Objective:To investigate the clinical efficiency of lumbar hernia repair based on path planning.Methods:The retrospective and descriptive study was conducted. The clinical data of 35 patients with lumbar hernia who were admitted to The First Affiliated Hospital of University of Science and Technology of China from November 2016 to March 2024 were collected. There were 14 males and 21 females, aged (61±8)years. According to preoperative computerized tomography examination of the hernia defect diameter, patients with a defect diameter <4 cm underwent enhan-ced field laparoscopic total extraperitoneal repair (eTEP), patients with a defect diameter of 4-8 cm underwent laparoscopic partial extraperitoneal repair (TAPE), and patients with a defect diameter >8 cm underwent open preperitoneal mesh repair (Sublay). Measurement data with normal distribu-tion were represented as Mean± SD, and comparison of three groups were conducted using the one-way ANOVA or Kruskal Wallis test, and Bonferroni correction was used for pariwise comparison. Measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Operation conditions. Of 35 patients, there were 15 cases undergoing eTEP, of 7 males and 8 females and 12 cases of left hernia and 3 cases of right hernia, with operation time of (92±44)minutes and the duration of postoperative hospital stay of (5.6±2.8)days. There were 17 cases undergoing TAPE, of 5 males and 12 females and 9 cases of left hernia, 7 cases of right hernia and 1 case of bilateral hernia, with operation time of (114±56)minutes and the duration of postoperative hospital stay of (6.4±3.0) days. There were 3 cases undergoing Sublay, of 2 males and 1 female and 1 case of left hernia and 2 cases of right hernia, with operation time of (150±55)minutes and the duration of postoperative hospital stay of (12.3±7.8)days. There were significant differences in the duration of postoperative hospital stay among the three groups ( F=4.83, P<0.05). (2) Follow-up. All 35 patients were followed up for 40.5(range, 3.0-91.0)days. None of patient underwent postoperative complications such as serous swelling, incision infection, intestinal fistula, intestinal obstruction, or puncture hematoma, and no recurrence of lumbar hernia occurred. One patient who underwent TAPE had postoperative abdominal distension, and was cured by symptomatic treatment. Cases with acute pain within postoperative 3 months were 0, 5, 2 in patients undergoing eTEP, TAPE, Sublay, respectively, showing significant differences among them ( χ2=8.69, P<0.05). Results of pariwise comparison showed that there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and Sublay ( P<0.05), and there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and TAPE ( P<0.05); Cases with chronic pain after postoperative 3 months were 0, 1, 1 in patients undergoing eTEP, TAPE, Sublay, respectively, showing no significant difference among them ( χ2=4.00, P>0.05). Conclusion:It is safe and feasible to formulate the surgical method according to the defect diameter of lumbar hernia.

Background and Aims:Parastomal hernia is a common complication after colostomy,with a high incidence rate.Laparoscopic Sugarbaker repair is currently the mainstream surgical approach for treating parastomal hernia.However,compared to other abdominal wall hernia repair techniques,the recurrence rate of parastomal hernia after laparoscopic Sugarbaker repair remains relatively high.Furthermore,the recurrence rate after surgery for recurrent parastomal hernias is significantly higher than that after the initial surgery,with inadequate lateral mesh coverage being one of the major contributing factors.This study was performed to analyze the efficacy of two-point mark-guided laparoscopic Sugarbaker repair in patients with terminal colostomy parastomal hernia,so as to provide evidence-based references for clinical practice. Methods:The clinical data of 120 patients with terminal colostomy parastomal hernia,who underwent laparoscopic Sugarbaker repair guided by the two-point mark of mesh at the Department of Hernia and Obesity Surgery,the First Affiliated Hospital of the University of Science and Technology of China,from January 2015 to December 2023,were retrospectively collected.The parastomal hernias were classified according to the European Hernia Society classification.Postoperative symptomatic and radiological recurrence rates were analyzed,as well as the incidence of complications such as bowel obstruction,stoma infection,and intestinal fistula in recurrent and non-recurrent patients. Results:Of the 120 patients,2(1.7％)were lost to follow-up.The mean follow-up duration was 48(6-96)months.The postoperative symptomatic recurrence rate was 5.1％(6/118),and the radiological recurrence rate was 6.8％(8/118).There were no statistically significant differences between recurrent(n=8)and non-recurrent patients(n=110)in terms of sex,age,body mass index(BMI),or hernia defect size(all P＞0.05),but the operative time in recurrent patients was longer than that in non-recurrent patients(P＜0.05).The overall postoperative complication rate was 8.5％(10/118),including stoma skin-mucosa separation(3 cases),stoma infection(2 cases),delayed bowel obstruction(2 cases),early bowel obstruction(1 case),hernia sac effusion(1 case),and delayed fistula formation in the hernia sac cavity(1 case).According to the Clavien-Dindo classification,there were 6 cases of grade Ⅱ,3 cases of gradeⅢa,and 1 case of grade Ⅳ complications.There were no statistically significant differences between patients with and without complications regarding sex,BMI,hernia defect size,operative time,and comorbidities(all P＞0.05);however,patients with complications were older than those without(P＜0.05). Conclusion:The application of laparoscopic Sugarbaker repair under the guidance of two-point mesh identification can effectively reduce the recurrence rate of parastomal hernia and It has high clinical applicability.

Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW max) and the maximum heart depth (HD max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.

Objective:To explore the effects of Xiao's double-C nursing mode based on enhanced recovery after surgery (ERAS) on perioperative related indexes and pain in patients undergoing mixed hemorrhoid surgery.Methods:From August 2019 to August 2020, 60 patients undergoing mixed hemorrhoid surgery who were admitted to anorectal surgery department of Anqing Municipal Hospital were enrolled as the research objects by single center, random, single blind and parallel control methods. They were divided into control group (routine perioperative nursing) and observation group (ERAS-based Xiao's double-C nursing mode) by random number table method, 30 cases in each group. The perioperative indexes, scores of postoperative Visual Analogue Scale (VAS) and wound healing, postoperative complications and nursing satisfaction were compared between the two groups.Results:The first urination time, defecation time, hospitalization time and hospitalization cost were (5.78±1.38) h, (13.37±2.38) h, (7.32±0.72) d and (7 337.84±524.99) yuan in the observation group, and (6.48±1.26) h, (16.72±2.33) h, (8.85±0.93) d, (8 689.54±688.34) yuan in the control group, and the differences were statistically significant ( t values were 2.052-8.552, P<0.01 or 0.05). There were between-group, time and interaction differences in the scores of VAS and postoperative wound healing between the two groups ( Fbetween-group values were 36.24, 42.36, Ftime values were 256.71, 377.42, Finteraction values were 88.62,90.62, P<0.01). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). The scores of nursing satisfaction with health education and services accessibility were (94.37±2.92), (95.11±3.85) points in the observation group, and (92.38±3.01), (91.72±4.31) points in the control group, and the differences were statistically significant ( t values were 2.599, 3.213, P<0.05). Conclusions:ERAS-based Xiao's double-C nursing mode is beneficial to shorten first defecation time, incision healing time and hospitalization time of patients undergoing mixed hemorrhoid surgery, accelerate wound healing and alleviate pain, with higher nursing satisfaction.

Objective:To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension.Methods:The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension.Results:Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged.Conclusion:Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

BACKGROUNDSleep deprivation (SD) has been used in treatment of depression disorder, and could effectively improve the patients' depressive symptoms.The aim of the study was to explore the effects of SD on electroencephalographic (EEG) and executive function changes in patients with depression.

METHODSEighteen depression patients (DPs) and 21 healthy controls (HCs) were enrolled in the present study. The whole night polysomnography (PSG) was recorded by Neurofax-1518K (Nihon Kohden, Japan) system before and after 36 hours of SD. The level of subjects' depression state was assessed by Visual Analogue Scale (VAS), and the executive function was assessed by Wisconsin Card Sorting Test (WCST).

RESULTSSignificantly decreased sleep latency (SL; before SD: (31.8 ± 11.1) minutes, after SD: (8.8 ± 5.2) minutes, P < 0.01) and REM sleep latency (RL; before SD: (79.8 ± 13.5) minutes, after SD: (62.9 ± 10.2) minutes, P < 0.01) were found after SD PSG in depression patients. Decreased Stage 1 (S1; before SD: (11.7 ± 2.9)%, after SD: (7.3 ± 1.1)%, P < 0.01) and Stage 2 (S2, before SD: (53.8 ± 15.5)%, after SD: (42.3 ± 14.7)%, P < 0.05) of non-rapid eye movement (NREM) sleep, and increased Stage 3 (S3, before SD: (11.8 ± 5.5)%, after SD: (23.6 ± 5.8)%, P < 0.01) and Stage 4 (S4, before SD: (8.8 ± 3.3)%, after SD: (27.4 ± 4.8)%, P < 0.01) NREM sleep were also found. After SD, the depression level in patients decreased from 6.7 ± 2.1 to 2.9 ± 0.7 (P < 0.01). In WCST, the patients showed significantly decreased Response errors (Re, before SD: 22.3 ± 2.4, after SD: 18.3 ± 2.7, P < 0.01) and Response preservative errors (Rpe, before SD: 11.6 ± 3.6, after SD: 9.3 ± 2.9, P < 0.05). Depression patients' RE (t = 2.17, P < 0.05) and Rpe (t = 2.96, P < 0.01) also decreased significantly compared to healthy controls.

CONCLUSIONSD can improve depression symptom and executive function in depression patients.

Adult ; Depression ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Sleep Deprivation ; physiopathology

Objective To investigate the effects of atorvastutin on the levels of plasm imflammation markers (hs - CRP, MMP - 3, TNF - α) and intima - media thickness(ITM) of the common carotid artery in patient with hyperlipidemic and atherosclerosis. Methods Fifty patient with hyperlipidemic and atherosclerosis were treated with atorvastatin (10mg qd) for 12 weeks. The levels of TC, TG, LDL -C, HDL -C, hs -CRP, TNF -α and MMP -3 were detected with radioimmmuneassay and eolorimetric methods. Color Doppler echo-cardiography was used to measure intima -media thickness(ITM) of the common carotid artery after 6 weeks and 12 weeks. Results TC, TG, LDL -C, hs -CRP, TNF -α and MMP -3 were decreased significantly(P < 0.01)after 12 weeks. IMT was decreased signifi-cantly(P < 0.05) and HDL - C was increased significantly (P < 0.05) after 12 weeks. Conclusion Atorvastatin could be effective in re-ducing blood - fat and anti - inflammatory action , regulating blood vessel endothelium (BVE) function and reversing structural chan-ges in IMT of the common carotid artery.

Objective To investigate the outcome and related risk factors of integrated intensive intervention in participants with impaired glucose regulation (IGR) after two years by the criteria of American Diabetes Association 2003. Methods The subjects who remained to be IGR at the end of first year following 75 g oral glucose tolerance test were randomly assigned to either a routine care control group or to an intensive integrated intervention group. The control group received general dietary and exercise advice at baseline and was followed up. In addition to dietary control and exercise advice, mefformin or acarbose were administrated in the intervention group. The latter group was also advised to take antihypertensive agents, lipid-regulating agents if necessary, as well as aspirin. Results The proportion of patients who fulfilled the assigned goals of blood glucose, blood pressure, body mass index or triglycerides was significantly higher in the intensive group than those in the control group. None in the intensive group developed overt diabetes mellitus, while 8 (9.3%) in the control group did. The proportion of patients who reverted to normal glucose tolerance (NGT) was slightly higher in the intensive group than in the control group (29.5% vs 22.1%, P>0.05). Logistic analysis showed that increase of waist circumference and systolic blood pressure was positively while the improvement of islet β-cell function was negatively correlated with the development of diabetes mellitus. Conclusions The intensive integrated intervention could significantly decrease the conversion rate of IGR to diabetes mellitus, and increase the chance of reversion to NGT. The increase of waist circumference or systolic blood pressure, the deterioration of islet β-ccll function were the influencing factors of the conversion of IGR to diabetes mellitus.

Objective To investigate the appropriate waist circumference (WC) cutoff points for central obesity in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of the International Diabetes Federation (IDF). Methods A total of 2,344Beijing residents aged ≥40 years were investigated. They answered questionnaires, received physical examinations, and underwent plasma glucose and lipid profile measurement. Those non-diabetic subjects underwent a 75g oral glucose tolerance test. All data were analyzed to calculate the appropriate WC cutoff points for central obesity reaching the diagonsis of MS. Results 1) Both in males and females, the triglyceride (TG), systolic blood pressure, diastolic blood pressure and fasting plasma glucose (FPG) increased linearly with WC, and the high density lipoprotein cholesterol (HDL-C) decreased linearly with WC (P＜0.05). 2)The prevalence of elevated TG,reduced HDL-C, elevated blood pressure, elevated FBG, or ≥ 2 of these factors increased with WC (P＜0.05). 3) Based on the receiver operating characteristic (ROC) curve analysis and Youden index, the WC values for central obesity and for detecting BMI ≥ 25 kg/m2were about 90 cm for men and 80 cm for women. 4) The odds ratio for the presence of two or more metabolic risk factors increased abruptly in men with WC ≥ 90 cm and in women with WC ≥ 80 cm. Conclusions The appropriate WC cutoff point for central obesity was determined to be 90 cm for men and 80 cm for women in the middle-aged and elderly Beijing residents by the metabolic syndrome definition of IDF.

Objective To investigate the clinical effects of Metoprolol Tartrate Tablets and Sodium Fructose Diphosphate(FDP) :injection in the early treatment of 48 cases of acute myocardial infarction(AMI) patients with thrombolytic therapy.Methods 84 cases of acute myocardial infarction who were in accordance with the indications for thrombolytic therapy in patients were randomly divided into a treatment group(group A,48 cases,treated with Metoprolol Tartrate Tablets and Sodium Fructose Diphosphate Injection) and a control group(group B,36 cases,treated with the conventional therapy).The occurrence of reperfusion arrhythmias,early sighs and symptms,and retoration of myocardial injury were observed in patients after thrombolytic therapy in order to understand clinical effect on the patients with that treatment.Results In treatment group there were decreased incidence of heart symptoms (chest pain,cardiopalmus) and RA(group A,36.1%;group B,71.4%),improved recovery of cardiac muscde enzymogram as compared to control,which was significantly different with control and between treatment groups (P