Ventral hernia is a very common surgical problem with its incidence gradually increasing due to aging population,and it has significantly threat to quality of life.Laparoscopic hernia repair is a kind of minimally invasive surgery based on tension-free hernia repair,which has become an effective way for treatment of ventral hernia after decades of development.Besides,the classic surgical approaches for adult inguinal hernia include intraperitoneal onlay mesh,transabdominal peritoneal and totally extraperitoneal repairs.However,some related complications including vascular injury and bleeding,postoperative pain,nerve damage,seroma,intestinal obstruction,infection and relapse have been increasingly reported with the extensive applications of laparoscopic ventral hernia repair.Surgeons still need to pay more attentions and take appropriate measures to prevent such events.Complications could be reduced by strictly following the indications of different laparoscopic hernia repair surgeries with a careful consideration of the advantages and disadvantages,understanding their pathogenesis,improving the laparoscopic operation techniques,getting familiar with the local anatomical structures and standardizing the surgical procedures.Establishing a correct and standard surgical training system will further shorten the learning curve of surgeons to promote the progression and development of hernia surgery in China.

Objective To study the diagnostic value of TREM-1,PCT and CD64 in children with sepsis disease and its effect on the application of low dose hormone.Methods 80 cases children with septic disease who received therapy from September 2014 to September 2016 in the third affiliated hospital of wenzhou medical university,28 cases of severe sepsis disease,52 cases of general sepsis disease,and selected 40 cases of healthy children in our hospital during the same period,the levels of TREM-1,PCT,CD64 of three groups were compared.And through the random number table method,those 80 cases children with sepsis disease were divided into the observation group(n=40) and the control group(n=40),the control group was treated with routine treatment,while the observation group was treated with hydroprednisone on the basis of the control group,after treatment for seven days,the levels of TREM-1,PCT,CD64 of two groups were compared.Results The levels of TREM-1, PCT and CD64 in the severe sepsis disease group and general sepsis disease group were higher than the healthy group(P<0.05),and the levels of TREM-1, PCT and CD64 in severe sepsis disease group were significantly higher than the general sepsis disease group(P<0.05).After treatment,the levels of TREM-1,PCT and CD64 were improved in two groups of patients with sepsis disease(P<0.05),after treatment of one day and seven days,the levels of TREM-1,PCT and CD64 in observation group were lower than in the control group(P<0.05).Conclusion TREM-1,PCT,CD64 levels can be used as early detection in children with sepsis disease,low dose glucocorticoid can effectively reduce the expression of TREM-1,PCT and CD64 levels in children with sepsis,it's conducive to the disease control.

This paper reports the optimized electro-transformation parameters of Bacillus thuringiensis plasmid-free mutant strain BMB171 by electroporation, and expressing effect of several cry genes introduced in this recipient. It showed that a highest electro-transformation frequency could be obtained, when SG solution was used as the buffer, and a 10.0V/cm of field strength, one time of pulse as well as a growth phase of recipient cells at the exponential phase (OD650nm value was 0.2~0.3) were selected. The highest of electro-transformation frequency with pHT3101 could reach at 8 ?107 hansformants/?g DNA. The transformation frequencies increased at linear velocity as the concentration increase of pHT3101 from 54.69pg/ml to 3.50?g/mL, then reached saturation afterwards. All plasmids introduced in BMB171 could produce characteristic insecticidal crystal proteins through expression of relevent cry genes carried by them. Meanwhile, these insecticidal crystal proteins could form parasporal crystals, which have characteristic geometric shapes.

Objective:To explore the possibility and methods of surgical treatment(ST) for huge primary liver cancer(HPLC).Methods:The clinical data of 86 HPLC were analyzed retrospectively and the main challenges as well as their counter measures during ST are concluded.Results:Among the 86 cases,there were 10 cases which complicated with portal vein(PV),and 5 cases with IVC thrombus respectively;there were 76 cases with HBV cirrhosis,2 HCV cirrhosis,there were 60 and 26 cases of primary and secondary hepatectomy in which included regular right(9 cases),left hemihepatectomy(8 cases)and combined hepatectomy(69 cases).Six cases received PV embolism before surgery.There were 10 and 5 cases of cancer thrombus extraction from PV and IVC respectively.In this group,81 patients were cured,and the perioperative mortality was 5.8%(5/86).The postoperative one—year survival rate for the patients was 77.9%.Conclusions:ST for HPLC is safe and acceptable.Full of preoperative assessment,careful intraoperative exploration,and surgical skill played a key roles.

Objective To evaluate the efficacy of closed-loop coadministration of propofol and remifentanil guided by Narcotrend index (NI) in laparoscopic cholecystectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic cholecystectomy,were randomized into 2 groups (n =30 each):program regulation group (group P) and artificial regulation group (group A).After the initial target effect-site concentration of propofol was selected,the target effect-site concentration of remifentanil was determined according to the formula.In group A,the target effect-site concentrations of propofol (2-4 μg/ml) and remifentanil (3-4 ng/ml) were adjusted artificially according to anesthesiologists' experience every 5 min to maintain NI value at 26-46.Induction time,anesthesia induction and mean maintenance doses and the initial,highest and lowest target concentrations of propofol and remifentanil,mean NI value,percentage of time with NI between 26 and 46,emergence time,and development of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value and intraoperative awareness were recorded.Results No intraoperative awareness was found in the two groups.Compared with group A,the induction time was significantly shortened,the induction dose and initial target concentration of remifentanil were increased,the mean maintenance dose and lowest target concentration of propofol and remifentanil were decreased,the percentage of time with NI between 26 and 46 was increased,and the emergence time was shortened (P＜0.05 or 0.01),and no significant change was found in the induction dose and initial target concentration of propofol,the highest target concentrations of propofol and remifentanil,mean NI value,or incidence of fluctuation in heart rate or mean arterial pressure ＞ 20％ of the baseline value in group P (P＞ 0.05).Conclusion For laparoscopic cholecystectomy,NI-guided closed-loop coadministration of propofol and remifentanil produces safe and effective anesthesia,and the efficacy of precise administration is superior to that of artificially regulated target-controlled infusion.

Objective To evaluate the effect of heme oxygenase-1 (HO-1) protein transduction on acute lung injury in septic rats.Methods Eighteen healthy male Sprague-Dawley rats,aged 7-9 weeks,weighing 210-260 g,were randomly allocated into 3 groups (n =6 each) using a random number table:sham operation group (group Sham),sepsis group (group Sep),and fusion protein PEP-1-HO-1 group (group HO).Sepsis was produced by cecal ligation and puncture (CLP).In group HO,PEP-1-HO-1 fusion protein 0.6 mg was injected via the left iliac vein at 1 h before CLP and 5 h after CLP.The equal volume of normal saline was given instead of PEP-1-HO-1 in Sham and Sep groups.At 12 h after CLP,blood samples were collected from the right common carotid artery for measurement of serum tumor necrosis factoralpha (TNF-α) and interleukin-6 (IL-6) concentrations.The rats were then sacrificed,and lungs were removed for microscopic examination and for determination of wet/dry lung weight ratio (W/D ratio) and malondialdehyde (MDA) content (by thiobarbituric acid colorimetric method).Results Compared with group Sham,the W/D ratio and MDA content were significantly increased,the serum TNF-α and IL-6 concentrations were significantly increased (P＜0.05),and the pathological changes were significantly aggravated in Sep and HO groups.Compared with group Sep,the W/D ratio and MDA content were significantly decreased,the serum TNF-α and IL-6 concentrations were significantly decreased (P＜0.05),and the pathological changes were significantly attenuated in group HO.Conclusion HO-1 protein transduction can attenuate acute lung injury in septic rats,and the mechanism is probably related to inhibition of lipid peroxidation in lung tissues and systemic inflammatory responses.

BACKGROUND: Long-term radioactive ray accumulation leads to surrounding tissues fibrosis accompanied by limitation of mouth-opening, which seriously affects life quality of tumor patients. OBJECTIVE: To observe pathological change of soft tissues in rats with radiation masseter injury and the level of transforming growth factor β1 (TGF-β1) mRNA expression in vivo.METHODS: A total of 30 Wistar rats were randomly divided into control group (n=10) and radiated group (n=20). Radiated group were radiated with linear accelerator at a dose of 40 Gy. The pathological changes of vessels were observed under light microscope and electron microscope and expression of TGF-β1 was detected by RT-PCR. RESULTS AND CONCLUSION: The microvessel density of radiated group was obviously decreased than that of the control group (P < 0.01), but the mRNA expression of was higher than that in the control group (P < 0.01). It suggests that radiated injury can induce fibrosis to repair the radiated injury.

Objective To evaluate the effect of losartan on mechanical ventilation-induced lung injury in diabetic mice.Methods Forty-eight female SPF C57/BL6 nice,aged 10-12 months,weighing 20-25 g,were randomly assigned into 3 groups (n =16 each):control group (group C).,diabetes + mechanical ventilation (group DM) and losartan group (group L).Diabetes mellitus was induced by intraperitoneal streptozotocin 150 mg/kg and confirmed by blood glucose level ＞ 16 mmol/L in groups DM and L.Diabetic mice were mechanically ventilated (FiO250％,VT 15 ml/kg,RR 70 bpm,PEEP 2 cm H2O) for4 h.Losartan 30 mg/kg was injected intraperitoneally 30 min before ventilation in group L.Eight mice from each group were chosen at 4 of ventilation and arterial blood samples were obtained for detection of PaO2.The animals were then sacrificed and the lungs were removed for determination of W/D lung weight ratio,myeloperoxidase (MPO) activity,pulmonary microvascular permeability,angiotensin Ⅱ (Ang Ⅱ) receptor AT1 mRNA expression (by RT-PCR),Ang Ⅱ content and nuclear factor kappa B (NF-κB) p65 expression (by Western blot).Results Compared with group C,PaO2 was significantly decreased,while W/D lung weight ratio,MPO activity,pulmonary microvascular permeability and Ang Ⅱ content were significantly increased,and the expression of AT1 mRNA and NF-κB p65 was up-regulated in groups DM and L (P ＜ 0.05).PaO2 was significantly higher,and W/D lung weight ratio,MPO activity,pulmonary microvascular permeability,Ang Ⅱ content and the expression of AT1 mRNA and NF-κB p65 were significantly lower in group L than in group DM (P ＜ 0.05).Conclusion Losartan can reduce mechanical ventilation-induced lung injury in diabetic mice through inhibiting AT1 receptor and Ang Ⅱ levels and improving pulmonary microvascular permeability and inhibiting NF-κB activation.

Objective To investigate the effect of electro-acupuncture at zusanli on Severe thermal injury-induced acute lung injury in rats.Methods Forty male SD rats weighing 200-250 g were used in this study.Thirty percent of the total body surface (TBS) was shaved chemically with 20% sodium sulfate and then exposed to 99-100℃ water for 12 s.The animals with third degree thermal injury involving 30% TBS were randomly divided into 5 groups(n=8 each):group Ⅰ control(group C);groupⅡ thermal injury;group Ⅲ electro-acupuncture at zusanli;group Ⅳ electric stimulation of non-acupoint and group Ⅴ electro-acupuncture at zusanli+α-bungarotoxin α-BGT).In group Ⅲ,Ⅳ,and Ⅴ electro-stimulation(3 v,2 ms,3 Hz) of zusanli or non-acupoint was performed for 12 min immediately after thermal injury model was established and every 8 h.hung specimens were obtained at 48 h after thermal injury for microscopic examination.The pulmonary HMGB-l protein level was measured by ELISA.The expression of HMGB-1 mRNA and protein in the lung was determined by RT-PCR and immuno-histochemistry respectively.Results Thermal injury induced leucocytosis in the interstitial capillaries,interstitial edema,intra-alveolar fibrin deposit,blebbing of type Ⅱ alveolar lining cells and decrease in lamellar body.Both expression of HMGB-1 mRNA and protein in the lung was significantly enhanced at 48 h after thermal injury.Electrical stimulation of zusanli significantly down-regalated the expression of HMGB-1 mRNA and protein in the lung.However,α-BGT pretreatment reversed the effects of electrical stimulation of zusanli.Conclusion Electrical stimulation of zusanli could significantly ameliorate severe thermal injury-induced acute lung injury through inhibition of HMGB-1 mRNA and protein expression and activation of cholinergic anti-inflammatory pathway mediated by nicotinic acetylcholine receptor α7 subunit.

Objective To evaluate the effect of electro-acupunctare at Zusanli on liver injury in a rat model of sepsis after scald.Methods Fifty SPF male Sprague-Dawley rats,weighing 200-250 g,aged 2-3 months,were randomly divided into 5 groups (n =10 each) using a random number table:control group (group C); sepsis after scald group (group SS); electro-acupuncture at Zusanli group (group E); electric stimulation of non-acupoint group (group NE); electro-acupuncture at Zusanli + α-bungarotoxin (α-BGT) group (group α-BGT).The rats were subjected to a third degree scald covering 20％ of the total body surface area (TBSA) and sepsis was induced with muramyl dipeptide (MDP) 5 mg/kg injected into the femoral vein immediately after scald.Electro-stimulation (3 V,2 ms,3 Hz) of bilateral Zusanli acupoints or non-acupoints was performed for 12 min every 8 h for 2 consecutive days starting from the time point immediately after MDP was injected in group E.In group NE,electro-stimulation was performed at the points 5 mm lateral to the acupoints of bilateral Zusanli and the method was similar to those previously described in group E.In group α-BGT,α-BGT 1.0 μg/kg (in normal saline 1 ml) was injected into the femoral vein before electric stimulation,then electro-stimulation was performed and the method was similar to those previously described in group E.After 48 h of continuous stimulation,liver specimens were obtained for microscopic examination of the pathological changes.The blood samples were obtained from the abdominal aorta for determination of the levels of serum ALT and AST,tumor necrosis factor-alpha (TNF-α),and high mobility group box-1 (HMGB1) (by ELISA),and expression of Nod-like receptor 2 (NLR2) mRNA (by RTPCR) and receptor-interacting protein 2 (RIP2) in the liver tissues (by Western blot).Results The serum ALT and AST,TNF-α and HMGB-1 levels and NLR2 mRNA and RIP2 expression in liver tissues were significantly higher in SS group than in C group.Compared with SS group,the serum ALT,AST,TNF-α and HMGB1 levels were significantly decreased and NLR2 mRNA and RIP2 expression was down-regulated in E group,and no significant changes were found in the parameters mentioned above in NE group.Compared with E group,the serum ALT,AST,TNF-α and HMGB1 levels were significantly increased,and NLR2 mRNA and RIP2 expression was up-regulated in α-BGT group.The pathological changes in liver tissues were significantly reduced in group EA as compared with SS,NE and α-BGT groups.Conclusion Electro-acupuncture at Zusanli can reduce liver injury in a rat model of sepsis after scald and inhibition of NLR2/RIP2 signaling pathway and activation of cholinergic antiinflammatory pathway mediated by α7 nicotinic acetylcholine receptors in liver tissues may be involved in the mechanism.