Objective To evaluate the effects of anterior approach preperitoneal repair for inguinal hernia with modified Kugel mesh.Methods Clinical data of 35 cases receiving inguinal hernia repair with modified Kugel mesh from May 2004 to June 2006 were reviewed.The critical surgical procedures:the hernial sac was dissected at high position,then reversed and reduced into abdominal cavity;a 10 cm?10 cm preperitoneal space was dissociated around the internal ring,into which a modified Kugel mesh was placed.The mesh was fixed to the conjoined tendon by superior tape,and to the shelving edge of inguinal ligament by inferior tape.Results The operation time was(47?10)min.No analgesic requirement in any case.The postoperative hospital stay was(6?4)days.All the wounds healed uneventfully without any seroma or infection.No recurrent case was found in the follow-up of 1-25 months(mean:13.2 months)in the 35 cases.Conclusions Modified Kugel mesh used in inguinal herniorrhaphy causes less pain and swelling response to the wound,therefore it is quite suitable for repairing Ⅲ and Ⅳ type hernia.

Objective To evaluate the methods and outcome of laparoscopic degradable bio-patch repair of umbilical hernia in adults. Methods From January 2003 to October 2008, 21 adult patients underwent elective laparoscopic patch repair of umbilical hernia. There were 15 women and 6 men. The mean age was 56 years old (range of 36-73). The diameter of hernia ring was from 3 to 7.5 cm averaging at 5.2 cm. All patients received general anesthesia. Preoperative bowel preparation routinely started one day before the operation. The patients received prophylaxis systemic antibiotics 30 minutes before the operation. An appropriate size of prosthetic patch (Composix E/X, Bard, USA) was that extended the defect margin for about 3-5 cm. The mesh was then inserted into the peritoneal cavity and spreaded flattening, with the polyplypylene side facing outside and it's center coinciding with that of the defect. The mesh was fixed to the abdominal wall with staple tacks in two rings, which was 3-5 cm along the hernia ring and 1-2 cm along the edge of the mesh. Results There was no conversion to open repair. The operative time was 30 to 96 rain and the average was 52 min. Two patients suffered from a transient postoperative tympanites and which subsided 2 to 3 days after the operation. One patient had a severe pain in the repair area around the umbilical and underwent oral medicine treatment, which disappeared one week after operation. There was no seroma and incision or mesh infection occurred. The postoperative hospital stay was 3 to 8 days and the average was 4. 2 days. The follow-up time was 3 months to 5 years and the average was 32 months. No ileus or hernia recurrence during the follow-up. Conclusion Laparoscopic patch repair of umbilical hernia in adults is a safe and effective procedure.

Objective To analyze the situation and trend of the application of antibacterial drugs in the case of typeⅠincision operation in our hospital.Methods A total of 1 964 patients in our hospital from 2010 to 2014 were randomly selected,and the changes of antimicrobi-al drugs during the treatment period were analyzed.The surgical site infection probability and antimicrobial application rules in typeⅠincision surgery in 3 years,including probability,category,first time and duration of drug use,and the relationship between antibacterial drugs and typeⅠincision infection were analyzed.Results Application of antibacterial drugs in typeⅠincision operation probability decreased significant-ly,and the surgical infection probability decreased year by year,with statistically significant difference(P<0.05).The first application of an-tibacterial drug time was more reasonable,the choice of antimicrobial drugs were mainly one generation or two generation of Cephalosporin. There was a significant increase in the probability of stopping medication within 2 days after surgery,and the difference was statistically signif-icant(P<0.05).Conclusion The application of antibiotics should be strictly applied to the application of the indications for the use of anti-biotics.To understand the scope of application of antimicrobial drugs,and should try to shorten the use of time,control of infection during peri-operative period,reduce drug resistance.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Intercellular Adhesion Molecule-1 ; blood ; Leukocytes, Mononuclear ; metabolism ; Lymphocyte Function-Associated Antigen-1 ; blood ; Male ; Seizures, Febrile ; blood

Evidence-based medicine is also currently promoted and extolled as the best way to evaluate its various treatment and to draft clinical guidelines for the management of severe sepsis with aim to result in a reduction in mortality. There are several obvious factors in the design and conduct of clinical trials in sepsis to be observed, including case selection, end points, and sub-population evaluation, etc. In the past years, several scientific reports of evidence-based strategies for the treatment of sepsis were published, including recombinant human activated protein C, control of hyperglycemia in sepsis, and administration of low dose of corticosteroid in severe sepsis management.

Objective: To develop and validate an accurate three-dimensional geometrical and mechanical finite element(FE) model of the lurabar L4-L5 segment using a new computer-aided designing (CAD) method. Methods: First, a modified "non-seed region segmentation" was done to extract the interest region in the CT image and to obtain a binary image, from which the iso-surface of vertebral body was produced by a discretized marching cubes algorithm. Second, "best cross-section planes" representing the morphologic characteristics of physiological lordosis were used for the initial iso-surface model, forming a "nonregular piecewise subspace". This subspace and the embedded iso-surface model were subsequently transformed by local affine transforms to a "regular subspace", in which a surface mesh of high quality was generated quickly. Finally, a reverse transform procedure was employed to restore the original three-dimensional (3D) image of the lumbar surface mesh of lumbar L4-L5. All coordinate dada of nodal points and message of triangular patches of the surface model were then subjected to ANSYS for the three-dimensional FE mesh construction. An accurate 3D non-linear FE model of lumbar motion segment (L4-L5) was developed and validated against published data. Results: The constructe d FE model of lumbar L4-L5 consisted of 94 794 solid elements, 1 196 link elements, 1 170 shell elements, 768 target elements and 464 contact elements, and included geometrical, material and contact non-linearities. The predicted results of lumbar L4-L5 segment were closely correlated with published results of experimental biomechanics in terms of axial displacement, segment rotation and intradiscal pressure under similar load condition. Conclusion: Based on advanced algorithm, this constructed surface model of L4-L5 segment is capable to perform whole digitalized binary image extraction and reconstruction of the lumbar surface with excellent simulation results.

Objective To evaluate the application of tubular stomach gastroesophagostomy on the life quality after esophagectomy surgery.Methods From March 2011 to September 2011,66 cases of esophageal cancer patients were divided in two groups in randomized principles.Tirty-four cases in group of tubiform gastro surgery whose the stomach was cut into tubiform stomach in width of 4 cm.And 32 cases of conventional group and whose surgery method was adopted to maintain whole stomach but cut the cardia.And then,using statistical methods,life quality after esophagectomy (treatment related symptoms,general symptoms,daily life,social life,emotional activities) and the perioperative complications were evaluated in 3,6,12,24 months in comparison and analysis.Results Sixty-six surgeries of both group patients were successfully performed,tumor resection rate was 100％,and there was no intraoperative accident also no perioperative death.There was no statistical significance of perioperative complications of 2 groups (P ＞ 0.05).Life quality of tubiform gastro group had improved apparently more than conventional group at the 3rd,6th,12th and 24th month after surgery(78.68 ±2.23 vs 65.94± 4.13,83.79 ± 2.40 vs 66.84 ± 5.86,86.41 ± 1.94 vs 67.09 ± 4.43,89.02 ± 1.71 vs 68.88 ±3.53,P＜0.05).At each time point,there were statistically significant differences between tubiform gastro group and conventional group on treatment related symptoms,general symptoms,daily life,emotion activities (P ＜0.05).At the 3rd,6th month after surgery,tubiform gastro group and the conventional group had no statistically significant difference in the aspect of social life (P＞0.05).In the conventional group,the evaluation of quality of life at each time point after surgery and before a point in time in the same group showed no statistical significance (P＞0.05).Conclusion Tubiform gastro esophagectomy has a positive influence on life quality of patients of esophageal cancer after surgery prospectively.

Objective To assess Bard3DMax Mesh pre-formed Knitted Polypropylene tension free hernia repair under local anesthesia. Methods Bard 3DMax Mesh was used for inguinal hernia repair in 30 cases under local anesthesia at our department. Results Hernia was successfully repaired in all cases using Bard 3DMax Mesh from the myopectineal orifice through anterior approach under local anesthesia.The mean operation time was (63.1 ± 2.6) min.All cases were able to drink and eat immediately after surgery,there was no postoperative urinary retention.Postoperative pain-free or mild pain was reported in 23 cases,moderate pain in 6,severe pain in only one.Wound healed by first intention in all 30 cases.Two cases suffered from subcutaneous ecchymosis,a seroma above the patch was observed in 2 cases.A inner thigh numb was complained in one case,which subsided 4 months later.Three patients complained below groin area foreign body sensation which disappeared after 1 -5 months. All patients recovered well without recurrence at a mean follow-up of ( 11 ± 7) months. Conclusions Bard 3DMax Mesh tension free inguinal hernia repairing the myopectineal orifice through anterior approach under local anesthesia is safe,and less traumatic.It also helps establish intraoperative diagnosis of combined and occult hernia.

Objective To evaluate the clinical,neuroimaging and electrophysiology features of 62 patients with multiple system atrophy(MSA).Methods Sixty-two cases with diagnosis of probable MSA were recruited in a retrospective studied.Clinical,neuroimage and external anal sphincter electromyography (EAS-EMG)data was retrospectively analyzed.Results In 62 cases(44 male and 18 female),the onset age was between 37 and 76.Among them,29 cases(46.8 % )were MSA-A,with orthostatie hypotension as the main clinical manifestation;24 cases(38.7 % )were MSA-C,with cerebellar ataxia ag the main chnical manifestation;9 cases(14.5 % )were MSA-P,with extrapyramidal symptoms as the main clinical manifestation.MRI showed that main lesion of MSA-A was in the cerebellum:that of MSA-C was in the cerebellum,pons and medulla;and that of MSA-P was in the putamen.Fifty-one cases did EAS-EMG and 46 cases showed neurogenie impairments.Nineteen cases were initially misdiagnosed with other diseases.Conclusions MSA is easy to be omitted or misdiagnosed at early stage.The diagnostie rate of MSA can be increased by the combination of clinical expressions,neuroimage,EAS-EMG and other necessary examinations.

Objective Thoracic cavity fistula following esophagus carcinoma resection is a serious complication with a high mortality.This study aims at a better therapy for thoracic cavity fistula following esophagus carcinoma resection by summarizing the ex-perience with the four-tube strategy ( jejunal fistula tube, stomach tube, chest drainage tube, and nasal fistula tube) in the treatment of the complication. Methods We retrospectively analyzed the clinical data about 62 cases of thoracic cavity fistula following esopha-gus carcinoma resection, 35 treated with the four-tube strategy ( treatment group) and the other 27 with the three-tube ( stomach tube, chest drainage tube, and nasal fistula tube) method ( control group) .We compared the hospital days, wound healing time, mortality, and incidence of anastomotic stenosis at 6 months after operation between the two groups of patients. Results Compared with the controls, the treatment group showed remarkable decreases in the hospital days (P<0.05), wound healing time (P<0.05), and mortality (P<0.05), but no statistically significant difference was observed in the incidence rate of anastomotic stenosis at 6 months after operation between the two groups of patients ( P >0.05 ) . Conclusion Compared with the three-tube method, the four-tube strategy has the advantages of shorter healing time and lower mortali-ty, and therefore is preferable for the treatment of thoracic cavity fis-tula following esophagus carcinoma resection.