions of succinate and NADH were assayed, and the intestinal ultrastructures were observed using transmission electron microscopy (TEM) following the exposures.

RESULTSCompared with those in the control group, the expression levels of the related mitochondrial genes, the activities of the respiratory chain complexes and the function of the respiratory chain were significantly lowered in the radiation groups. At the doses below 8 Gy, the exposures caused significant reduction in the measurements as the radiation doses increased, but at higher doses, these measurements showed no further reductions. Ultrastructurally, exposures at 2 and 5 Gy caused mitochondrial expansion and mild reduction of the density, whereas radiation at 8 Gy or greater resulted in vacuolar changes and obvious expansion of the mitochondria with damages of the mitochondrial cristae and membranes.

CONCLUSIONBelow the doses of 8 Gy, intestinal mitochondrial damages in the minipigs increase with the radiation dose, but at higher doses, the damages do not further increase with the radiation dose.

Animals ; Dose-Response Relationship, Radiation ; Intestines ; cytology ; radiation effects ; Male ; Mitochondria ; radiation effects ; Radiation Dosage ; Swine ; Swine, Miniature

Complex systems science (CSS) is an evaluation system that integrates the overall system and draws multilateral conclusions in the form of dynamic and reasonable interpreta-tion. Evaluation of modern hernia and abdominal wall surgery by CSS includes the application of artificial intelligence, data analysis and other methods. It implements the value oriented clinical quality improvement principle in the overall treatment cycle through the measurement of value, combined cost, quality evaluation and patient perspective. Finally, CSS will realize the sustainable development of hernia and abdominal wall surgical diagnosis and treatment system of medical care system.

Reviewing the development of hernia and abdominal wall surgery, at the begin-ning, they were only used in simple repair, effects of which were unsatisfactory. Hernia treatment has made a milestone progress with the development of repair materials. Repair materials (Mesh patches) have been applied to various types of abdominal hernia. As surgeons gradually realized the importance of abdominal wall layer in the treatment of abdominal wall defects, they began to pay attention to abdominal wall reconstruction, and applied repair materials to reinforce the abdominal wall, so that the treatment of abdominal wall dysfunction (huge incisional hernia and complex abdominal hernia) has made great progress. Subsequently, surgeons and scientists put forward a new concept "functional repair of the abdominal wall" for the repair of abdominal hernia. An ideal functional repair can restore the function of the abdominal wall, and ultimately achieve the unity of structure and function. The authors discuss the development of the treatment of abdominal hernia from repair, reconstruction to functional restoration.

Objective:To compare the application value of different polypropylene mesh in inguinal hernia repair of adults.Methods:The prospective cohort study was conducted. The clinical data of 120 adult patients with inguinal hernia who were admitted to two medical centers (60 in Huadong Hospital affiliated to Fudan University and 60 in Shanghai Ninth People′s Hospital affiliated to Shanghai Jiaotong University from March 2012 to Match 2014 were collected. Patients were randomly divided into study group and control group using the random number table. Patients in the study group underwent repair of inguinal hernia using the SMP95958X mesh, and patients in the control group underwent repair of inguinal hernia using the modified Kugel mesh. All patients underwent preperitoneal repair by senior hernia surgery specialists. Observation indicators: (1) postoperative pain; (2) complications and follow-up. Patients were followed up at postoperative 3 months and 6 months using outpatient examination to detect the short-term complications by physical or color doppler ultrasonography examination, and at postoperative 5 years using telephone interview or outpatient examination to detect long-term complications including infection, foreign body sensation and recurrence of hernia. The follow-up was up to March 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), comparison between groups was analyzed using the nonparametric rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square, continuous correction chi-square test or Fisher exact probability. Comparison of ranked data were analyzed using the nonparametric rank sum test. Results:A total of 118 patients with inguinal hernia were selected for eligibility, including 116 males and 2 females, aged (64±12)years, with a range from 29 to 84 years. Of the 118 patients, 59 were in the study group and 59 were in the control group, respectively. (1) Postoperative pain: of the 59 patients in the control group, 34 took painkiller and 1 case lost the data of taking painkiller at postoperative 2 days. Of the 59 patients in the study group, 29 cases took painkiller. There was no significant difference in taking painkiller between the two groups ( χ2=1.055, P>0.05). The pain score at postoperative 2 days and 3 months were 3.26(range, 0.70-6.90) and 0.87(range, 0.00-4.10) of the control group, respectively, and 3.03(range, 0.00-8.80) and 0.83(range, 0.00-3.10) of the study group, respectively, showing no significant difference between the two groups ( Z=0.782, 0.729, P>0.05). (2) Complications and follow-up: the incidence of postoperative complications at perioperative period (within postoperative 2 days) was 1.7%(1/59) and 1.7%(1/59) in the control group and study group, respectively, showing no significant difference between the two groups ( P>0.05). Both of 59 patients in the control group and study group were followed up for 6 months after operation, respectively. The incidence of postoperative complications at 3 months and 6 months after operation was 1.7%(1/59) and 1.7%(1/59) in the control group, respectively, and 5.1%(3/59) and 5.1%(3/59) in the study group, showing no significant difference between the two groups ( P>0.05). Fifty-five patients of the control group and 52 patients of the study group were followed up for 5 years after operation, respectively. There was 1 case of infection in the control group, with the incidence of postoperative long-term ( within 5 years after operation) complication of 1.8%(1/55), and there were 2 cases of infection and 1 case of foreign body sensation in the study group with the incidence of postoperative long-term (within 5 years after operation) complication of 5.8%(3/52), showing no significant difference between the two group ( P>0.05). There was no recurrence of hernia in either group. Conclusion:Both of the SMP95958X mesh and the modified Kugel mesh can be used in preperitoneal repair of inguinal hernia, showing no significant difference in the efficacy between them.

Objective To verify the effectiveness and safety of domestic neurosurgery medical robot Remebot for the biopsy of intracranial lesions.Methods Thirteen patients with intracranial lesions having comparatively difficulty in diagnosis in our hospital from January 2016 to May 2016 were randomly selected to robot operation group (n=6) and frame stereotactic group (n=7).In the robot operation group,four marks were pasted to the patient's head for the stereotaxy without frame,while in the frame stereotactic group,the frame should be fixed to the patient's head for the operation.The targets were set at the central of the lesions and the biopsies were performed through targets to the whole lesions.The specimens were sent for pathologic examinations with immunohistochemical staining.Results The confirmed diagnostic rate of robot operation group was 6/6:glioblastoma multiforme in 3,oligodendroglioma in one,non-Hodgkin's lymphoma in one and focal cortical dysplasia in one;the confirmed diagnostic rate of the frame stereotactic group was 6/7:glioblastoma multiforme in 2,grade Ⅱ-Ⅲ astrocytoma in 2,follicular thyroid carcinoma in one and cerebellum ganglion glioma in one,and the one without confirmed diagnosis was intracranial multiple cystic lesion.The positional accuracy in the robot operation group was 1.48±0.62 (accuracy error:0.66-2.47 mm) and that in the frame stereotactic group was 1.06±0.49 (accuracy error:0.50 mm-l.90 mm).Conclusions The domestic neurosuregery medical robot Remebot is characteristic by minimal invasive and high positional accuracy.It is quite suitable for frameless stereotactic intracranial lesion biopsy.The surgical planning could be made according to the shape of lesions and the positional accuracy is reached to the requirement of biopsy.Since the procedure of operation could be performed without fixing the frame on patients' head,the pain and fear of patients are reduced in a great deal and the operation is quite easy to be performed.Thus,it's more suitable for the biopsy ofintracranial lesions.

Objective Neuromuscular electrical stimulation(NMES)-evoked kinesthetic information in muscle spindle can be purely extracted from the mixed motor and sensory afferents using Ischemic nerve block(INB).This study aims to investigate the somatosensory cortical response evoked by NMES activating muscle spindle afferents in forearm.Methods All subjects performed four experimental tasks designed according to a 2×2 factors,including one factor of the INB state(without INB and within INB)and the other of the stimulation intensity(above and below motor threshold).During the experiment,we recorded EEG data with 64 channels and then beta event-related desynchronization(Beta ERD)were utilized quantize somatosensory cortical excitability evoked by the tasks.The subjective perception about the sensation and movement of the right hand were evaluated by a psychophysical test after the right wrist was performed by INB.Results INB significantly reduced beta ERD on the contralateral somatosensory cortex evoked by NMES above the motor threshold,and there was significant difference of NMES-evoked beta ERD values on the contralateral somatosensory cortex between above and below motor threshold.Meanwhile,contralateral dominance of NMES-evoked beta ERD on the somatosensory cortex was transferred to ipsilateral hemisphere under INB.Conclusion INB can significantly reduce NMES-evoked somatosensory cortical response above motor threshold and decrease cortical perception on the stimulus intensity,which may be due to INB resulting in rapid functional reorganization of somatosensory cortex.