Objective To investigate the feasibility of hernia needle assisted suture in single-incision laparoscopic transabdominal preperitoneal repair(SIL-TAPP).Methods From February 2023 to April 2024,20 young patients with indirect inguinal hernia were treated with SIL-TAPP.A 2 cm curved incision was made at the navel,and a three channel port was inserted for transabdominal preperitoneal repair.A hernia needle was inserted into the affected side lower abdominal wall to assist in one handed suturing and closure of the peritoneum.Results All the operations were successful.The operation time was 85-125 min,with an average of(91.3±10.0)min.The closure of the peritoneum took 18-30 min,with an average of(23.4±3.2)min.Intraoperative blood loss was 5-25 ml.The Visual Analogue Scale(VAS)score at 24 h after surgery was 1-3 points.Postoperative hospitalization lasted 1-5 d,with an average of(2.4±1.0)d.After surgery,one patient had seroma in the groin area and one patient had fat liquefaction in the umbilical cord.All the patients were followed up for 8-22 months after operation,with an average of(15.3±3.4)months.No recurrence after operation or umbilical hernia was noted.Conclusion The use of hernia needle assisted suturing to close the peritoneum during SIL-TAPP surgery can reduce the difficulty of one handed suturing,especially suitable for the early stage of single-incision laparoscopic surgery.

Objective To investigate the feasibility of hernia needle assisted suture in single-incision laparoscopic transabdominal preperitoneal repair(SIL-TAPP).Methods From February 2023 to April 2024,20 young patients with indirect inguinal hernia were treated with SIL-TAPP.A 2 cm curved incision was made at the navel,and a three channel port was inserted for transabdominal preperitoneal repair.A hernia needle was inserted into the affected side lower abdominal wall to assist in one handed suturing and closure of the peritoneum.Results All the operations were successful.The operation time was 85-125 min,with an average of(91.3±10.0)min.The closure of the peritoneum took 18-30 min,with an average of(23.4±3.2)min.Intraoperative blood loss was 5-25 ml.The Visual Analogue Scale(VAS)score at 24 h after surgery was 1-3 points.Postoperative hospitalization lasted 1-5 d,with an average of(2.4±1.0)d.After surgery,one patient had seroma in the groin area and one patient had fat liquefaction in the umbilical cord.All the patients were followed up for 8-22 months after operation,with an average of(15.3±3.4)months.No recurrence after operation or umbilical hernia was noted.Conclusion The use of hernia needle assisted suturing to close the peritoneum during SIL-TAPP surgery can reduce the difficulty of one handed suturing,especially suitable for the early stage of single-incision laparoscopic surgery.

Background: and Purpose We investigated the causal relationships between the gut microbiota (GM), stroke, and potential metabolite mediators using Mendelian randomization (MR). Methods: We leveraged the summary statistics of GM (n=18,340 in the MiBioGen consortium), blood metabolites (n=115,078 in the UK Biobank), and stroke (cases n=60,176 and controls n=1,310,725 in the Global Biobank Meta-Analysis Initiative) from the largest genome-wide association studies to date. We performed bidirectional MR analyses to explore the causal relationships between the GM and stroke, and two mediation analyses, two-step MR and multivariable MR, to discover potential mediating metabolites. Results: Ten taxa were causally associated with stroke, and stroke led to changes in 27 taxa. In the two-step MR, Bifidobacteriales order, Bifidobacteriaceae family, Desulfovibrio genus, apolipoprotein A1 (ApoA1), phospholipids in high-density lipoprotein (HDL_PL), and the ratio of apolipoprotein B to ApoA1 (ApoB/ApoA1) were causally associated with stroke (all P<0.044). The causal associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were validated using the weighted median method in an independent cohort. The three GM taxa were all positively associated with ApoA1 and HDL_PL, whereas Desulfovibrio genus was negatively associated with ApoB/ApoA1 (all P<0.010). Additionally, the causal associations between the three GM taxa and ApoA1 remained significant after correcting for the false discovery rate (all q-values <0.027). Multivariable MR showed that the associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were mediated by ApoA1 and HDL_PL, each accounting for 6.5% (P=0.028) and 4.6% (P=0.033); the association between Desulfovibrio genus and stroke was mediated by ApoA1, HDL_PL, and ApoB/ApoA1, with mediated proportions of 7.6% (P=0.019), 4.2% (P=0.035), and 9.1% (P=0.013), respectively. Conclusion The current MR study provides evidence supporting the causal relationships between several specific GM taxa and stroke and potential mediating metabolites.

Objective:To understand the present situation of the construction of standardized asthma clinic for children in China, to explore the problems existing in the process of construction, and to promote the healthy development of standardized clinic construction.Methods:The process and current situation of the construction of standar-dized asthma clinics for children in China were reviewed and investigated, and the practical significance of the China Children′s Asthma Action Plan (CCAAP) in the construction of standardized asthma clinics for children was explored.Results:(1)By December 2020, 1 289 standardized asthma clinics for children and 135 regional demonstration centers had been built; 56 training sessions had been held, with a total of 2 560 doctors and 650 nurses trained, covering 2 560 hospitals across the country; and 4 518 patient education sessions were held.Online publicity covers a total of 1 million person-times, with an annual average of 1.33 million patients.(2)CCAAP improved the quality control level of standardized asthma clinic and promoted the standardized management of children.Conclusions:Through process optimization, professional evaluation, individual health education and real-time disease monitoring, standardized asthma clinic for children with asthma can effectively enhance asthma management awareness of children and their parents, improve disease awareness, and promote better control of asthma.It is an effective management model of asthma in children at present, and it is worthy of clinical promotion.CCAAP plays a good role in the construction of standardized outpatient clinic for asthma in children.The construction of standardized asthma clinic for children in China has achieved remarkable results, and the development trend is good in the future.

Objective To investigate the molecular mechanism of the effect of CYP2C19 polymorphism on the efficacy of clopidogrel in patients with stable coronary artery disease (SCAD).Methods A total of 208 patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) were included.The CYP2C19 variant alleles were detected by gene sequencing.Platelet reactivity was assessed by thrombelastograph at 24 h after 300 mg clopidogrel loading.P2Y12-Gi signaling was measured by flow cytometric analysis of vasodilator-stimulated phosphorylation-platelet reactivity index (VASP-PRI) and Akt phosphorylation (P-Akt) index.Results Among 208 patients,40.9％ were classified as CYP2C19 * 1/* 1 (non-carriers) with no loss-of-function (LOF),44.7％ as CYP2C19 * 1/* 2 or CYP2C19 * 1/* 3 (one LOF carriers) and 14.4％ as CYP2C19 * 2/*2 or CYP2C19 * 2/* 3 (two LOF carriers).Both postclopidogrel platelet aggregation and VASP-PRI increased by the presence of one LOF allele,and were even more pronounced with the presence of two LOF alleles.In contrast,P-Akt index only increased in two LOF carriers.VASP-PRI was positively associated with postclopidogrel platelet aggregation (r =0.661,P＜0.001),but not with P-Akt index.Conclusions The two CYP2C19 LOF carriage was associated with more active state of P2Y12-Gi signaling in postclopidogrel platelet in Chinese patients with SCAD.

Objective:To detect pathogenic gene expression in patients with high risk hereditary cardiovascular diseases and explore its predictive value for high risk ventricular arrhythmia .Methods :The expression of pathogenic genes in 30 patients with clinically diagnosed high risk hereditary cardiovascular diseases were detected by using second‐generation high‐throughput sequencing on the basis of gene chip probes associated with high risk hereditary cardiovascular diseases .The patients were divided into two groups by whether the malignant ventricular arrhythmia had happened . And gene expression features of pathogenic genes in the two groups were comparatively analyzed .Results: Among the 30 patients , there were 8 patients (positive rate 26 .67% ) with pathogenic genes .In ten cases with history of high risk ventricular arrhythmia ,the pathogenic gene positive rate was 20% (2/10) .And the pathogenic gene positive rate in control group was 30% (6/20) .The difference between the two groups was not statistically significant .Conclusions :There is a certain positive rate of pathogenic genes in patients with high risk hereditary cardiovascular diseases .However ,further researches are needed to confirm the predictive value of the pathogenic gene expression for high risk ventricular arrhythmia happened in these patients .

Objective To explore the efficacy,mechanism and safety of silibinin combined with Ruangan pills(a Chinese herbal preparation)in the treatment of schistosomiasis liver fibrosis. Methods A total of 200 patients with schistosomiasis liver fibrosis were randomly divided into a control group and a treatment group,and 100 patients in each group were respectively admin-istered with oral silibinin alone and oral silibinin combined with Ruangan pills,respectively. The curative effects in the two groups were evaluated in 3 months,6 months,9 months and 12 months respectively. Results The common five clinical symptoms of schistosomiasis liver fibrosis patients significantly relieved in the treatment group 12 months after the therapy,and the total effi-ciency reached more than 75%,which were significantly higher than that in the control group. In the treatment group and the con-trol group,there was no improvement in the liver B ultrasonic classification 3 months and 6 months after the therapy(P>0.05);however,in 9 months and 12 months,the liver B ultrasonic classification in the treatment group was better than that in the control group(P<0.05,P<0.01,respectively). For the four serum indexes of liver fibrosis,there was no significant differences between the two groups in 3 months,however,in 6 months,9 months,and 12 months,there was a significant improvement in the treat-ment group compared with the control group. There were no obviously adverse effects in two groups. Conclusion Silibinin com-bined with Ruangan pills has a better curative effect in the treatment of schistosomiasis liver fibrosis.

After communication with professional course teachers, clinical experts and graduates by investigation, informal discussion and expert interviews, the course and teaching of rehabilitation therapy was reformed to make the students not only meet the skill requirement,but also acquire basic theory and sustainable develop in their career.

Objective To identify the feasibility and the anatomical parameters of posterior transarticular pedicle screw fixation in the thoracic spine, provide a reference for clinical applications. Methods Twenty human cadaveric thoracic spine segments were dissected posteriorly and anteriorly, with care taken to expose the laminas and pedicles. The entrance point of transarticular pedicle screws was located in the 7 mm away from the above at the inferior margin of the lamina and the inside at the exterior margin, respectively. Posterior transarticular pedicle screws implantation was performed under direct visualization into T1,2,T5,6 and T9,10 Under direct abservation, the feasibility of posterior transarticular pedicle screw fixation was assessed. Then a CT was done. On the morphologic CT scan, the angle and length of the transarticular pedicle crew trajectory were measured. Results The thoracic transarticular pedicle screw trajectory were caudal tilting in the sagittal plane and lateral tilting in the axial plane with successful placement. Screws were placed across the facet joint, and from the inferior articular process of upper thoracic vertebra into the pedicle of lower thoracic vertebra. There was little difference between different number of thoracic vertebrae of the angle, but without significance. The average angles of the screws were 41.4°+3.2°caudal tilting in the sagittal plane and 2.1°±0.7° lateral tilting in the axial plane. The average trajectory lengths were (40.6±4.9)mm, and the lengths increased gradually from upper thoracic vertebra to middle and lower. There were significant differences statistically among T1,2, T5,6 and T9.10 (F=74.09, P＜0.01 ). Conclusion Posterior transarticular pedicle screw fixation is feasible, and there are some directions for implantating the screws. Transarticular pedicle fixation in the thoracic spine affords an alternative to standard pedicle screw placement for thoracic stabilization.

OBJECTIVETo explore the cytogenetic features of mantle cell lymphoma (MCL).

METHODSBone marrow cells from 18 MCL patients with bone marrow invasion were cultured for 24 hours, then routine karyotype analysis was performed with R-banding technique. Interphase fluorescence in situ hybridization (FISH) and a panel of 5 probes, including CCND1/IgH, CEP12, D13S319, p53 gene and ATM gene, were used to investigate the cytogenetic features of the samples.

RESULTSChromosome aberrations were found in 9 (64.3%, 9/14) patients by conventional cytogenetics (CC), 8(57.1%, 8/14) patients had the aberration of t(11; 14), 6(42.9%, 6/14) had complex aberrant karyotypes, of which 2 (14.3%, 2/14) had highly complex aberrant karyotypes. A total of 28 abnormalities were detected, among them 19 (67.9%) were structural abnormalities, the other 9 (32.1%) were numerical aberrations. The aberration of t(11; 14) was found in all 18 (100%) patients with MCL by FISH. Secondary cytogenetic aberrations were detected in 14 patients by FISH. The most common abnormality was del(11q22.3) (57.1%), the rate of aberrations for del(17p13), + 12 and del(13q14) were 42.9%, 35.7% and 21.4%, respectively. Two (14.3%) and 4 (28.6%) patients were detected to have combinations of 2 and 3 aberrations.

CONCLUSIONIn addition to t(11; 14), most MCL patients have other chromosome aberrations, especially complex aberrant karyotype.

Adult ; Aged ; Aged, 80 and over ; Chromosome Aberrations ; Chromosomes, Human, Pair 11 ; genetics ; Chromosomes, Human, Pair 14 ; genetics ; Female ; Humans ; Karyotyping ; Lymphoma, Mantle-Cell ; genetics ; mortality ; pathology ; Male ; Middle Aged ; Neoplasm Staging