Objective To explore the effect of transabdominal preperitoneal prosthetic(TAPP) repair combined with intraperitoneal onlay mesh(IPOM) on laparoscopic repair of inguinal hernia.Methods From January to December 2006,laparoscopic hernioplasty was performed on 30 adult patients with inguinal hernia.The hernia area was divided into two parts by the subperitoneal vessel across the area.The medial part was repaired by TAPP using polypropylene patch,and the lateral part was repaired by IPOM with Proceed patch.During to operation,an incision was made on the peritoneum along the subperitoneal vessel,and then the peritoneum was separated medially to expose an operative area(7.5 cm?6.5 cm),which was an avascular area with loose connective tissues and few vital nerves.Results All the operations were accomplished under epidural anesthesia.The operative time was 30-40 min(mean 35 min) for unilateral hernia,and 50-60 min(mean 55 min) for bilateral ones.The amount of blood loss during the operation was 1-5 ml.The patients could walk on the second day after the operation.They were discharged from the hospital 3-4 days after the operation,and were back to work in 2 weeks.During a 2-12-month follow-up(mean,9 months),no adhesive intestinal obstruction and local or systemic complications was observed.Conclusions The combined technique of IPOM and TAPP is a minimal invasive method with confirmed efficacy.By using this easily mastered method,the operative time is reduced,and the patients can recover quickly.

Objective To evaluate mid-term clinical effects of laparoscopic intraperitoneal onlay mesh herniorrhaphy (IPOM) for adult inguinal hernia. Methods A retrospective analysis was made on 546 cases of inguinal hernia treated by IPOM (603 sides) between June 2002 to December 2004. We closed the hernia sac by the lift-insert method following with the implantation of the Prolene mesh with the help of a stapler. Results The operation was successfully completed in all the cases, except for 2 cases of conversions to open surgery because of difficulties in covering the defects. There were no intraoperative complications, and 5 cases of postoperative seroma which subsided after physical therapy. The operative time was 25~40 min (mean, 31 min), and the hospital stay was 36~72 h (mean, 46 h). Follow-up observations for 18~48 months (mean, 28 months) found 6 cases of recurrence, with the recurrence time at 30~45 months (mean,38.2 months). The racurrence rate was 0.995%. Conclusions Laparoscopic intraperitoneal onlay mesh herniorrhaphy a minimally invasive method with reliable outcomes, low recurrence rate, and rapid recovery.

Objectives: To clarify the diagnostic value of sTFR and its compound parameters sTFR/SF, sTFR/logSF in the differential diagnosis of IDA, ACD and CDID. Methods: Forty nine anemia patients were classified into IDA, ACD and CDID by clinical presentations and the laboratory results. The serum concentration of sTFR was detected by ELISA. The difference of sTFR, sTFR/SF, sTFR/logSF and routine parameters in the three groups and the correlation among sTFR and routine parameters were analyzed. Using ROC curve, the diagnostic value of these parameters in the differential diagnosis of the three diseases were compared. Results: The serum concentration of sTFR in the IDA, ACD and CDID were (50.8?8.2)nmol/L, (33.5?6.9)nmol/L and (22.7?9.9)nmol/L,respectively. The differences among three groups were significant( P

Objective To retrospectively analyze clinical manifestations of autonomic nervous system (ANS) and skin sympathetic response (SSR) in Lambert-Eaton myasthenic syndrome (LEMS).Methods Fifty-three LEMS patients' medical records were reviewed and information regarding clinical symptoms and signs of ANS and SSR testing results were collected.Results ( 1 ) The most common initial symptom of LEMS was weakness of lower extremities ( n =41 ) and the most common symptom of ANS dysfunction was constipation ( n =25 ) and dry-mouth ( n =23),which could be occurred before the onset of the legs (n =7).(2) In symptoms of ANS,cardiovascular system dysfunction was found in 4 patients include one of ingone of bradycardia,one of postural hypotension and 2 of tachycardia- Secretory glands dysfunction was found in 34 patients:23 dry-mouth,6 dry-eyes,and 8 patients sweating dysfunctions.Twenty-eight patients complained of alimentary dysfunction including constipation and diarrhea.Bladder dysfunction was found in 2 patients,who complained of urinary incontinence.Seven male patients complained of sexual dysfunction.Abnormal skin scratch test was found in 17 patients.(3) SSR was performed in 33 patients and 18 found abnormal.Conclusions ANS manifestations are common and prominent in LEMS patients.SSR abnormality is also common in LEMS.More electrophysiology tests are needed in LEMS patients.

AIM: To investigate the effect of Ginkgo Biloba Extract on coronary blood flow in patients with coronary artery disease(CAD). METHODS: Ninety CAD patients confirmed by cardioangiography were randomly assigned to Ginkgo Biloba Extract Injection group(n=45) and control groups(n=45).Before and after intravenous administration,the distal left anterior descending coronary artery(LAD) flow was measured by transthoracic Doppler echocardiography. RESULTS: Ginkgo Biloba Extract Injection treatment demonstrated significant improvement in diastolic peak velocity,systolic peak velocity and diastolic time velocity integral(P0.05). CONCLUSION: CAD patients in the treatment of Ginkgo Biloa Extract lead to the increase in LAD blood flow.

Objective To explore the relationship between cervical spondylotic radiculopathy (CSR) and carpal tunnel syndrome (CTS) by investigating their electrophysiological characteristics and the incidence of CSR root injury and root injury complicating with CTS.Methods One hundred and twenty-four cases of CSR diagnosed in Peking Union Medical College Hospital from September 2013 to February 2014 by electromyography (EMG) were recruited.According to the results of EMG,patients were divided into root injury and root injury complicating with CTS groups.The distal motor latency (DML),motor nerve conduction velocity (MCV),sensory nerve conduction velocity (SCV),sensory nerve action potential (SNAP),compound muscle action potential (CMAP) and spontaneous potential (SP) were compared between the two groups.Results There were 81 (65.3％) cases with root injury,11 cases with double sides injury and 29 cases with normal EMG among these 124 patients.The CMAP,DML,MCV,SCV and SNAP were normal in 76 cases,CMAP lowered 5％-12％ in 3 cases,DML extended 3％ and 9％ in 2 cases.There were 14 cases (11.3％) with concomitant CTS (female 10 cases and male 4 cases,double sides CTS 10 cases).Among the 14 cases with concomitant CTS,there were 9 cases with simply sensory nerve conduction abnormality,SCV slowing down 26％-47％,SNAP reducing 58％-86％ or normal,while other 5 cases with motor conduction abnormality as well as sensory nerve conduction abnormality,CMAP reducing 21％-78％,DML extending 27％-39％ in 3 cases,MCV slowing down 32％ and 40％ in 2 cases.Five cases had spontaneous electricity position movement in the abductor pollicis brevis.The incidence of root injury complicating with CTS in C6 (27.4％,9/33),C7 (26.9％,7/26) and C8 (5/7) showed statistically significant difference (x2 =5.96,P ＜ 0.01).Conclusions There is a high incidence of root injury and CTS in CSR patients,indicating a possible double crush between CSR and CTS.

Objectives To assess the value of external anal sphincter electromyography (EASEMG) in evaluating the related autonomic dysfunction in Parkinson's disease ( PD), parkinsonism dominant multiple system atrophy (MSA-P) and progressive supranuclear palsy (PSP). Methods From the records of EAS-EMG collected in our lab (total 562 cases), 60 PD (male 41, female 19), 68 MSA-P (male 35,female 33) and 13 PSP (male 10, female 3) were included in the analysis in this study. Mean duration,polyphasic ratio and satellite potential occurrence rate were comparable among the groups. Mean duration prolongation were graded as normal ( ＜ 10.0 ms), mild ( 10.0-11.9 ms), moderate ( 12.0-13.9 ms)and severe ( ≥ 14.0 ms). Results Among all related autonomic symptoms, the occurrence rate of constipation, urinary incontinence, urgency and frequency in patients with MSA-P(95.8% (23/24) ,94.6% (53/56) ,87.7% ( 50/57 ), 85.7% (42/49), 76.5% ( 39/51 ) ) were higher than that of PD ( 61.5%(16/26), 62.3% (33/53), 30.6% (15/49), 46.2% (24/52), 45.7% (21/46)) and PSP (75.0%(3/4) , 62.5% (5/8), 50.0% (4/8), 42.9% (3/7), 42.9% (3/7)). The abnormal rate of EAS-EMG in PD, MSA-P and PSP were 60.0%, 94.2% and 84.6%, accordingly. Mean duration ( PD ( 12.0 ± 1.6)ms, MSA-P (15.4±3.0) ms, PSP (13.8±1.8) ms), polyphasic ratio (PD 46.2% ±19.2%, MSA-P 63.9% ± 15.8%, PSP 51.5% ± 12.1% ) and satellite potential occurrence rate ( PD 9.5% ± 8.3%,MSA-P 26.5% ± 15.9%, PSP 19.2% ± 12.5% ) varied significantly different among the groups ( F =31.724, F = 17.412, x2 =45. 335, all P ＜0.01 ). Severe mean duration prolongation was overwhelming in MSA-P (66.2% ) , compared with mild 10.3% and moderate 23.5%. The predominant prolongation degree was moderate in PSP (61.5%, mild 7.7%, severe 30.8% ), and mild in PD (36.7%, moderate 36.7% ,severe 11.7%, normal 15.0% ). Conclusions EAS-EMG could play a role in evaluating the related autonomic dysfunctions in PD, MSA-P and PSP. The EAS-EMG impairment was severe and frequent in MSA-P, mild and infrequent in PD, moderate in PSP. The spectrum of mean duration prolongation suggested the possibility of Onuf's nucleus involvement in these diseases.

Objective To investigate the effects of aldosterone on the expression of endothelin(ET)in cultured neonatal rat cardiac fibroblasts(CFs).Methods CFs were isolated by trypsin digestion.ET concentration in conditioned medium was measured by radioimmunoassay,intracellular ET-1 level was evaluated by immunofluorescence assay,and the expression of preproendothelin-1(ppET-1)was detected using reverse transcriptase-polymerase chain reaction(RT-PCR)method.Results Aldosterone(10-9,10-8,10-7 mol/L)induced a dose-dependent changes in ppET-1 mRNA expression,as well as ET-1 synthesis and secretion in CFs.Meanwhile,aldosterone(10-7 mol/L)time-related induced ppET-1 mRNA expression in CFs,which began to increase in 2 h and reached the highest level in 4 h,thereafter decreased.The effects of aldosterone(10-7 mol/L)were significantly inhibited by the pre-incubation with spironolactone(10-6 mol/L).Conclusion Aldosterone increases the expression of ppET-1 mRNA,ET-1 synthesis and secretion via mineralocorticoid receptor.

Objective To determine whether peripheral nerve ultrasound can differentiate CharcotMarie-Tooth type 1 (CMT1) from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Methods Eighteen patients with CIDP,13 patients with CMT1 and 16 healthy controls were recruited prospectively from Peking Union Medical College Hospital between January 2014 and July 2015 for this study.Ultrasonographic tests were performed via nerve tracing from wrist to axilla on median and ulnar nerve with a 10 MHz linear array probe.The cross sectional areas (CSAs) were measured at 10 defined sites of the nerves,respectively.Results CSAs (mm2) at all sites of median nerve were significantly increased in CMT1 than in CIDP (10.5 ±5.3 vs7.8 ±2.4,10.9 ±3.6 vs 6.8 ±1.9,11.5 ±5.0 vs7.3 ±1.8,13.5 ± 4.4vs7.2±2.5,16.0±4.5vs7.2±2.1,17.1±5.1vs7.0±2.8,21.0±4.5vs9.5±4.8,24.3±6.9 vs 9.5 ±4.3,23.9 ±6.0 vs 10.2 ±4.3,22.4 ±6.7 vs 9.8 ±2.1;t=2.141,4.766,2.935,4.858,6.715,6.602,7.148,7.100,8.078,6.498,respectively,all P ＜ 0.05).CSAs (mm2) at all sites of ulnar nerve were significantly increased in CMT1 than in CIDP (7.9 ± 1.8 vs 4.0 ± 1.3,8.9 ± 2.0 vs 4.9 ± 1.3,13.5±1.9 vs6.5±2.4,15.0±4.3 vs 6.5 ±1.5,15.8 ±4.4 vs 6.8 ±3.3,11.6±2.3 vs6.9± 3.1,10.2±3.2vs7.6±2.8,14.0±3.0vs6.6±2.1,19.2±3.7vs7.6±4.4,18.1±3.6vs6.3± 2.5;t =7.652,7.414,9.194,6.893,6.443,4.766,2.561,7.897,8.113,11.554,respectively,all P ＜ 0.05).CSAs at 8 sites of median nerve and 8 sites of ulnar nerve were significantly increased in CIDP than in healthy controls.Receiver operation characteristic curve analysis revealed that CSA was suited for differentiating CMT1 from CIDP,and the area under curve in 8 sites of median nerve and 9 sites in ulnar nerve was more than 0.9.Conclusions CSAs measured at different sites by peripheral nerve ultrasound in CMT1 were significantly increased than in CIDP.Measurement of CSAs by peripheral nerve ultrasound can be used for differentiating CMTI from CIDP.

Objective To explore the effect of traumatic brain injury on the fracture healing and its related mechanism by observing the expression of platelet-derived growth factors (PDGF) in serum and bone callus in rats with bone fracture and cerebral trauma.Methods One hundred and forty-four SD rats were randomized into 4 equal groups (n =36) which were subjected respectively to:no treatment (group N),traumatic brain injury (group TBI),bone fracture (group F) and bone fracture and cerebral trauma (group TBI + F).The animals were sacrificed at 3 days,1,2,3 and 4 weeks after modeling.In all the 4 groups,ELISA was used to detect the expression of PDGF in serum.In groups F and TBI + F,the callus growth was observed at the right tibial fracture site by X-ray,the callus growth and morphology were also observed by HE staining,the expression of PDGF in the callus tissue was measured by immunohistochemieal analysis,and the expression of PDGF mRNA in the callus tissue was measured by RT-PCR.Results X-ray showed that fracture healing was accelerated in group TBI + F compared with group F.The serum expression of PDGF in group TBI + F was significantly higher and the peak time was significantly earlier than in the other 3 groups (P ＜ 0.05).H-E staining showed that osteoblastic activity at the fracture ends in group TBI + F was stronger than in group F.Inmunohistochemica[staining showed that the expression of PDGF in the local callus was significantly higher at 3 days and 1 week in group TBI + F and the peak time was significantly earlier than in group F (P ＜ 0.05).RT-PCR showed that the expression of PDGF mRNA in the local callus was significantly higher at 3 days and 1 week in group TBI + F than in group F (P ＜0.05).Conclusions Traumatic brain injury can promote fracture healing in rats,which is probably related to increased expression of PDGF after cerebral trauma.