Objective To investigate the risk factors for complications after tension-free repair in patients with inguinal hernia.Methods A retrospective analysis was made on clinical data of 503 patients with inguinal hernia after tension-free repair.The gender,adhesion,BMI index,the size of hernia sac,hernia type,patch type,degree of adhesion of the hernia ring and the mode of anesthesia were analyzed,and the risk factors were summarized.Results 47 cases occurred complications in 503 patients,the incidence rate was 9.34%.Chi square test showed that the degree of adhesion of the hernia ring and BMI index might be the influence factors of complications after operation,the differences were statistically significant(x2=11.495,8.944,all P<0.05).The degree of adhesion of the hernia ring and BMI index were taken into logistic regression analysis,and found that the degree of adhesion of the hernia ring and BMI index were the independent risk factors,the differences were statistically significant(OR=2.034,2.439,all P<0.05).Conclusion The incidence rate of complications after tension-free repair in patients with inguinal hernia is high,and the degree of adhesion of the hernia ring,BMI index are the independent risk factors of complications,target measures should be taken before operation.

Objective To investigate the effect of hemostatic drug on coagulation status after operation of bladder tumor.Methods Eighty-two bladder tumor patients in hospital for treatment were selected,and were randomly divided into observation group and control group with 41 patients in each.The patients in observation group were treated with hemostatic drug after operation,and the patients in control group were treated without hemostatic drug.The coagulation status between two groups were compared after operation.Results The index of preoperative coagulation status between two groups had no significant difference (P＞ 0.05).Compared with the preoperative,the activated partial thromboplastin time(APTT) and prothrombin time (PT) in two groups were prolonged on postoperative 1,2 d,plasminogen activator inhibitor (PAI)-1,tissue plasminogen activator (t-PA),D-Dimer (D-D) were increased,platelet (PLT) was decreased,thrombin time(TT) was shortened,there were significant differences (P ＜ 0.05).On postoperative 1,2 d,Tr in observation group was shorter than that in control group[(14.36 ± 0.17) s vs.(15.42 ± 0.18) s,(14.36 ± 0.28) s vs.(15.29 ± 0.27) s],PAI-1,t-PA,D-D were significantly higher than those in control group [(98.19±2.32) μg/Lvs.(82.19±2.38) μg/L,(84.52±2.25) μg/Lvs.(72.94±2.26) μg/L,(27.06 ± 1.69) μg/L vs.(21.63 ± 1.16) μg/L,(27.28 ± 1.37) μg/L vs.(21.69 ± 1.19) μg/L,(7.06 ±0.08) μg/L vs.(1.89 ± 0.28) μg/L,(12.83 ± 1.05) μg/L vs.(1.96 ± 0.18) μg/L],there were significant differences (P＜0.05).No significant difference was found in PLT,APTT,PT between two groups (P＞0.05).The incidence of deep vein thrombosis (DVT) in observation group and control group was 7.32％(3/41),2.44％ (1/41),which had no significant difference (P ＞ 0.05).Conclusions The application of hemostatic drug can aggravate hypercoagulability of patients with bladder tumor after operation.Therefore,it should be carefully applied preventive hemostatic drug.

The metastases status of internal mammary lymph node(IMLN) is an independent prognostic factor for breast cancer and it also is an important reference for neoplasm staging.The patients with IMLN metastases consistently have worse outcomes.The overall risk of IMLN metastases is 18 ％-33 ％.Metastases exclusively situated in the IMLN,without concurrent axillary metastases,occur in 2 ％-11％ of patients.Factors related to IMLN metastases include the status of axillary node,the age of patients,the localization and characteristics of primary tumor.Recently,with the development of sentinel lymph node biopsy(SLNB), internal mammary-SLNB may access the status of IMLN with a minimal risk. Internal mammary-SLNB procedure can improve the system for nodal staging of breast cancer,and it will contribute to the individualized treatment for breast cancer patients.

Objective To analyze and discuss the clinical effect of the four-hands technique mode of doctor-nurse collaboration in endoscopic sinus surgery. Methods Convenient sampling method was used to select 50 cases of patients with nasal endoscopic surgery who met the inclusion criteria and agreed to participate in this study in the period between January to May in 2016. Designing one side of the nasal cavity of patients with traditional surgery mode, the other side of the nasal cavity to carry out the four-hands operation mode. The operation time and amount of bleeding were recorded. Results The operation time, amount of bleeding of traditionalsingle hand operationside and the other side of four-hands operation respectively were (39.30 ± 21.96) min, (143.86 ± 15.01) ml and (31.60 ± 19.27) min, (102.98 ± 12.85) ml, with significant differences between the two groups (t=2.096, 14.625, P<0.01). Conclusions The four-hands technique of doctor-nurse collaboration can significantly reduce the operation time, reduce the amount of bleeding and get a better surgical field, clinical nurse and doctor′s cooperation is more closely and also improve the quality of patient care.

Medicine is a practical science which needs comprehensive analysis.The old fashion of disease treatment model divided by different professions or departments was gradually unable to meet the needs of the clinical diagnosis and treatment,and the corresponding medical education pattern was very limited.As the development of multi disciplinary treatment (MDT) focused on a certain disease or organ,medical teaching mode also changed.Since our hospital used MDT as the treatment of severe acute pancreatitis (SAP),teaching model has been reformed by launching the joint multidisciplinary teaching.After that,the graduate students and advanced students from relevant departments have greatly improved their diagnosis and treatment skills.

Anatomic segmental hepatectomy,as an important part ofprecision surgery,has been accepted and widely applied as the promotion of precision hepatectomy.Anatomic segmental hepatectomy is superior to non-anatomical hepatectomy in clinical efficacy,application scope and operation techniques.There are many operation techniques developed by surgeons to accomplish segmental hepatectomy,and it is worthy for spreading in clinical practice.

Objective:To explore scientific and effective methods of management regarding the features of Da Vinci Surgical Robotic System and clinical applications.Methods: Enhance operation room management of Da Vinci Surgical Robotic System; Establish surgical robotic system management system to carry out inter-provincial communication and cooperation, thereby building novel forms of treatment by teamwork and multidisciplinary integration; Regular maintenance and reparation of the equipment by engineers to avoid or reduce the possibility of equipment failure during the operation of equipment.Results: Proposing scientific and effective suggestions for clinical application and management of Da Vinci Surgical Robotic System to provide references for using of such equipment.Conclusion: Via surgical management of Da Vinci Surgical Robotic System and its operation room as well as quality control and preventive maintenance during the operation of equipment, the methods play an important role in reducing the usage risk of equipment, improving usage efficiency of equipment, extending life span of equipment and improving surgical precision and security.

Objective To evaluate the therapeutic efficacy and safety of micro-invasive craniopuncture scavenging technique (MPST) for treatment of intracranial hematoma in patients with hypertensive cerebral hemorrhage (HICH).Methods All the clinical randomized controlled trial (RCT) studies published on MPST and internal medicine conservative treatment of HICH were searched via computer screening of databases including Cochrane clinical trials database, the Chinese biomedical literature database (CBM), Chinese periodical network full-text special topic database, Chinese science and technology periodical database and electronic periodicals database of Wanfang from January 2006 to January 2017. The study group was given the MPST plus basic treatment, and the control group was given conservative treatment. The studies collected meeting the eligible criteria were sorted and analyzed by the software RevMan 5.0, the differences in therapeutic effect and mortality were compared between the two groups, and a funnel chart was plotted to analyze the potential publication bias.Results A total of 13 RCTs published studies consistent with the eligible criteria were found, including1556 patients. The Meta-analysis showed that the effective rate in the study group was significantly higher than that in the control group [odds ratio (OR) = 4.29, 95% confidence interval (95%CI) 3.33 - 5.53,P < 0.01]; the fatality rate was markedly lower than that of the control group (OR = 0.25, 95%CI 0.19 - 0.35,P < 0.01). The funnel graph showed that each study had asymmetrical scatter plot of the variable quantity of research results, indicating a publication bias being present, which might be related to the subjectivity of the researchers in publishing their results.Conclusions Using MPST to treat HICH can significantly improve the therapeutic efficiency and reduce deterioration rate. However, due to the low quality of clinical research, it is necessary to carry out rigorous andmulti-center randomized controlled studies to further confirm the results.

Objective Along with the theoretical and practical development of hospital management,revenue is no longer the single indicator for measuring the overall performance of a hospital,the level of scientific research will be more and more important.The management of scientific research becomes a key factor in promoting the overall performance of a hospital.Since the third technology revolution,scientific research has been playing a more and more important role across all sectors of society,and in the field of healthcare,we witnessed the integration of clinical practice and scientific research in most comprehensive hospitals which has brought mutual benefits and joint development.A complete management system for scientific research is significant for discipline development,scientific research advancement,and it can set up a guideline for future hospital research development.The applicability and limits of performance evaluation of scientific research is studies and discussed.

ObjectiveTo explore the effect of age on clinical outcomes of patients with massive infarction after decompressive craniectomy.MethodsClinical data of 103-sufferers,who have been operated by decompressive craniectomy in our hospital from January 1999 to January 2010 were summarized.Based on age,these data are divided into the research group( ≥60 years old,number =48) and the control group( ＜ 60 years old,number =55 ).Then two groups were studied and discussed by mortality,the ratio of postoperative complications and cases of preoperative comorbidities.ResultsComparing with the control group,it was evident that patients of the research group had higher mortality and ratio of postoperative complications,and moat of them suffered from preoperative manifold comorbidities ( x2 =11.097,24.915,14.404,all P ＜ 0.01 ).Besides,the percentage of patients with good prognosis was significantly lower( x2 =9.821,P ＜ 0.01 ).ConclusionPostoperative clinical outcomes of aged patients with the massive infarction were affected by preoperative manifold comorbidities and postoperative complications.However,younger patients could correspondingly achieve the preferable treatment effect after surgery.Hence,age should possess an imporrant impact for clinical outcomes of patients with massive cerebral infarction after decompressive craniectomy.