Objective:To investigate the long-term clinical value of composite biomaterial mesh in inguinal hernia repair.Methods:The prospective randomized controlled non-inferiority study was conducted. The clinical data of 172 adult patients with inguinal hernia who were admitted to 3 medical centers, including Huadong Hospital Affiliated to Fudan University et al, from July 2014 to February 2015 were selected. Based on random number table, patients were divided into two groups. Patients underwent technique of abdominal wall reinforcement with biological mesh. Patients using the electrospun composite biomaterial mesh were allocated into experimental group, and patients using the small intestinal submucosa mesh were allocated into control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) endpoint of the study. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Taking the recurrence rate of hernia at 6 years after surgery as the basis of efficacy evaluation, the Cochran-Mantel-Haenszel test was used for comparison between groups. The confidence interval method was used to conduct non-inferiority statistical analysis. If the lower limit of 95% confidence interval of the difference of recurrence rate of hernia between the experiment group and the control group was more than -10%, the experiment group was considered to be non-inferior to the control group. If the lower limit of 95% confidence interval is more than 0, the experiment group was considered to be superior to the control group. Results:(1) Grouping situations of the enrolled patients. A total of 172 adult patients with inguinal hernia were selected for eligibility. They were males, aged (61±2)years. All 172 patients were randomly divided into to the experimental group and the control group with 86 cases in each group. At 6 years after surgery, 20 patients in the experi-mental group and 19 patients in the control group was lost to follow-up. (2) Endpoint of the study. ① The primary endpoint of study. At 6 years after surgery, no patient had recurrence in the 66 patients of experimental group and 4 patients had recurrence in the 67 patients of control group. Results of non-inferiority statistical analysis showed that the 95% confidence interval of the difference of recurrence rate of hernia between the two groups was 0.27% to 14.41%, with the lower limit as 0.27%, which was more than -10% and simultaneously more than 0. ② The secondary endpoint of study. There was no significant difference in the simple verbal scale between the two groups after 6 months and 6 years at rest or cough status ( P>0.05). At a follow-up of 6 months after surgery, 2 cases of the experimental group and 5 patients of the control group had complications, showing no significant difference between the two groups( χ2=1.38, P>0.05). At a follow-up of 6 years after surgery, no complication occurred in either group. Conclusion:Composite biological mesh in inguinal repair is safe and feasible, which can have low long-term recurrence and achieve good long-term efficacy.

Objective:To evaluate the myocardial work of patients with different degrees of coronary artery stenosis with normal left ventricular ejection fraction and no segmental ventricular wall motion abnormality by left ventricular pressure-strain ring (PSL), and to explore the clinical value of myocardial work parameters in predicting severe coronary artery stenosis.Methods:The data of 238 patients undergoing coronary angiography (CAG) in the Affiliated Hospital of Jining Medical University from December 2020 to August 2021 was prospectively collected. According to the results of CAG, the patients were divided into control group, moderate stenosis group, severe stenosis (1-2 branches) group, severe stenosis (complex multiple branches) group. Global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global work waste (GWW) and global work efficiency (GWE) were measured by PSL. Univariate and multivariate logistics regression were used to analyze the influencing factors of severe coronary artery stenosis. The receiver operating characteristic (ROC) curve was constructed to analyze the predictive value of GLS, GWI, GCW, GWW and GWE for severe coronary artery stenosis.Results:The GLS, GWI, GCW and GWE in severe stenosis group were lower than those in control group and moderate stenosis group (all P<0.05), while GWW was higher than those in control group and moderate stenosis group (all P<0.05); the GWI, GCW and GWE in severe stenosis (complex multiple branches) group were lower than those in severe stenosis (1-2 branches) group (all P<0.05), while GWW was higher than those in severe stenosis (1-2 branches) group (all P<0.05). Multivariate logistic regression analysis showed that GWE was an independent influencing factor for severe coronary stenosis ( OR=0.266, P<0.05). Compared with GLS, GWI, GCW and GWW, GWE had the largest area under the curve (0.920) to predict severe coronary stenosis, with sensitivity of 92.24% and specificity of 73.77%. The intra observer and inter observer correlation coefficients of GWI, GCW, GWW and GWE analyzed by two ultrasound physicians were 0.916 and 0.907, 0.989 and 0.981, 0.932 and 0.955, 0.931 and 0.937, respectively, which showed good repeatability. Conclusions:PSL provides a new method for quantitative evaluation of left ventricular systolic function in patients with coronary artery stenosis. GWE can be used as a sensitive indicator to predict patients with severe coronary artery stenosis, and is worth to be popularized and applied in the clinical.

Objective:To investigate the diagnostic value of Chinese-thyroid imaging reporting and data system (C-TIRADS) combined with shear wave elastography (SWE) in thyroid microcarcinoma.Methods:The clinical data of 270 patients (367 nodules) who underwent thyroid ultrasound examination and confirmed by pathology from January 2019 to June 2021 in the Affiliated Hospital of Jining Medical University were analyzed retrospectively. All patients were assisted by SWE in preoperative ultrasound examination to measure the maximum elastic modulus (E max), the average elastic modulus (E mean) and the minimum elastic modulus (E min). The receiver operating characteristic (ROC) curve was drawn to get the optimal threshold of SWE according to the pathological results. The diagnostic value of C-TIRADS, SWE and their combined in different diameters thyroid micronodules was analyzed. Results:Among 367 thyroid nodules, 119 nodules were benign and 248 nodules were malignant. The area under the curve (AUC) of E max in diagnosing TMC was significantly larger than that of E mean and E min (0.883 vs. 0.822 and 0.706), and there was statistical difference ( P<0.05); the best cut-off value of E max was 29.5 kPa. The ROC curve analysis results showed that the AUC of C-TIRADS combined with SWE in diagnosis of TMC was significantly larger than that of C-TIRADS and SWE alone (0.884 vs. 0.800 and 0.853), and there was statistical difference ( P<0.05); the sensitivity, accuracy and negative predictive value of C-TIRADS combined with SWE in diagnosis of TMC were significantly higher than those of C-TIRADS alone (90.32% vs. 80.24%, 89.10% vs. 80.11% and 81.10% vs. 65.97%), and there were statistical differences ( P<0.05). Thyroid nodules were divided into ≤0.5 cm nodules (56 nodules) and 0.5 to 1.0 cm nodules (311 nodules) according to the maximum diameter, the sensitivity and accuracy of C-TIRADS combined with SWE in diagnosing TMC in 0.5 to 1.0 cm nodules were significantly higher than those in ≤0.5 cm nodules: 91.82% (202/220) vs. 78.57% (22/28) and 90.68% (282/311) vs. 80.36% (45/56), and there were statistical differences ( χ2 = 4.99 and 5.20, P<0.05), but there was no statistical difference in specificity between 2 groups ( P<0.05). Conclusions:C-TIRADS combined with SWE can further improve the diagnostic value of TMC, which is worth popularizing and applying in clinic.

Thyroid cancer and breast cancer are two of the most common malignant tumors in women. Concurrent tumors of the thyroid and breast are relatively rare in clinical practice; however, the incidence of such dual malignancies has recently increased. Researches conducted in the past mainly focused on the possible increase in the incidence of contralateral breast cancer, while the increased risk of synchronized thyroid cancer in women with breast cancer has attracted widespread attention recently. The specific mechanism has not been fully understood. This article reviews the pathogenic factors between these two diseases, and evaluates the etiological role of these factors in these double primary cancers, so as to provide a better basis for clinical practice.

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 probe how to ensure and improve the teaching quality of full-English-teaching in Medical Imagology for international MBBS students.Methods 144 MBBS international students and 13 full-English-teaching teachers in Kunming Medical University (KMU) were enrolled.Nationality of international students,development of teaching staff and teaching mode were studied by analysis of basic data and questionnaire.Results MBBS students of KMU are mainly from South Asia countries where students' pronunciation is different to England and America;the full-English-teaching staff of Medical Imagology are excellent teachers with good English and professional knowledge,but professional communicative ability in English is still needed to be improved;most students regarded inspiring-teaching-method as a useful way to enhance interesting and efficiency and teachers were sure that this method could improve teachers' comprehensive ability.Conclusion Inspiring-teaching-method is worth of further developing and extending because it is useful in promoting the communication between teachers and international students,in developing the teachers' professional communicative competence in English,and in improving students' learning interesting and efficiency.

ObjectiveTo investigate the protective effects of panax quinquefolium 20s-protopanaxtriol saponins (PQTS) on ventricular remodeling in rats with pressure overloaded hypertrophic myocardium.Methods Wister rats were randomly divided into operation,model,positive captopril,and low,moderate,high PQTS groups.The model of pressure overload-induced ventricular remodeling was established through the method of rat's abdominal aorta deligation.After 6 weeks of PQTS treatment ( 12.5,25.0 and 50.0 mg · kg-1 · d-1,i.p),myocardial morphological and hemodynamic parameters were determined.The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD)in serum,and the concentrations of prostacycline (PGI2),thromboxane A2 (TXA2),endothelium (ET) and angiotensin Ⅱ( Ang Ⅱ ) in plasma were also determined.ResultsCompared with remodeling group,PQTS could inhibit myocardial pathological changes,decrease significantly ventricular weight and cardiac coefficient,increase significantly systolic blood pressure,diastolic blood pressure,mean arterial pressure,left ventricular systolic pressure and the maximum left ventricular pressure rising and dropping rates(dp/dtmax),reduce the heart rate and left ventricular end-diastolic pressure in ventricular remodeling rats.PQTS could also decrease the content of MDA and enhance significantly activity of SOD in serum.In addition,PQTS could decline the contents of ET,Ang Ⅱ and TXA2 in plasma while increase significantly the content of PGI2 in plasma and PGI2/TXA2 ratio(P＜0.05 or P＜0.01).ConclusionsPQTS has protective effects on ventricular remodeling through improving systolic and diastolic function in ventricular remodeling rats,increasing anti-oxidase activity,reducing the damage of free radicals and vasoactive substance onmyocardium,and correcting disequilibrium of PGI2/TXA2 in ventricular remodeling rats.

Objective To investigate the effect of a selective cyclooxygenase-2 inhibitor on tumor metastasis,tumor angiogenesis,and vascular endothelial growth factor(VEGF)of orthotopic implanted human gastric carcinoma in non.obesity diabetes(NOD)severe combined immune deficiency(SCID)mice.Methods Human gastric cancer SGC-7901 tissues were orthotopically implanted into the stomach of the NOD SCID mice.Forty mice were randomly divided into two groups which received either intravenous injections of 0.9% Nacl solution (0.9% NaCL solution group)or 50mg/kg.d Nimesulide(Nimesulide group)twice weekly for two weeks.Mice were sacrificed in the 5th week after implantation.Tissues from stomach and other organs were obtained for histopathologieal evaluation.The intratumoral microvessel density(MVD)and VEGF protein expression in tumor were evaluated by immunochemical method.Results The tumor metastasis rates were 18/20 in 0.9% Nacl solution group and 5/20 in Nimesulide group(P＜0.05).MVD was 9.5±2.9 in 0.9% NaCl solution group and 3.9±2.1 in Nimesulide group(P＜0.01).VEGF protein expression was 90% in 0.9%NaCl solution group and 25% in Nimesulide group(P＜0.01).Conclusions Nimesulide can inhibit the metastasis or gastric cancer through inhibiting tumor VEGF expression and tumor angiogenesis with no obvious anticoagulant activity.

Objective To observe the mechanism of action of panax quinquefolium diolsaponins (PQDS) on anti-ventricular remodeling in rats. Methods The model of pressure-loading ventricular remodeling was established through the method of rat’s abdominal aorta deligation. The male Wistar rats were divided into 5 groups,including sham operation group,remodeling model group,Benazepril group,and low and high dose groups of PQDS. The rats were treated with PQDS (with dose of 50 and 100 mg?kg-1 i.g) for 6 weeks. The rats in sham operation group and remodeling model group were treated with normal sodium (with dose of 10 mL?kg-1?d-1 i.g) for 6 weeks. The rats in masculine medicine group were treated by Benazepril (with dose of 10 mg?kg-1 i.g) for 6 weeks. After 6 weeks of treatment,myocardial morphological parameters,the content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in serum,the contents of prostacycline (PGI2),thromboxane A2 (TXA2),nitric oxide (NO) and angiotensinⅡ (AngⅡ) in plasma were determined. At the same time,the contents of endothelium (ET) in plasma and myocardium were also determined. Results Compared with remodeling model group,the ventricular weight and cardiac coefficient were decreased significantly in the rats treated with PQDS (P0.05). Conclusion PQDS has protective effects on ventricular remodeling through increasing anti-oxidase activity,reducing the damage of free radicals and vasoactive substance on myocardium and correcting disequilibrium of PGI2/TXA2 in ventricular remodeling etc.