Objective To explore the medium and long term curative effect of laparoscopic treatment of incarcerated indirect inguinal hernia and summarize the experience of laparoscopic treatment and the characteristics of incarcerated indirect inguinal hernia.Methods A retrospective summary was made on clinical data of 170 children with incarcerated hernia who underwent laparoscopic surgery between January 2016 to February 2024,including 109 boys and 61 girls.The patient's age ranged from 11 days to 11 years old,with a median of 8 months and 27 days.There were 88 cases of right incarcerated hernia and 82 cases of left incarcerated hernia.The incarcerating time (from onset to surgery) was 0.5-360 h,with a median time of 24 h.Results The surgical time was 11-191 min (mean,51.9±29.5 min).Conversion to open surgery was required in 20 cases,in which 14 cases were engaged through the inguinal region for reduction of incarcerated organ and removal of necrotic organ,and 6 cases were treated through umbilical incisions (4 cases of intestinal resection and anastomosis and 2 cases of ileal repair).Most of incarcerated organs among them were small intestine (ileum,84 cases),followed by the ovaries and fallopian tubes (53 cases),and ileocecal region (15 cases),as well as the greater momentum (11 cases).During the surgery,148 cases underwent manual reduction through laparoscopic surgery,14 cases underwent open inguinal region reduction,and 8 cases underwent self-reduction.There were 5 cases ( 2.9％) of small intestinal necrosis,3 cases (1.8％) of greater omentum necrosis,2 cases (1.2％) of small intestine perforation,2 cases (1.2％) of small intestine sarcoplasmic layer damage,2 cases (1.2％) of ovarian fallopian tube necrosis,and 1 case of colonic seromuscular layer damage.The intraoperative exploration revealed 109 cases ( 64.1％) of contralateral hidden hernia,7 cases ( 4.1％) of cryptorchidism,7 cases (4.1％) of umbilical hernia,1 case (0.6％) of Meckel' s diverticulum,and 1 case (0.6％) of ovarian cyst.Intestinal incarceration was seen in 106 cases,with 32 cases (30.2％) showing vomiting symptoms before surgery.Among them,all the 7 cases of necrosis or perforation of incarcerated intestinal tract had vomiting,2 out of 3 cases of damage to the seromuscular layer of incarcerated intestinal tract had vomiting,41.2％ cases (7/17) of blue purple incarcerated intestinal tract had vomiting,and 20.3％ cases (16/79) of incarcerated intestinal tract with fair blood supply had vomiting.The hospital stay was 1-11 d ( median,1 d).Follow-up period ranged from 4 months to 8 years and 5 months,with a median of 4 years and 11 months.Among them,51 cases were less than 3 years,38 cases were between 3 and 5 years,and 81 cases were over 5 years.Recurrence was seen in 2 cases (1.2％).One patient (0.6％) suffered from inguinal incision infection,and there were no complications such as intestinal obstruction or iatrogenic cryptorchidism.Conclusions Laparoscopic treatment of incarcerated indirect inguinal hernia has good medium and long term curative effect.During the surgery,it is necessary to consider the difficulty of hernia reduction and the blood supply of incarcerated organ for timely conversion to open surgery.Once a child with incarcerated hernia has vomiting symptoms before surgery,it indicates blood flow of incarcerated intestinal tract is affected,which requires a timely surgical treatment.

Objective To explore the medium and long term curative effect of laparoscopic treatment of incarcerated indirect inguinal hernia and summarize the experience of laparoscopic treatment and the characteristics of incarcerated indirect inguinal hernia.Methods A retrospective summary was made on clinical data of 170 children with incarcerated hernia who underwent laparoscopic surgery between January 2016 to February 2024,including 109 boys and 61 girls.The patient's age ranged from 11 days to 11 years old,with a median of 8 months and 27 days.There were 88 cases of right incarcerated hernia and 82 cases of left incarcerated hernia.The incarcerating time (from onset to surgery) was 0.5-360 h,with a median time of 24 h.Results The surgical time was 11-191 min (mean,51.9±29.5 min).Conversion to open surgery was required in 20 cases,in which 14 cases were engaged through the inguinal region for reduction of incarcerated organ and removal of necrotic organ,and 6 cases were treated through umbilical incisions (4 cases of intestinal resection and anastomosis and 2 cases of ileal repair).Most of incarcerated organs among them were small intestine (ileum,84 cases),followed by the ovaries and fallopian tubes (53 cases),and ileocecal region (15 cases),as well as the greater momentum (11 cases).During the surgery,148 cases underwent manual reduction through laparoscopic surgery,14 cases underwent open inguinal region reduction,and 8 cases underwent self-reduction.There were 5 cases ( 2.9％) of small intestinal necrosis,3 cases (1.8％) of greater omentum necrosis,2 cases (1.2％) of small intestine perforation,2 cases (1.2％) of small intestine sarcoplasmic layer damage,2 cases (1.2％) of ovarian fallopian tube necrosis,and 1 case of colonic seromuscular layer damage.The intraoperative exploration revealed 109 cases ( 64.1％) of contralateral hidden hernia,7 cases ( 4.1％) of cryptorchidism,7 cases (4.1％) of umbilical hernia,1 case (0.6％) of Meckel' s diverticulum,and 1 case (0.6％) of ovarian cyst.Intestinal incarceration was seen in 106 cases,with 32 cases (30.2％) showing vomiting symptoms before surgery.Among them,all the 7 cases of necrosis or perforation of incarcerated intestinal tract had vomiting,2 out of 3 cases of damage to the seromuscular layer of incarcerated intestinal tract had vomiting,41.2％ cases (7/17) of blue purple incarcerated intestinal tract had vomiting,and 20.3％ cases (16/79) of incarcerated intestinal tract with fair blood supply had vomiting.The hospital stay was 1-11 d ( median,1 d).Follow-up period ranged from 4 months to 8 years and 5 months,with a median of 4 years and 11 months.Among them,51 cases were less than 3 years,38 cases were between 3 and 5 years,and 81 cases were over 5 years.Recurrence was seen in 2 cases (1.2％).One patient (0.6％) suffered from inguinal incision infection,and there were no complications such as intestinal obstruction or iatrogenic cryptorchidism.Conclusions Laparoscopic treatment of incarcerated indirect inguinal hernia has good medium and long term curative effect.During the surgery,it is necessary to consider the difficulty of hernia reduction and the blood supply of incarcerated organ for timely conversion to open surgery.Once a child with incarcerated hernia has vomiting symptoms before surgery,it indicates blood flow of incarcerated intestinal tract is affected,which requires a timely surgical treatment.

Objective:To explore the correlation between oxidative stress markers malondialdehyde(MDA), superoxide dismutase(SOD), magnetic resonance burden and vascular cognitive impairment in patients with ischemic cerebrovascular disease (CSVD).Methods:Totally 300 patients with ischemic cerebral small vessel diseases who were admitted to the Department of Neurology, North China University of Science and Technology Affiliated Hospital were selected as the research subjects, and 60 healthy outpatients in the same period were selected as the control group.According to the results of mini mental state examination(MMSE), patients with ischemic cerebral small vessel diseases were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (101 cases), moderate cognitive impairment group (58 cases ) and severe cognitive impairment group (35 cases) according to Montreal cognitive assessment (MoCA). MDA and SOD were determined by double antibody sandwich method and the results were compared and analyzed.Results:(1) Compared with the control group(MDA: (8.40±1.81)μmol/L, SOD: (112.73±83.48)U/ml), the level of MDA increased while the level of SOD decreased significantly in normal group(MDA: (8.46±2.05)μmol/L, SOD: (108.90±88.72)U/ml) and cognitive impairment group(MDA: (12.19±7.02)μmol/L, SOD: (62.64±20.34)U/ml). Compared with the cognitive normal group, the level of SOD decreased significantly and MDA increased significantly in cognitive impairment group, the differences were statistically significant (all P<0.05). Compared with the normal cognitive group (1.18±1.10), the cognitive impairment group (1.93±1.05) had a higher MRI burden score ( P<0.05). (2)Multivariate analysis showed that the decrease of plasma SOD level( β=-0.024, OR=0.977, 95% CI=0.961-0.992)and the increase of plasma MDA level( β=0.110, OR=1.117, 95% CI=1.005-1.241)and the MRI overall burden( β=0.453, OR=1.573, 95% CI=1.011-2.446)were independent protective factors of vascular cognitive impairment in patients with ischemic CSVD.(3) Compared with mild cognitive impairment group(MDA: (9.79±5.79)μmol/L, SOD: (81.64±58.09)U/ml, MRI overall burdern (1.69±0.99)), the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in moderate cognitive impairment group and severe cognitive impairment group(MDA: (7.95±2.44)μmol/L, SOD: (76.13±46.00)U/ml, MRI overall burden: (1.78±0.86)), (MDA: (11.16±6.68)μmol/L, SOD: (63.49±20.04)U/ml, MRI overall burden: (2.89±1.02). Compared with the moderate cognitive impairment group, the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in the severe cognitive impairment group (all P<0.05). Conclusion:Increased plasma MDA level, MRI burden score and decreased SOD level in patients with CSVD are all risk factors for the occurrence of cognitive impairment.It is suggested that oxidative stress injury and cerebral small vessel lesions may be involved in the occurrence and development of cognitive impairment of CSVD from multiple aspects.

Objective To study the value of 256 spiral CTA and DSA in diagnosis of carotid artery stenosis (CAS) and cerebral collateral circulation in acute ischemic stroke (AIS) patients.Methods The imaging data of 256 spiral CTA and DSA in 30 AIS patients were retrospectively analyzed.The sensitivity,specificity and consistency of 256 spiral CTA and DSA in diagnosis of CAS and cerebral collateral circulation were compared.Results The consistency rate of 256 spiral CTA and DSA was 82.8％ in diagnosis of CAS,especially in diagnosis of severe stenosis (κ=0.75).Cerebral collateral circulation was detected in 18 patients by 256 spiral CTA and in 19 patients by DSA with a consistency of 90 ％.Cerebral collateral circulation was detected in 40 by CTA and in 43 by DSA out of the 330 collateral arteries with a high consistency (κ=0.925,0.894).Conclusion The consistency of 256 spiral CTA and DSA is very high in diagnosis of CAS and cerebral collateral circulation in AIS patients.

Objective To explore the influencing factors of the collateral circulation formation in patients with acute cerebral infarction.Methods Three hundred and fifty-two patients with acute cerebral infarction were included in this study,the clinical date of their head and neck 256 slice spiral CT angiography (CTA)examination was analyzed.According to the formation of collateral circulation in the head and neck CTA imaging results,it is divided into the collateral circulation group and the non-collateral circulation group.The clinical data of the two groups were compared.The influencing factors of the formation of collateral circulation in patients with acute cerebral infarction were analyzed by single factor analysis and multivariate logistic regression analysis.Results (1)In 352 cases of acute cerebral infarction,197 cases(56.0%)had collaterals,155 cases (44.0%)had none collateral.(2)Single factor analysis showed that age(t=-2.860,P=0.004),hypertension combined with diabetes(χ2 = 10.709,P= 0.001),history of TIA(χ2 = 4.626,P= 0.034),low density lipoprotein(t=-2.176,P=0.030),high homocysteine(t=2.885,P=0.004),cerebral vascular stenosis(Z=-5.936,P=0.000),posterior circular lesions(χ2=8.548,P=0.004)were the influencing factors in the formation of collateral circulation.(3)Multivariate Logistic regression analysis showed that old age(OR=1.031;95%CI=1.008-1.054;P=0.007),hypertension combined with diabetes(OR= 2.009;95%CI=1.159-3.482;P=0.013),high homocysteine(OR=1.023;95%CI,1.005-1.041;P=0.014),circular lesions(OR=1.727;95%CI=1.063-2.804;P=0.027)were relatively independent risk factors in acute cerebral infarction patients with none circulation,the degree of cerebral vascular stenosis(OR=0.507;95%CI=0.389-0.661;P=0.000),low density lipoprotein(OR=0.723;95%CI=0.532-0.982;P=0.038)served as protective factor.Conclusion Old age,hypertension combined with diabetes,high homocysteine and posterior circulation lesions are risk factors for the formation of collateral circulation in patients with acute cerebral infarction,cerebral vascular stenosis degree and low density lipoprotein can promote the formation of collateral circulation.

Objective To explore the effect of dexmedetomidine for the dosage of drug of pain pump of the patients postoperative.Methods From April 2013 to July 2015,86 patients with intestinal obstructionwhich come to our hospital for surgical treatment were divided into observation group and control group according to the lottery method,each had 43 cases.The patients of control group were given pain pump for pain treatment ; and the patients of observation group were given dexmedetomidine on the base of control group for treatment.The heart rate,systolic arterial pressure(SAP),arterial oxygen pressure(PaO2),analgesia satisfaction,visual analogue scale/score(VAS)pain score,sleep quality score,sufentanil dosage,the number of self-administration,adverse reactions,postoperative anal exhaust time.Results 36h and 72h,SAP,PaO2 in the observation group were significantly better than those in the control group after treatment(P<0.05); The total satisfaction of analgesia was significantly higher than that of control group(P<0.05); VAS pain score was significantly lower than the control group(P<0.05); The sleep quality score was significantly higher than that of the control group(P<0.05); The dosage of sufentanil and the times of administration were significantly lower than those of the control group(P<0.05); Anal exhaust time was significantly shorter than the control group(P<0.05); The incidence of adverse reactions was significantly lower than that of the control group(P<0.05).Conclusion By using dexmedetomidine on the base of pain pump can improve the analgesic effect postoperative,reduce the dosage of pain pump medication and the adverse reactions.

Objective To observe the neural protection of 3-n-butylphthalide (NBP) injection in focal cerebral ischemia-reperfusion rats. Methods 160 male Sprague-Dawley rats were randomly divided into sham group (n=10), ischemia-reperfusion group (IR group, n=50), high-dose NBP treatment group (high-dose group, n=50), middle-dose NBP treatment group (middle-dose group, n=25) and low-dose NBP treatment group (low-dose group, n=25). The later 4 groups were occluded the middle cerebral artery for 2 hours and reperfused. The sham group was sacrificed 24 hours after operation, and the other groups at 6, 12, 24, 48 and 72 hours after reperfusion, in which 5 of them were stained with TdT mediated dUTP Nick End Labeling (TUNEL) to observe the neuronal apoptosis, and immunohistochemistry to observe the expression of silent information regulation 2 homolog 1 (SIRT1) and peroxisome proliferator-activated receptorγcoactivator-1α(PGC-1α);the other 5 of sham group, IR group and high-dose group were observed with quantitative real-time PCR of SIRT1 and PGC-1α. Results Compared with the IR group, the number of apoptotic cells decreased and the SIRT1 and PGC-1αpositive cells increased in all NBP groups at each time (F>160.60, P<0.001), and it was the least of apoptotic cells and most of SIRT1 and PGC-1α positive cells in the high-dose group (P<0.05), while there was significant difference between the low-dose group and the middle-dose group, excluding 6 hours after reper-fusion (P<0.05). Compared with IR group, the expression of SIRT1 and PGC-1αmRNA increased in the high-dose group at each time (t>4.13, P<0.01). Conclusion NBP can protect brain from apoptosis in focal cerebral ischemia-reperfusion rats, which may relate to more ex-pression of SIRT1 and PGC-1α.

Objective To observe the effects of autophagy on the expression of synaptic plasticity related protein, growth-associated pro-tein-43 (GAP-43) and microtubule associated protein-2 (MAP-2), in CA1 area of hippocampus of vascular dementia rats. Methods Nine-ty-six healthy male Sprague-Dawley rats were randomly divided into sham group, vascular dementia model group (VD group), autophagy in-hibitor 3-methyl adenine preconditioning group (3-MA group) and autophagy agonist rapamycin preconditioning group (Rap group). Each group was divided randomly into subgroups of one week, two weeks, four weeks and eight weeks after modeling, six rats in each group. The vascular dementia rat model was established with modified Pulsineli's four-vessel occlusion. The expression of GAP-43 and MAP-2 in CA1 area of hippocampus were detected with immunohistochemistry. Results Compared with the sham group, the expression of GAP-43 protein increased, and the expression of MAP-2 protein decreased at every time point in VD group (P<0.01). Compared with VD group, the expres-sion of both GAP-43 and MAP-2 increased in 3-MA group (P<0.05), and decreased in Rap group (P<0.05). Conclusion Autophagy may in-hibit the expression of synaptic plasticity related protein, GAP-43 and MAP-2, in CA1 area of hippocampus in vascular dementia rats, indi-cating inhibition of autophagy may promote synaptic remodeling.

Objective To investigate the effect of Yangxue Qingnao granule on the expression of glial fibrillary acidic protein (GFAP) in CA1 area of hippocampus in rats with vascular dementia (VD). Methods 144 Sprague-Dawley rats were randomly divided into sham opera-tion group (n=48), VD group (model group, n=48) and Yangxue Qingnao granule treatment group (treatment group, n=48). The VD model was prepared by modified Pulsineli's four-vessel occlusion. The sham operation group and the model group were given normal saline 10 ml/(kg?d) by gavage, and the treatment group was given Yangxue Qingnao granule 3.2 g/(kg?d) by gavage. The expression of GFAP in CA1 ar-ea of hippocampus was detected with immunohistochemical analysis and Western blotting method 1, 2, 4 and 8 weeks after modeling. Re-sults The expression of GFAP in CA1 area of hippocampus was significantly higher in the model group than in the sham operation group (P<0.01), and was lower in the treatment group than in the model group (P<0.05) at every time point. Conclusion Yanxue Qingnao granule could inhibit the activation and proliferation of astrocytes in rats.

This study was aimed to observe the effect ofYang-Xue Qing-Nao(YXQN) granules on expressions of glycogen synthase kinase-3β (GSK-3β) andβ-catenin in CA1 area of hippocampus among vascular dementia (VD) rats. A total of 72 SD rats were randomly divided into the sham operation group, VD group (model group) and the YXQN granules treatment group (treatment group). The VD rat model was prepared by modified Pulsineli’s four-vessel occlusion. The expressions of GSK-3β andβ-catenin in CA1 area of hippocampus were detected by immunohistochemistry and western blotting at the 1st week, 2nd week, 4th weeks and 8th week after VD model operation. The results showed that expressions of GSK-3βwere increased in the model group at different time points, which were many quantities of expression at the 1st week, and a large number of expressions at the 2nd week. It reached peak at the 4th week; and began to decline but still higher at the 8th week. Compared with the sham operation group, the expression of GSK-3β was significantly increased in the model group at different time points (P < 0.01). The expression ofβ-catenin was increased in the model group at different time points. However, there was no statistical significance compared with the sham operation group (P > 0.05). Compared with the model group, expressions of GSK-3β andβ-catenin were significantly increased in the treatment group at different time points (P < 0.01). It was concluded that YXQN granules upregulated the expression of GSK-3β andβ-catenin, which may be helpful to VD treatment.