Tension-free repair for inguinal hernias has been led into China since 1997 and being promoted quick development of hernia and abdominal wall surgery in China,meanwhile,there are still many problems in the recurrence,chronic pain and patch infection due to irregular operations.In order to solve these problems and improve the diagnosis,treatment and research levels of hernia and abdominal wall surgery,surgeons must pay attention to the basic and clinical technologies,quality control and so on.The studies on etiology of hernia will bring innovative therapy,registration system will contribute to summarize the clinical experiences,and establishment and implementation of quality control of hernia could ensure the effects of diagnosis and treatment.However,there is still a controversy about whether laparoscopic technology on inguinal hernias is minimally invasive surgery or not,though it is safe and effective.

Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation.Methods From March 2006 to October 2012,21 patients (15 male,6 female) with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove.In this group:Ⅰ grade 5 cases;Ⅱ grade 9 cases;Ⅲ grade 5 cases;Ⅳ grade 2 cases.All patients were followed up for at least 24 months.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score and visual analogue score (VAS) were used to evaluate the clinical outcomes.Operation time,time to heal and complications were also recorded.Results The average operation time was 50 minutes (30-70 minutes).The blood loss was 30-60 ml,average 40 ml.All incisions healed after operation,no case of incision infection,skin necrosis and sural nerve,vascular injuryed.Mean AOFAS score was significantly increased from (55.2±7.1) preoperative to (93.6±5.6) postoperative.15 patients with excellent,good for 1 cases.The excellent and good rate was 100％ (16/16).VAS score by an average of (5.3±2.1) points down to (1.2±1.1) points postperative.All the patients can wear normal shoes postoperative,waking with normal gait.No patients had peroneal tendon tenosynovitis,tendon adhesion,fracture of lateral malleolus and other serious complications,no dislocation recurrent,strength of the peroneal muscle returns to normal.Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.

In recent 20 years, hernia and abdominal wall surgery has made great progress in China. However, what we′ve done still leaves much to be desired. Related guidelines of hernia disease had been conducted, but China is short of multi-center, prospective, and large-sample research evidence. These guidelines are still with low evidence level, and contents need additional modified to well meet Chinese real situation. In terms of treatment of inguinal and abdominal wall incisional hernia, some consensus has been reached from certain key issues globally, but further exploration are still needed. To stand at top of the world, we are a long distance. We should not only strengthen training and quality control but also establish patient registration system and overall management process.

Objective To investigate the clinical efficacy of mesh repair via inguinal approach in acute femoral hernia.Methods The retrospective cohort study was conducted.The clinical data of 48 patients with acute femoral hernia who were admitted to Huadong Hospital Affiliated to Fudan University between January 2007 and December 2016 were collected.Of 48 patients,29 undergoing hernia repair with polypropylene mesh and 19 undergoing hernia repair with suture were allocated into the study group and control group respectively.All the patients underwent hernia repair via inguinal approach.Observation indicators:(1) surgical and postoperative situations;(2) follow-up and survival situations.Follow-up was performed by outpatient examination and telephone interview to detect complications,hernia recurrence,survival situations at 1-,3-month and 1 year postoperatively for 1 year up to December 2017.Measurement data with normal distribution were represent as x±s and comparison between groups was done by the t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability.Results (1) Surgical and postoperative situations:patients in the 2 groups underwent successful incarcerated or strangulated acute femoral hernia repair.There were 3 and 4 patients receiving small bowel resection in the study group and control group respectively,with no statistically significant difference between groups (x2=1.50,P＞0.05).The operation time was respectively (82±16)minutes and (96± 13)minutes in the study group and control group,with statistically significant difference between groups (t =-2.94,P＜0.05).There was no femoral vascular injury in the 2 groups.The time of drainage-tube removal and duration of postoperative hospital stay were respectively (4.5 ± 1.6) days and (9±4) days in the study group and (3.9± 1.3)days and (10±4)days in the control group,with no statistically significant difference between groups (t =1.36,-0.33,P＞0.05).(2) Follow-up and survival situations:all the 48 patients were followed up for one year.No mesh infection was found in the study group.[ncisional infection was detected in 4 and 2 patients of the study group and control group respectively,with no statistically significant difference between groups (x2 =0.11,P＞ 0.05).Patients with incisional infection were cured after incision open drainage.Two and 2 patients had postoperative chronic pain in the study group and control group respectively,with no statistically significant difference between groups (x2 =0o 20,P＞0.05).The 4 patients had mild intermittent pain,without special treatment.There were no seroma occurred in the 2 groups.Hernia recurrence was occurred in 0 aud 5 patients of the study group and control group respectively,with statistically significant difference between groups (x2 =8.52,P＜0.05).There were 2 and 1 patient dead in the study group and control group respectively,with no statistically significant difference between groups (P ＞ 0.05).Conclusions Hernia repair with Polypropylene mesh via inguinal approach in acute femoral hernia is safe and feasible.Compared to suture repair,it can not only shorten operation time and reduce hernia recurrence,but also had no mesh infection and cannot iucrease postoperative complications.

Objective:To compare the expression difference of Toll like receptor (TLR) and inflammatory factors between pancreatic cancer and normal pancreatic epithelial cells, and explore the correlation between TLR and inflammatory microenvironment.Methods:Normal pancreatic duct epithelium cells (HPNE) and pancreatic cancer cells (Panc-1 and Mia-PACA-2) were cultured and proteins were obtained. The expression of TLR family protein, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and myeloid differentiation factor 88 (MyD88) were examined by western blot in HPNE, Panc-1 and Mia-PACA-2. The correlations between TLR and inflammation cytokines of pancreatic cancer were analyzed by Pearson correlation analysis.Results:Compared with HPNE, the TLR2, TLR3, TLR4, TLR7, TLR8 and TLR9 were highly expressed in Panc-1 and Mia-PACA-2 (all P<0.05). Compared with Panc-1, the expression of TLR2 and TLR4 in Mia-PACA-2 were increased obviously, while the TLR9 expression was mildly decreased (all P<0.05). The expression of IL-6 in HPNE was found less than that in Panc-1 (0.52±0.03 vs. 0.76±0.04) and Mia-PACA-2 (0.52±0.03 vs. 1.12±0.09) with statistical differences ( P<0.05). Similarly, the expression of TNF-α was found significantly less than that of Panc-1 cells (0.63±0.04 vs. 0.87±0.06) and Mia-PACA-2 cells (0.63±0.04 vs. 0.95±0.10) with statistical differences (all P<0.05). The expression of IL-6 was found positively correlated with expressions of TLR2 ( r=0.964), TLR4 ( r=0.968), TLR7 ( r=0.844), TLR8 ( r=0.668) (all P<0.05), and the expression of TNF-α was found positively correlated with expressions of TLR2 ( r=0.805), TLR4 ( r=0.893), TLR7 ( r=0.847), TLR8 ( r=0.780) (all P<0.05). In contrast with HPNE, the expression of MyD88 was found highly expressed in Panc-1 (0.91±0.10 vs. 0.33±0.03) and Mia-PACA-2 (1.14±0.10 vs. 0.33±0.03) (all P<0.001). Compared with Panc-1, the expression of MyD88 in Mia-PACA-2 was obviously increased (1.14±0.10 vs. 0.91±0.10) with statistical difference ( P=0.048). Conclusion:The TLR family may play a critical role in development of pancreatic cancer by regulating the immune microenvironment, and its mechanism may be through upregulating MyD88 which functions as key signal transduction.

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 analyze the clinical value of laparoscopic and hybrid technique for the repair of incisional hernia.Methods The clinical data of 70 cases of incisional hernia undergoing laparoscopic and hybrid repair from Jan 2014 to Dec 2015 in Huadong Hospital were analyzed retrospectively.Results All cases were operated on successfully and recovered.The operation time was (60 ± 27) min for laparoscopic and (120 ± 32) min for hybrid repair.The length of incision was (6 ± 4) cm for laparoscopic repair and (8 ± 6) cm for hybrid.Postoperative complications included seroma in 1 case in laparoscopic group,incisional fat liquefation in 1 case in hybrid group.All were cured with conservative treatment.Hospital stay was (8 ± 5) days in hybrid group and (14 ± 16) days in hybrid group.No recurrence was observed during 6-30 months of follow-up.Conclusion Both laparoscopic and hybrid technique for incisional hernia repair are safe and effective.

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.

OBJECTI VE To optimize the extraction technology of the leaves of Dimocarpus longan according to flavonoids and phenolic acids. METHODS The contents of gallic acid ，protocatechuic acid ，ethyl gallate ，quercetin，luteolin and kaempferol in the leaves of D. longan were determined by HPLC. Based on single factor test ，with the ethanol volume fraction ，solid-liquid ratio and extraction time as factors ，using comprehensive scores of the contents of above six components as indexes ，the extraction technology of the leaves of D. longan was optimized by Box-Behnken response surface methodology. RESULTS The optimal extraction technology included ethanol volume fraction of 100％，solid-liquid ratio of l ∶ 7（g/mL），extraction time of 90 min， extraction temperature of 80 ℃. After 3 times of validation tests ，the average comprehensive score was 97.54（RSD＝0.33％，n＝ 3），relative error of which with predicted score （99.05）was 1.55％. CONCLUSIONS Box-Behnken response surface methodology combined with multi-index comprehensive score can be used for the extraction technology of the leaves of D. longan ，and the optimized extraction technology is stable and feasible.

【Objective】 To evaluate the clinical use of the baseline CT angiography (CTA) quantitative score (self-designed collateral circulation quantitative, SD-CCQ) in determining the collateral circulation compensation status in patients with acute ischemic stroke (AIS), as well as the reliability and accuracy of the SD-CCQ score and the Alberta Stroke Program Early CT Score (ASPECTS). 【Methods】 Retrospective analysis was made on the clinical and imaging data, including CT, CTA and DWI image data, of 84 patients who were admitted for acute ischemic stroke to the Department of Neurorehabilitation of Zhongshan Hospital of Traditional Chinese Medicine from January 2020 to December 2022.Their CTA source images were annotated using a multi-task deep learning method for vascular segmentation. The ASPECTS score and SD-CCQ score were then applied to the CTA images following vascular segmentation in order to assess the collateral circulation compensation of AIS patients. The Kappa test was used to assess the consistency of the two methods used to assess collateral circulation, and the multifactorial Logistic regression analysis was used to examine the relationship between the SD-CCQ and the prognosis of the AIS patients. 【Results】 ASPECTS score had good consistency with SD-CCQ score in evaluating collateral circulation in AIS patients (κ=0.65, P<0.001), and the diagnostic accuracy of the latter for benign collateral circulation in AIS was 96.15%. Logistic regression analysis showed that the new collateral circulation score, baseline NIHSS, and DWI infarct volume were the main factors affecting the long-term prognosis of AIS patients. 【Conclusion】 The new scoring system SD-CCQ can be used to evaluate the compensatory status of collateral circulation in AIS patients, which may help in clinical treatment decision-making and prognosis prediction.