Large Hiatal Hernia(LHH)is a special type of hiatal hernia,usually defined as more than 1/3 of stomach mi-gration with or without other organs or diameter of esophageal hiatus more than 5 cm.Operation is the only therapeutic method. With the development of laparoscopic surgery, laparoscopic repair of large hiatal hernia(LRLHH)is the standard technique for repair of large hiatal hernias.However LRLHH still is a kind of complexity, difficulty, high risk and recurrence to some extent. Moreover, there is still no consensus amongst surgeons about what is the optimal technique for LRLHH .Currently, controver-sies and advancement of LRLHH mainly concentrated on completely dissection and reduction of the sac from the mediastinum , suture cruroplasty with or without mesh, deal with short esophagus and gastroesophageal reflux.Modified LRLHH achieves completely dissection hiatal hernia sac , which is more convenient and more helpful for suture cruroplasty and reduce the ten-sion.The use of mesh effectively reduces the anatomical recurrence rate and may lead to complications such as esophageal ero-sion or extensive fibrosis with troublesome dysphagia .LRLHH with mesh or without mesh should be individualized .Optimal technique for LRLHH needs continual improvement and high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term.In this paper, the controversy and progress of laparoscopic huge esophageal hiatal hernia repair will be summarized.

AIM: A novel method for the overall quality control of Herba Artemisiae scopareiae has been established by HPLC fingerprint. METHODS: The chromatographic fingerprints were obtained by injecting ~5 ?L of the sample solution each time on a Kromasil ODS column (250 mm?~4.6 mm ,~5 ?m ) with the gradient elution solvent system composed of 1%acetate acid-water-methanol. The flow rate was 1 mL/min, the column temperature was maintained at ~30 ℃ and the detection wavelength was set at ~326 nm . RESULTS:22 co-possessing peaks were selected as the fingerprint peaks of Herba Artemisiae scopareiae and the similarities between the chromatographic fingerprints of the herbal drugs were calculated taking chlorogenic acid peak as the reference peak. The chromatographic fingerprints also were evaluated by the chromatographic fingerprint index (F), the relative index (Fr) and the fingerprint components apparent prercentage contents (P%). CONCLUSION: This method with good precision and reproducibility can be useful in the quality control of Herba Artemisiae scopareiae.

AIM: To develope the quantitative analysis approach for irigenin (IRG) in Shegan Kangbingdu Injection(Rhizoma Belamcandae, Flos Lonicerae, Radix Bupleuri, etc.). METHODS: The operation was carried out on the Kromasil ODS column (5 ?m, 4.6 mm?200 mm) with the mobile phase comprised of a mixture of water-methanol-acetonitril(50∶46∶5) adjusted pH3.0 by phostrate acid, the flow rate of 0.8 mL?min -1 , the UV detection wavelength at 265 nm and the temperature at (30.5?1) ?C . RESULTS: The linear range was in the range of 0.028 2-9.4 ?g(r=0.999 9). The relative standard deviations of peak areas for IRG was 1.2% and the standard was stable within 18 h(RSD=0.72%). The LOD (S/N=3) was 3.2 ng, and the limit of quantification (S/N=10) was 10.6 ng and the average recovery was 99.7%. CONCLUSION: The method is simple, rapid and accurate. It can be used for the quality control of Shegan Kangbingbu Injection.

Objective:To investigate the effect of O-6-methylguananine-DNA methyltransferase (MGMT) gene promoter methylation status on the treatment and prognosis of elderly patients newly-diagnosed with glioblastoma (GBM).Methods:Clinical data of 65 newly-diagnosed GBM patients admitted to Tianjin Huanhu Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients received intensity-modulated radiotherapy after surgery and 49 patients received temozolomide (TMZ) monotherapy. All patients were divided into the MGMT(+ ) group and MGMT(-) group according to the methylation status of MGMT promoter. Kaplan- Meier method and log-rank test were used for univariate survival analysis, and Cox regression model was used for multivariate prognostic analysis. Results:The median overall survival (OS) for all patients was 18.0 months. The median OS was 27.0 months and 15.3 months in the MGMT(+ ) group and MGMT(-) group, respectively. Univariate analysis revealed that tumor number, MGMT promoter methylation, postoperative concurrent chemoradiotherapy were significantly related to clinical prognosis ( P=0.029, P=0.001 and P<0.001). In multivariate analysis, tumor number and postoperative concurrent chemoradiotherapy were identified as significant prognostic factors for OS ( P=0.037, P=0.004). In the MGMT(+ ) group, the median OS was 27.0 months for patients receiving concurrent chemoradiotherapy and 12.0 months for radiotherapy alone ( P=0.040). In the MGMT(-) group, the median OS was 17.0 months for concurrent chemoradiotherapy patients and 10.0 months for radiotherapy alone ( P=0.122). Conclusions:MGMT promoter methylation status is significantly associated with longer OS in elderly GBM patients. Conventional fractional radiotherapy combined with concurrent and sequential TMZ chemotherapy probably yields better survival benefits.

Objective To evaluate the efficacy and safety of the endovascular interventional minimally invasive techniques(IMIT)for treatment of carotid artery iniury. Methods A total of 111 cases of carotid artery injury diagnosed by digital subtraction angiography(DSA)were treated with IMIT.Except for 1 case of extracranial segment injury of internal carotid artery treated with transcatheter stentgraft placement to obturate the rupture of carotid artery,the other 110 cases of intracranial segment injury of internal carotid artery(ICA)were treated with embolization with balloons in 73,embolization with coils in 12,injection of NBCA and PVA in 6,stent-graft placement in 11 and embolization with multiple materials in 8. Results Angiography demonstrated rupture of extracranial segment of internal carotid artery and arteriovenous fistula(AVF)at the neck in 1 case,traumatic carotid cavernous fistula(TCCF)in 83.traumatic pseudoaneurysm at intracranial segment of carotid artery in 14 and both TCCF and pseudoaneurysm in 13.The interventional treatment succeeded in all cases and interual carotid arteries were well protected in 62 cases.Completion angiography documented complete obliteration of the fistulas,with complete disappearance of the clinical symptoms in 110 cases and improvement in 1.Minor complications occurred in 2 cases,without death occurred.During the follow-up for 1-14 months,16 cases reexamined with DSA,which showed that the symptoms of 3 cases reoccurred,2 of whom were cured by re-embolization and 1 was under clinical observation. Conclusions IMIT including transcatheter selective embolization and stent-graft implantation is minimally invasive,safe and effective for treatment of carotid artery injury.

Objective To investigate the safety and efficacy of technical modification for laparoscopic repair of giant hiatal hernias.Methods A total of 49 patients with giant hiatal hernia underwent modified laparoscopic repair by dissecting sac, closing hiatal, mesh placement and fundoplication from June 2010 to May 2014.The operation time, hospitalization time, postoperative complications, upper gastrointestinal imaging and improvement of postoperative symptoms were observed.Results The average operation time was (103.6 ±31.7) min(88-173min).The average length of post operation hospitalization was (4.2 ± 1.8) d (range,3-12d).Postoperative complication occurred in 4 patients,including pleural effusion (1 patient),respiratory failure (1 patient), difficulty in swallowing (2 patients)with complication occurrence rate being 8.2％ (4/49).No conversion or death occurred.The average time of follow-up was (28.3 ± 12.7) months (6-50 months) in 49 cases.During the follow-up, main symptoms were relieved and no recurrence was found by barium swallow.Conclusion Technical modification for laparoscopic repair of giant hiatal hernias is safe and effective.

Depending on the meaning and function of the liver in traditional Chinese medicine and modern medicine,this paper explores the important role of liver in the pathogenesis of DM (Diabetes Mellitus,DM).Combined with treatment based on syndrome differentiation and specific case report study,this paper has stressed the importance of treating DM from liver and so to set a sound basis for the systemic treatment based on syndrome differentiation from internal organs for DM.

Objective To observe the effects of treating acute ischemic stroke in rats with interventional administration of nitric oxide precurcer L-Arginine or nitric oxide donor nitroglycerin.Methods The right middle cerebral arteries of rats were occluded by insertion of a suture to duplicate ischemia-reperfusion models.Forty-two male SD rats were randomly divided into four groups: MCAO group(n=12);sham operation group(n=6);NG group(n=12) and L-ARG group(n=12),intracarotid arteries administrated respectively by NS、NS、NG and ARG.Each of the four groups were subdivided into 2 groups according to the reperfusion time(3 h and 24 h),measurement of Longa scores,NO2-/NO3-in serum,HE staining and immunohistochemical(SABC)method were utilized to assess the changes of ischemic brain tissues in different groups.Results OX-42 positive cells of cortex and CA3 area of hippocampal: OX-42 positive cells were found,their features identified at 3 h after reperfusion.24 h the response of microglias was obvious,the number of the cells increased(P

Objective To establish a rat model of middle cerebral artery occlusion (MCAO)by blockage or obstruction of middle cerebral artery. NO precursor L-Arginine (L-ARG) and NO donator Nitroglycerine (NG)are administrated from intraearotid arteries. DWI and PWI are applied to evaluate blood circulation and brain damage of the effected region to elucidate the piotective function of L-ARG and NG in the early stage of brain ischemia. Methods The middle cerebral artery was occluded by insertion of a suture through the internal carotid artery of SD male rats to duplicate ischemia-reperfusion model. Reperfusion was established by suture withdrawal. After 2 hours of blockage, reperfusion and administrate L-ARG,NG by interventional therapy through the internal carotid artery simultaneously. Image indexes such as T1WI, T2WI, DWI and PWI are utilized to assess the changes in different time points. These indexes, Longa score and TTC stain were compared. Results There were obvious decrease in DWI high signal region and Trc pale region in drugs groups, compared with MCAO group(P＜0.01).ADC and rADC values in DWI high signal region increased gradually from 2 hours after ischemia to 24 hours after reperfusion in each group. ADC and rADC values in DWI high signal region of the drugs groups increased obviously(P＜0.01).Conclusion Interventional therapy with NO precursor/donator showed significant protective function in the early stage of brain ischemia.

Objective To investigate the effect of different amplification methods and probes with various length on the results of comparative genomic hybridization (CGH) analysis of pre-implanted single blastomere and to establish the basis for preimplantation genetic diagnosis.Methods Twenty blastomeres of embryo at 6-8 cells stage were randomly divided into A and B group with 10 in each.Twenty peripheral blood lymphocytes from a healthy man were similarly divided into C and D group with 10 in each.Degenerate oligonucleotide primed polymerase chain reaction (DOP-PCR) was used to amplify whole genomic DNA in group A and C,and multiple displacement amplification (MDA) was used in group B and D for whole genome amplification (WGA).The specificity of resultant products was confirmed by amplification of TBX1 gene exon 2.CGH was performed respectively with 250-750 bp and 750-2000 bp probes prepared from the amplified whole genomic DNA.The result of CGH was verified by sex-determining region of Y (SRY).Results (1) Nine of the 10 samples in group A and all in group C were amplifiable by DOP-PCR,but there were multiple non-specific bands in the amplification of TBX1 exon 2 when WGA products were used as templates.When 250～750 bp probe was used in CGH,1 of the 5 blastomeres was failed and another one had different karyotype from that analyzed by SRY.(2) All samples in group B and D were successfully amplified by MDA,and the non-specific bands were significantly less in the amplification of TBX1 exon 2.All 5 blastomeres were successful in CGH with the 250～750 bp probe.Moreover,the karyotype was in agreement with that of SRY.(3) When 750 ～ 2000 bp probe was used,the CGH results were suboptimal.Conclusions In WGA of single blastomere,MDA is superior to DOP-PCR in the stability and specificity.The karyotype image detected by CGH with the 250～750 bp probe is clear and homogenous.