Objective:To investigate the characteristics and surgical management of mesh infection after tension-free repair of inguinal hernia.Methods:The clinical and follow-up data of 87 patients with mesh infection after tension-free repair of inguinal hernia at the Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital from 2018 to 2020 were retrospectively analyzed.Results:The most frequent type of repair was plug implantation, accounting for 57.5% of the procedures. The most common clinical presentation was a chronic sinus. 79.3% patients had a >3-month history of chronic infection. Staphylococcus aureus was the most common bacteria. All patients underwent open debridement. Fifty-one patients had a complete removal of the infected mesh, and 36 had partial removal. All patients were followed up for 18.7-54.2 months. There was no significant difference in the incidence of wound infection, seroma, hematoma, inguinal hernia recurrence, and chronic pain between those with complete removal and that partial removal (all P>0.05). Seventeen cases suffered recurrent sinus in the partial mesh removal group, and the incidence was significantly higher than that in the complete mesh removal group ( P<0.001). Conclusion:Infected mesh removal is an effective treatment for mesh infection after tension-free repair of inguinal hernia and should be removed as completely as possible.

Objective:To investigate the surgical treatment of mesh infection after lapa-roscopic inguinal hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 32 patients with mesh infection after laparoscopic inguinal hernia repair who were admitted to the Affiliated Beijing Chaoyang Hospital of Capital Medical University from January 2018 to December 2020 were collected. There were 30 males and 2 females, aged 59(range, 19-81)years. All patients underwent debridement. Observation indicators: (1) surgical and postopera-tive situations; (2) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between was conducted using Fisher exact probability. Results:(1) Surgical and postoperative situations. All 32 patients underwent debridement success-fully, with the operation time and volume of intraoperative blood loss as 110(range, 45-220)minutes and 24(range, 5-200)mL. Of the 32 patients, there were 6 cases undergoing open debridement, 26 cases undergoing laparoscopic exploration with 12 cases clarified the cause of infection, in which 4 cases had intestinal fistula by mesh infection breaking through the peritoneum and invading the intestinal tract and underwent laparoscopic intestinal fistula repair, 3 cases had significant amount of residual medical glue, 3 cases had mesh wrinkling and curling, 2 cases underwent peritoneum suturing with black silk thread. There were 18 cases undergoing complete removal of infected mesh and 14 cases undergoing partial mesh removal. There were 18 cases undergoing removal of infected mesh by laparoscopic posterior approach and 14 cases undergoing removal of infected mesh by open anterior approach. Twenty-nine of the 32 patients had bacterial culture and drug allergy testing, including 24 cases with positive cultures, while 5 cases with negative cultures. The duration of hospital stay of the 32 patients was 27.0(range, 9.0-85.0)days. (2) Follow-up. All 32 patients were followed up for 37.9(range, 18.7-52.5)months. There were 5 cases and 2 cases with postoperative incision infection in the 18 patients undergoing complete removal of infected mesh and 14 cases undergoing partial mesh removal, respectively, showing no significant difference between them ( P>0.05). There were 7 cases, 4 cases with seroma, recurrent sinus in the 18 patients undergoing complete removal of infected mesh and 5 cases, 6 cases in the 14 cases undergoing partial mesh removal, respectively, showing no significant difference between them ( P>0.05). None of patient in the two groups had hematoma, recurrent inguinal hernia or chronic pain. The 7 patients with incision infec-tion recovered effectively after symptomatic treatment. The 12 patients with seroma received no special treatment. The 10 patients with recurrent sinus underwent debridement, in which 9 cases did not experience any further abdominal wall infections and 1 case underwent the third debride-ment. Conclusion:The management of mesh infection following laparoscopic inguinal hernia repair necessitates the expertise of hernia specialists to complete remove the infected mesh or partial remove the infected mesh based on the specific clinical scenario.

Objective:To introduce an innovative simulation training system of liposuction and compare the effect of the traditional training method with this system in the liposuction training for medical students.Methods:Thirty medical postgraduates (18 males and 12 females, aged 22 to 30 years) at Peking Union Medical College without liposuction experiences were selected. All the participants were randomly divided into two groups. In the traditional training group, the trainees were trained on the phantom, while the teachers gave explanations and demonstrations. In the simulation training system group, the trainees were trained by themselves on the simulation training system. Before and after the training, the two groups were required to perform a liposuction simulation test on the simulated training system. The resistance of liposuction cannula, the acceleration of liposuction cannula and the uniformity degree of operation of the two groups were recorded, and the differences in the training effects between the two groups were compared. R 3.5 and Python 3.7 were used for analysis. Application of the t test for measurement data was in accordance with normal distribution, and the results were expressed as Mean±SD deviation. Application of Wilcoxon signed-rank test or Wilcoxon rank sum test for the measurement data did not conform to the normal distribution. The results were expressed as M( P25, P75). P< 0.05 indicated statistical differences. Results:After the training, the area of liposuction in the traditional training group was more moderate than that before the training [skewness: -0.22(-0.38, -0.14) vs. -0.07(-0.24, 0.02)( V=20, P=0.022); kurtosis: 2.32(2.09, 2.58) vs. 1.96(1.90, 2.00)( V=112, P=0.002)]. After training, the number of times of lateral resistance[7.0(3.5, 13.5) vs. 0(0, 0)( V=111.5, P=0.004)] and acceleration [7.0(5.0, 17.5) vs. 3.0(2.0, 12.5)( V=102, P=0.002)] over-threshold were significantly reduced, the angle of liposuction coverage [131.18°(117.71°, 137.88°) vs. 169.89°(162.96°, 180.00°)( V=0, P<0.001)] was significantly improved, and the area of liposuction [skewness: -0.17(-0.33, 0.03) vs. -0.01(-0.13, 0.06)( V=21, P=0.026); kurtosis: 2.35(2.08, 2.50) vs. 1.94(1.83, 2.00)( V=118, P<0.001)] was more evenly distributed. The differences before and after training were analyzed between the simulation training system group and the traditional training group. The simulation training system group was superior to the traditional training group in the number of times of lateral resistance[-7.5±7.4 vs.-1.4±9.0 ( t=111.5, P=0.026)], the number of times of acceleration [-3.0(-6.5, -2.0) vs. -1.0(-4.0, 2.0)( W=156.5, P=0.035)] and the angle of coverage[(-40.24±18.88)° vs. (-11.10±25.54)° ( t=3.553, P<0.001)]. Conclusions:Simulation training system is an effective method in liposuction training to enhance the skills of trainees.

Objective:To introduce an innovative simulation training system of liposuction and compare the effect of the traditional training method with this system in the liposuction training for medical students.Methods:Thirty medical postgraduates (18 males and 12 females, aged 22 to 30 years) at Peking Union Medical College without liposuction experiences were selected. All the participants were randomly divided into two groups. In the traditional training group, the trainees were trained on the phantom, while the teachers gave explanations and demonstrations. In the simulation training system group, the trainees were trained by themselves on the simulation training system. Before and after the training, the two groups were required to perform a liposuction simulation test on the simulated training system. The resistance of liposuction cannula, the acceleration of liposuction cannula and the uniformity degree of operation of the two groups were recorded, and the differences in the training effects between the two groups were compared. R 3.5 and Python 3.7 were used for analysis. Application of the t test for measurement data was in accordance with normal distribution, and the results were expressed as Mean±SD deviation. Application of Wilcoxon signed-rank test or Wilcoxon rank sum test for the measurement data did not conform to the normal distribution. The results were expressed as M( P25, P75). P< 0.05 indicated statistical differences. Results:After the training, the area of liposuction in the traditional training group was more moderate than that before the training [skewness: -0.22(-0.38, -0.14) vs. -0.07(-0.24, 0.02)( V=20, P=0.022); kurtosis: 2.32(2.09, 2.58) vs. 1.96(1.90, 2.00)( V=112, P=0.002)]. After training, the number of times of lateral resistance[7.0(3.5, 13.5) vs. 0(0, 0)( V=111.5, P=0.004)] and acceleration [7.0(5.0, 17.5) vs. 3.0(2.0, 12.5)( V=102, P=0.002)] over-threshold were significantly reduced, the angle of liposuction coverage [131.18°(117.71°, 137.88°) vs. 169.89°(162.96°, 180.00°)( V=0, P<0.001)] was significantly improved, and the area of liposuction [skewness: -0.17(-0.33, 0.03) vs. -0.01(-0.13, 0.06)( V=21, P=0.026); kurtosis: 2.35(2.08, 2.50) vs. 1.94(1.83, 2.00)( V=118, P<0.001)] was more evenly distributed. The differences before and after training were analyzed between the simulation training system group and the traditional training group. The simulation training system group was superior to the traditional training group in the number of times of lateral resistance[-7.5±7.4 vs.-1.4±9.0 ( t=111.5, P=0.026)], the number of times of acceleration [-3.0(-6.5, -2.0) vs. -1.0(-4.0, 2.0)( W=156.5, P=0.035)] and the angle of coverage[(-40.24±18.88)° vs. (-11.10±25.54)° ( t=3.553, P<0.001)]. Conclusions:Simulation training system is an effective method in liposuction training to enhance the skills of trainees.

Chimeric antigen receptor T (CAR-T) cell therapy is a novel cellular immunotherapy that is widely used to treat hematological malignancies, including acute leukemia, lymphoma, and multiple myeloma. Despite its remarkable clinical effects, this therapy has side effects that cannot be underestimated. Cytokine release syndrome (CRS) is one of the most clinically important and potentially life-threatening toxicities. This syndrome is a systemic immune storm that involves the mass cytokines releasing by activated immune cells. This phenomenon causes multisystem damages and sometimes even death. In this study, we reported the management of a patient with recurrent and refractory multiple myeloma and three patients with acute lymphocytic leukemia who suffered CRS during CAR-T treatment. The early application of tocilizumab, an anti-IL-6 receptor antibody, according to toxicity grading and clinical manifestation is recommended especially for patients who suffer continuous hyperpyrexia, hypotensive shock, acute respiratory failure, and whose CRS toxicities deteriorated rapidly. Moreover, low doses of dexamethasone (5-10 mg/day) were used for refractory CRS not responding to tocilizumab. The effective management of the toxicities associated with CRS will bring additional survival opportunities and improve the quality of life for patients with cancer.

Objective: To explore the biological characteristics of synovial fluid-derived mesenchymal stem cells (SF-MSCs) cultured in serum-free medium and the ability of in vitro reconstruction of three-dimensional cartilage combined with scaffold material. Methods: Human SF-MSCs were cultured in serum medium and mesenchymal stem cells medium-serum free (MSCM-sf) respectively, then the proliferative ability and morphology of SF-MSCs were compared; The third passage SF-MSCs cultured in MSCM-sf were identified by flow cytometry, three-way(chondrogenic, osteogenic, adipogenic)differentiation assay and induced for chondrogenic differentiation when combined with polyglycolic acid/polylactic acid (PGA/PLA). Results: SF-MSCs cultured in MSCM-sf had better morphology and proliferative ability than that cultured in serum medium. The expression levels of positive markers of the third passage SF-MSCs cultured in MSCM-sf, such as CD73 (99.5%), CD90 (98.9%) and CD105 (96.5%), were more than 95%. However, the overall negative markers (CD34, HLA-DR and CD11b) expressed less than 2%. Three-way differentiation staining was positive. The combination of SF-MSCs and PGA / PLA can be induced into cartilage in vitro. Conclusions SF-MSCs cultured in MSCM-sf can be amplified under the condition of maintaining the stem cell characteristics, and can be combined with PGA/PLA scaffold to construct three-dimensional cartilage in vitro.

Objective To evaluate preperitoneal tension-free herniorrhaphy for incarcerated and (or) strangulated inguinal hernia.Methods During Mar,2008 to Mar,2015,89 incarcerated and (or)strangulated hernia patients(incarcerated hernia group) and 1 741 primary inguinal hernia patients (elective group) underwent preperitoneal tension-free herniorrhaphy.Results The operation time (42 ± 8 min),length of stay (4.0 ± 2.6 d) and the time return to work (9.0 ± 3.3 d) in incarcerated hernia group were longer than in elective group of (38 ± 4 min),(3.0 ± 0.6 d) and (8.1 ± 2.5 d),respectively (all P ＜0.01).Blood loss [(10 ± 14 ml) vs (7 ±4 ml)] was compareble,P =0.148.There were 1 infection case and 20 seroma cases (22.5％) vs 5 infection cases and 187 seroma cases (12.7％) all P ＞0.05.Followup found hernia recurrence in one case in elective group.Conclusion Preperitoneal tension-free herniorrhaphy is safe and effective for the treatment of incarcerated and(or) strangulated hernia.

Objective To investigate the effect of sagittal split ramus osteotomy(SSRO) combined with distraction osteogenesis(DO) for hemifacial microsomia (HFM).Methods From January 2013 toSeptember 2015,7 cases of unilateral HFM were included in the study.The 3-dimensional reconstruction images were used for the operation design.The location of the germs and inferior alveolar nerve was marked to avoid injury.The distractor was fixed after SSRO.The distractor was distracted 2-4 mm intraoperatively and began enlongation 3-5 days after operation,1-2 mm every day until the pre-designed length attained.The patients were followed up for 3-D CT and measurement of the height of bilateral ramus.Results The enlongation length was 7 mm to 20 mm(mean,14.6 mm).The facial symmetry and occlusion plane was improved a lot.No complication occurred.The mean follow-up period was 22 months (range 17-32 months) with almost symmetrical appearance and occlusion function.Conclusions SSRO combined with DO has a good therapeutic effect and low complication for patients with HFM.The distraction rate is relatively bigh with a short treatment period.The ramus width,even thickness,are not decreased,or even can be increased after DO.

Objective To investigate the effect of sagittal split ramus osteotomy(SSRO) combined with distraction osteogenesis(DO) for hemifacial microsomia (HFM).Methods From January 2013 toSeptember 2015,7 cases of unilateral HFM were included in the study.The 3-dimensional reconstruction images were used for the operation design.The location of the germs and inferior alveolar nerve was marked to avoid injury.The distractor was fixed after SSRO.The distractor was distracted 2-4 mm intraoperatively and began enlongation 3-5 days after operation,1-2 mm every day until the pre-designed length attained.The patients were followed up for 3-D CT and measurement of the height of bilateral ramus.Results The enlongation length was 7 mm to 20 mm(mean,14.6 mm).The facial symmetry and occlusion plane was improved a lot.No complication occurred.The mean follow-up period was 22 months (range 17-32 months) with almost symmetrical appearance and occlusion function.Conclusions SSRO combined with DO has a good therapeutic effect and low complication for patients with HFM.The distraction rate is relatively bigh with a short treatment period.The ramus width,even thickness,are not decreased,or even can be increased after DO.

Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.