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Objectives:To investigate the clinical value of a novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair.Methods:The prospective randomized controlled study was conducted. The clinical data of 50 adult patients with unilateral inguinal hernia who were admitted to 3 medical centers, including Ruijin Hospital of Shanghai Jiaotong University School of Medicine et al, from September 2019 to March 2020 were selected. Based on random number table, patients were divided into two groups. Patients using the novel non-crosslinked biological mesh in repair surgery were divided into the experiment group and patients using the lightweight, micro-porous, partially absorbable synthetic mesh in repair surgery were divided into the 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 t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter rank sum test. Count data were described as absolute numbers and (or) persentages, 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. Repeated measurement data were analyzed using the repeated ANOVA. Taking the recurrence rate of hernia as the basis of efficacy evaluation, according to the intention-to-treat analysis, the confidence interval method (Newcombe Wilson method) was used to conduct non-inferiority statistical analysis of the recurrence rate of hernia between the experiment group and the control group. If the upper limit of 95% confidence interval of the difference of recurrence rate of hernia between the experiment group and the control group is less than 10%, the experiment group is considered to be non-inferior to the control group. Results:(1) Grouping situations of the enrolled patients. A total of 50 adult patients with inguinal hernia were selected for eligibility. There were 44 males and 6 females, aged (60±15)years. All 50 patients were randomly divided into to the experiment group and the control group with 25 cases each. One patient in the control group was not followed up at postoperative month 2, and the rest of 49 patients completed all expected follow-up. No patient in the two groups fell off or were removed. (2) Endpoint of the study. ① The primary endpoint of study. The recurrence rate of hernia was 0 in the experiment group, versus 4%(1/25) in the control group, respectively, showing no significant difference between the two groups ( P>0.05). 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 -19.54% to 9.72%, with the upper limit as 9.72%, which was less than 10%. ② The secondary endpoint of study. There were 2 patients in the control group occurred seroma at postoperative day 14, and none of the rest of patient in the two groups occurred seroma during the follow-up, showing no significant difference in the occurrence of seroma between the two groups ( P>0.05). There was 1 patient in the control group feeling discomfort or foreign body sensation in groin area at postoperative month 2, and none of the rest of patient in the two groups feeling discomfort or foreign body sensation in groin area during the follow-up, showing no significant difference in the feeling discomfort or foreign body sensation in groin area between the two groups ( P>0.05). There was no patient occurred surgical site infection in the experiment group, and there was 1 patient in the control group occurred postoperative skin infection, which had no relationship with mesh. There was no patient in both two groups occurred fever, anaphylaxis and patch related serious adverse reaction during the follow-up. The resting visual analogue scale score, active visual analogue scale score of patients at postoperative 2 days and postoperative 18 months were 0.44±1.00, 1.28±1.46 and 0, 0 in the experiment group, versus 0.40±0.76, 1.28±1.14 and 0.24±1.20, 0.44±1.29 in the control group, respectively. There was a significant difference in the time effect of postoperative active visual analogue scale score of patients between the two groups ( Ftime=10.19, P<0.05). The thickness of the novel non-crosslinked biological mesh before implantation was 0.5?0.7 mm. Two months after operation, results of B-ultrasonic examination in groin area of 10 patients from the experiment group showed a strong echo area at the patch implant area with a thickness as 2 mm. Conclusion:Application of novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair is safe and effective.
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Objective:To investigate the feasibility of the surgical mode of immediate implant-based breast reconstruction (IIBR) with silicone implants under subcutaneous tissue directly after the total mastectomy in breast cancer.Methods:Data of 53 patients who underwent (skin-sparing mastectomy, SSM) or (nipple-areola-complex-sparing mastectomy, NSM) combined with IIBR in Department of Breast Surgery, Maoming People’s Hospital were retrospectively analyzed. Patients were divided into two groups, 31 cases with the silicone implant placed in different anatomical locations of the chest wall, including subcutaneous tissue, and 22 cases with subpectoral space implantation followed NSM or SSM. The two groups were compared in terms of the short-term and long-term complications, as well as the aesthetic outcome. Within 12 months the local recurrence rate was collected to evaluate the treatment safety of the two groups preserving the thickness of subcutaneous adipose after NSM or SSM.Results:There was no nipple-areola-complex (NAC) or skin flap for both groups, and the time of removing the drainage tube had no significant difference ( P>0.05) . There was no significant difference between the two groups in terms of the short-term complications within 6 months (repeated local infection and unknown effusion occurrence) , the long-term complications after 6 months (local skin with wrinkles sign, prosthesis displacement, and grade III-IV capsular contracture ( P>0.05) . However, the subcutaneous tissue implant group were superior ( P<0.05) in cosmetic outcome because of the breast had better symmetry. What’s more, no local tumor recurrence occurred in either group within 12 months. Conclusions:IIBR of subcutaneous tissue implantation (without patches) is an economical, novel, safe, and effective surgical mode for breast reconstruction, and the key to this operation mode depends on quality control of surgical procedures and the thickness of skin flap ≥ 1cm covering silicone implants. However, due to the cases enrolled in this study is not enough and short follow-up time, further clinical studies are still needed.
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The Rives-Stoppa technique was developed by two French surgeons in the 1960s and the plane where they placed the meshes is the plane in Sublay repair which is familiar to modern surgical community. After more than half a century of clinical practice, a large amount of evidence-based medical evidences indicate that the Sublay repair has become the recognized preferred surgical procedure in open repair. The Sublay repair as well as laparoscopic intra-peritoneal onlay mesh repair have become the two dominant procedures for the treatment of abdominal incisional hernia. With the deeply rooted concept of minimally invasive and the increasing integration of laparoscopic technique, the current Sublay repair is constantly deriving multi-dimensional development directions. Integration of laparoscopic technique and Sublay repair has become one of the important exploration directions of minimally invasive non-intraperitoneal mesh repair. The authors comprehensively analyze the research progress at home and abroad, and introduce the history, current status and prospective of Sublay repair.
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Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.
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Objective:To evaluate the effect of edaravone on long-term cognitive function in elderly patients undergoing hip replacement.Methods:A total of 160 patients, aged≥65 yr, undergoing elective hip replacement, were divided into 2 groups ( n=80 each) using the random sequence generated by the McLeod-modified Wichmann-Hill pseudo-random number generator: edaravone group (group E) and control group (group C). Spinal-epidural anesthesia was applied in two groups.Edaravone 60 mg (in 100 ml of normal saline, infusion rate 200 ml/h) was intravenously infused from the time point immediately after achieving the anesthesia plane until the following 30 min.Serum chemokine ligand 13 (CXCL13) and interleukin-6 (IL-6) concentrations were detected by enzyme-linked immunosorbent assay before anesthesia, during surgery (30 min after skin incision), and at postoperative days 1, 3 and 7.The Confusion Assessment Method Scale in Chinese was used to detect the postoperative delirium at postoperative days 1, 2, 3 and 7, and the Telephone Interview for Cognitive Status-Modified and ADL score were adopted to assess the cognitive function and quality of daily living, respectively, and the occurrence of cognitive impairment was recorded at 1 and 12 months after surgery. Results:Compared with group C, the total Telephone Interview for Cognitive Status-Modified score and ADL score were significantly increased, the incidence of postoperative delirium and cognitive impairment was decreased, and the serum CXCL13 and IL-6 concentrations were decreased during surgery and at each time point after surgery in group E ( P<0.05). Conclusion:Edaravone can reduce inflammatory responses and improve long-term cognitive function in elderly patients undergoing hip replacement.
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Objective To investigate the upregulation of long-chain non-coding RNA LINC01204 on the expression of glypican-5 (GPC5) gene in bladder cancer cells and its effect on the proliferation,migration and invasion of bladder cancer cells.Methods Quantitative real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the expression of LINC01204 in 12 cases of bladder cancer tissues and paracancerous tissues,bladder cancer cell lines (BIU-87,T24,J82,5637) and normal bladder epithelial cell SV-HUC-1.The bladder cancer cells with the lowest level of LINC01204 were infected with lentivirus particles carrying LINC01204 (experimental group) or infected with negative control lentivirus particles (control group),and the expression of LINC01204 and GPC5 were detected by qRT-PCR in both groups of cells.Western blot was used to detect the expression of GPC5 protein in the two groups of cells.Cell counting kit-8 (CCK-8) and Transwell chamber assays were used to determine cell proliferation,migration and invasion.Results The expression of LINC01204 in bladder cancer tissues (0.773 ±0.063) was significantly higher than that in adjacent tissues (3.665 ± 0.330),with statistically significant difference (t =8.612,P ＜ 0.001).The expression of LINC01204 in bladder cancer cell lines BIU-87 (0.320 ± 0.034),T24 (0.515 ±0.056),J82 (0.644 ±0.039),and 5637 (0.147 ±0.018) were lower than that of normal bladder epithelial cells SV-HUC-1 (1.009 ± 0.077),with statistically significant difference (t =8.160,P＜0.001;t=5.179,P=0.002;t=4.221,P=0.006;t=10.890,P＜0.001).The expression of LINC01204 in 5637 cells was the lowest.The expression of LINC01204 and GPC5 mRNA in experimental group were significantly higher than that in the control group,with statistically significant difference [(11.000±1.028) vs (1.019 ±0.119),t =9.651,P＜0.001;(4.476 ±0.347) vs (1.046 ± 0.163),t =8.962,P ＜ 0.001],with statistically significant difference.Western blot showed that the expression of GPC5 protein was up-regulated.Compared with the control group,the proliferation ability of 5637 cells infected with LINC01204 in experimental group began to decrease significantly from the third day (0.686 ±0.044 vs 0.536 ±0.026,t =2.943,P =0.026).The number of migration cells in experimental group (118.300 ± 16.260) was significantly lower than that in the control group (208.200 ±22.930),with statistically significant difference (t =3.198,P =0.019).The number of cell invasion in experimental group (50.390 ±5.368) was significantly lower than that in the control group (97.480 ± 15.350),with statistically significant difference (t =2.896,P =0.028).Conclusions LINC01204 can upregulate the expression of GPC5 gene and inhibit the proliferation,migration and invasion of bladder cancer cells.Targeted therapy for LINC01204 is expected to become a new gene therapy method for bladder cancer.
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Objective To investigate the safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected.There were 81 males and 51 females,aged from 45 to 83 years,with an average age of 62 years.Among the 132 patients,60 undergoing LARP-PPC were allocated into LARP-PPC group,and 72 patients undergoing conventional LARP were allocated into LARP group.All the patients received standardized preoperative and postoperative treatments.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) postoperative complications.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (range),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers,and the chi-square test or the Fisher exact probability was used for comparison between groups.Mann-Whitney U test was used for comparison of ordinal data between groups.Results (1) Surgery and postoperative conditions:all the patients in the two groups underwent successful surgery without conversion to open surgery.The operation time,volume of intraoperative blood loss,time to first flatus,and time to first liquid intake of the LARP-PPC group were (163±45) minutes,168 mL(range,85-280 mL),2 days(range,1-5 days),3 days(range,2-6 days),versus (155±39) minutes,160 mL(range,100-305 mL),3 days(range,1-7 days),4 days(range,2-7 days) of the LARP group;there was no differencebetween the two group (t =1.113,Z =-1.623,-1.468,-0.321,P＞0.05).The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days (range,11-21 days) and 19 days (14-24 days),respectively,with a significant difference between the two groups (Z =-5.888,P＜0.05)].In the LARP-PPC group,time of PPC was (13± 3) minutes.(2) Postoperative pathological examination:the length of specimen,the number of lymph node dissection,tumor diameter,cases with high-,middle-,and low-differentiated tumor in the LARP-PPC group was (18±4)cm,16±t5,(3.7±1.4)cm,10,34,16 in the LARP-PPC group,and (18±4)cm,16±5,(3.9±1.5) cm,13,41,18 in the LARP group,showing no significant difference between the two groups (t =0.779,0.390,0.703,Z=-0.267,P＞0.05).(3) Postoperative complications:cases with perineal wound infection,delayed perineal wound healing,intestinal obstruction,and perineal hernia were 2,1,1,0 in the LARP-PPC group,and 12,10,8,6 in the LARP group,showing significant differences between the two groups (x2 =6.137,6.400,P＜0.05).There were 2 and 4 patients with urinary tract infection in the LARP-PPC group and the LARP group,respectively,showing no significant difference between the two groups (P ＞ 0.05).Conclusion LARP-PPC is safe and feasible for the treatment of low rectal cancer,which can significantly reduce postoperative perineal-related complications and consequently shorten postoperative hospital stay.
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Objective To investigate the clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti.Methods The retrospective cross-sectional study was conducted.The clinical data of 14 patients with postpartum diastasis recti who were admitted to Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2016 and June 2018 were collected.Patients underwent laparoscopic-assisted linea alba reconstruction.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,diastasis recti and umbilical hernia recurrence up to September 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (P25,P75).Results (1) Intra-and post-operative situations:14 patients underwent successful laparoscopic-assisted linea alba reconstruction and 8 complicated with umbilical hernia area of (6± 3) cm2 were sutured and closed.The mesh area,operation time,visual analogue score for pain at the first day after operation,time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively (214±26) cm2,(74 ± 14) minutes,3.7 ± 0.6,(3.3 ± 0.7) days and (4.1 ± 1.2) days.No patient required administration of analgesics and had postoperative complication.(2) Follow-up:14 patients were followed up for 17 months (5 months,21 months).During the follow-up,1 patient returned visit at postoperative day 10 due to surgical incision drainage and cured after dressing change.The other patients had no complications,without diastasis recti and umbilical hernia recurrence.Conclusion Laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti is safe and effective.
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Laparoscopic inguinal hernia repair (LIHR) is a surgical procedure of preperitoneal repair under laparoscope.It is well suited for young patients due to the advantages of postoperative slighter pain,faster resuming non-restrictive activities and better cosmetic effect.Total extraperitoneal and transabdominal preperitoneal (TAPP) are alternative for experienced surgeons and TAPP is recommended for complicated hernias or beginners.Most of the inguinal hernias in young males are congenital indirect hernias,accompanied with varicocele or cryptorchid.Varicocele can be handled simultaneously during LIHR and treatment scheme for cryptorchid should be formulated before LIHR according to different situations.Cryptorchid located in abdominal cavity or inner mouth can be resected in LIHR for resectable cryptorchid.Incaecerated scrotal hernia is common in young males and can be treated by hybridization technique.Femoral hernia should be paid attention in young females.Femoral hernia of most patients can be excised completely under laparoscope if combined with cyst of uterus round ligament.If possible,young females are suggested to preserve round ligament of uterus.Keyhole surgery and T-dissection are available for selected.
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Objective To assess the efficacy and safety of tacrolimus combined with prednisone for treat-ment of refractory idiopathic membranous nephropathy(IMN)patients whose serum anti-phospholipase A2receptor (PLA2R)antibody titers were persistent high. Methods An open prospective study of 12 refractory IMN patients was performed in Guangzhou First People's Hospital between June of 2012 and June 2016.The 12 patients failed to re-spond after a standard course of 6 months in a conventional immunosuppressive therapy(cyclophosphamide,myco-phenolate mofetil or cyclosporine A)combined with prednisone and the patients'serum anti-PLA2R antibody titers were persistent high. They were divided into two groups:The tacrolimus group received tacrolimus combined with prednisone for 12 months and the control group received the same or another conventional immunosuppressive therapy for 6 months.Results At the end of the sixth month after enrollment,proteinuria and serum albumin levels in the ta-crolimus group were significantly improved as compared with those in the control group(P<0.01),and eGFR was higher in the tacrolimus group than in the control group(P<0.05).Severe proteinuria and hypoalbuminemia still re-mained in the control group,and eGFR in the control group declined significantly prior to enrollment(P<0.01).Af-ter 6-month treatment,none of the control group became negative for serum anti-PLA2R antibody,and achieved clini-cal remission. Five patients(83.3%)in the tacrolimus group became negative for serum anti-PLA2R antibody and achieved clinical remission(complete remission in two patients and partial remission in three).After 12-month treat-ment,complete remission was achieved in four patients(66.7%)in the tacrolimus group.Conclusions Persistent high serum anti-PLA2R antibody titers may be a cause of no response to a conventional immunosuppressive therapy in refractory IMN patients.For these patients,tacrolimus combined with prednisone may be an effective alternative treat-ment for disappearance of anti-PLA2R antibody and remission.
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Molecularly imprinted polymer (MIP) was synthesized by precipitation polymerization using ribavirin as the template molecule and methacrylic acid as the functional monomer.The sensitive film of ribavirin electrode was constructed by molecularly imprinted polymer doped with graphene oxide as the ionophore, poly(vinylchloride) (PVC) as matrix and dioctyl sebacate for plasticizer.The results showed that the best performance of the electrode was obtained when the sensitive film compositions were 100.8 mg of MIP, 14.7 mg of GO, 450.8 mg of PVC and 901.6 mg of dioctyl sebacate, and the inner filling solution composition was 0.1 mol/L NaCl + 0.05 mol/L NaAc-0.05 mol/L HAc + 1.0×10.-5 mol/L ribavirin solution.The electrode showed a near-Nernstian slope of 45.565 mV/decade for ribavirin over the range of 1.0×10.6-1.0×10.-4 mol/L and a detection limit of 1.0×10.-7 mol/L.The electrode could be used in the pH range of 3 to 5 with response time of less than 3 min.The developed electrode exhibited high selectivity for ribavirin and was successfully applied to the determination of ribavirin in feed and injection with recoveries of 90%-110% and RSD of 3.0%-7.9%.
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Objective To assess the efficacy of mycophenolate mofetil (MMF) combined with prednisone in the treatment of idiopathic membranous nephropathy (IMN) patients with positive serum phospholipase A2 receptor (PLA2R) antibody.Methods An open prospective study was performed on twenty-four biopsy-proven IMN patients with positive serum PLA2R antibody in Guangzhou First People''s Hospital from June 2012 to June 2016.The 24 patients were divided into two groups: MMF group in which MMF combined with prednisone was given for 12 months and CTX group in which intravenous cyclophosphamide (CTX) was monthly given combined with oral prednisone.Results After 6 months of immunosuppressive therapy,complete remission and partial remission rates were 25.0% vs.16.7% and 25.0% vs.25.0% in the MMF group and CTX group,respectively (P>0.05).In the MMF group and CTX group,serum PLA2R antibody in the same amount (8/12,66.7%) of patients turned negative.At the end of twelve-month treatment,all patients with negative PLA2R antibodies achieved complete or partial remission.Clinical remission (including complete and partial remission) rates in the MMF group and CTX group were both 66.7%.After immunosuppressive therapy,the levels of proteinuria and serum albumin in the two groups were significantly improved,but no significant difference were found between the two groups (proteinuria:F within-grouP=98.688,P<0.01;F between-grouP=0.133,P=0.719;F cross-grouP=1.223,P=0.304;serum albumin:F within-grouP=30.629,P<0.01;F between-grouP=0.137,P=0.715;F cros-grouP=0.455,P=0.565).At the end of six and twelve months of treatment,the proteinuria (after six months,MMF group: (2 893±2 515) mg/g vs.(6 236±2 117) mg/g,t=-3.522,P=0.002;CTX group: (2 690±2 254) mg/g vs.(5 386±2 447) mg/g,t=-2.808,P=0.010;after twelve months,MMF group:1 025(99-4 635) mg/g vs.(6 236±2 117) mg/g,Z=-3.291,P<0.0005;CTX group: (775(41-3 517) mg/g vs.(5 386±2 447) mg/g,Z=-3.118,P=0.001) and serum albumin levels (after six months,MMF group: (28.5±9.7) g/L vs.(19.8±4.4) g/L,t=2.841,P=0.012;CTX group: (29.0±7.6) g/L vs.(22.3±4.1) g/L,t=2.690,P=0.016;at the end of twelve months of treatment,,MMF group: (32.4±8.5) g/L vs.(19.8±4.4) g/L,t=4.570,P<0.0005;TX group: (32.2±7.9) g/L vs.(22.3±4.1) g/L,t=3.862,P=0.001) of the two groups were better than those prior to treatment.Conclusion For the IMN patients with positive serum PLA2R antibody,MMF combined with prednisone was as effective as conventional CTX combined with prednisone in the negative conversion of PLA2R antibody and the remission.The negative conversion of PLA2R antibody after 6 months of immunosuppressive treatment was an important indicator of predicting the remission.
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Objective To investigate the effect of interfering Hiwi gene on the apoptosis of MDA-MB-231 cells. Methods The mRNA and protein expression of Hiwi mRNA and its target protein were analyzed by qRT-PCR and Western Blot after transfection. MDA-MB-231 cells were divided into 6 groups according to the experimental design. Interference effects were screened as siRNA interference group (Hiwi10330 group), and then divided into 3 groups according to the experimental design: interference group, negative control group/NC, blank control group/Blank. The cell apoptosis rate was detected by flow cytometry after transfection. Results The expression of mRNA in the interference group was significantly lower than that in the siRNA group (P < 0.05), the expression of target protein of Hiwi gene was also significantly inhibited (P < 0.05). The apoptosis rate of MDA-MB-231 cells was significantly higher than that of NC and Blank groups (P<0.05). Conclusion The apoptosis rate of breast cancer cells MDA-MB-231 was significantly increased after siRNA targeting hiwi gene silencing.
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Objective To investigate the value of ADC and FA of diffusion tensor imaging(DTI)and T2 value of T2 mapping for assessing lumbar intervertebral disc degeneration.Methods 12 cases of healthy volunteers(8 males and 4 females),28 cases of patients with chronic low back pain(15 males and 13 females,19-70 years old)were performed lumbar spine MRI,DTI and T2 mapping to obtain ADC,FA and T2 value.Intervertebral discs were classified according to the Pfirrmann grading.The correlations of different degeneration grade with ADC,FA and T2 value were analyzed.The diagnostic value of ADC,FA and T2 values of lumbar intervertebral disc degeneration were compared. Results Both ADC value and T2 value were significantly negative correlated with lumbar intervertebral disc degeneratic Pfirrminn grading(r=-0.779,r=-0.708,P<0.001).FA value were positively correlated with Pfirrminn grading(r=0.474,P<0.001), the correlation was not closely.Conclusion DTI and T2 mapping can be effectively used to quantitatively evaluate the degeneration degree of lumbar intervertebral disc,the diagnostic value of ADC was the highest,followed by T2 ,and FA was the worst.
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Objective To explore the clinical efficacy of laparoscopic inguinal hernia repair (LIHR) in elderly patients.Methods The retrospective cohort study was adopted.The clinical data of 3 203 patients with inguinal hernias (3 847 sides) who were adnitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected.Of 3 203 patients,979 (1 107 sides) with age ＜ 60 years and 2 224 (2 740 sides) with age ≥ 60 years were respectively allocated into the under 60 years group and 60 years or older group.The surgical procedures including transabdominal preperitoneal (TAPP) approach,total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team.There were light-weight and heavy-weight patches.Observation indicators included (1) overall operation situations,(2) surgical comparison between the 2 groups,(3)comparison of postoperative indicators between the 2 groups,(4) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recovery time of non-restricted activity,recurrence of hernia and complications.Measurement data with normal distribution were represented as ~ ± s and comparison between groups was done by the t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.Ranked data were compared by the nonparametric rank sum test.Results (1) Overall operation situations:3 203 patients with inguinal hernias (3 847 sides) underwent LIHR,including 1 475 (1 677 sides) using TAPP approach,1 718 (2 154 sides) using TEP approach and 10 (16 sides) using IPOM approach (6 using TAPP and IOPM approaches in each side).The light-weight patch was used in 2 206 sides and heavy-weight patch was used in 1 641 sides.Operation time was (31 ± 12) minutes in all 3 203 patients,(27 ±9)minutes in 2 559 patients with unilateral hernia and (44 ± 12)minutes in 644 patients with bilateral hernia,respectively.Duration of postoperative hospital stay was (1.5 ± 1.2) days.(2) Surgical comparison between the 2 groups:TAPP approach,TEP approach,IPOM approach,light-weight patch and heavy-weight patch were performed to 567,538,2,751,356 sides in the under 60 years group and 1 110,1 616,14,1 455,1 285 sides in the 60 years or older group,respectively,with statistically significant differences in above indicators between the 2 groups (X2 =37.976,70.022,P ＜ 0.05).Operation time in unilateral hernia and bilateral hernia and total operation time were (27 ± 9)minutes,(42 ± 10)minutes,(29 ± 10)minutes in the under 60 years group and (27 ± 10)minutes,(44 ± 12)minutes,(3 1 ± 13)minutes in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =-0.106,-1.768,-4.445,P ＞ 0.05).(3) Comparison of postoperative indicators between the 2 groups:the pain score at postoperative day 1 and duration of postoperative hospital stay were 2.4 ± 1.1,(1.5 ± 1.1) days in the under 60 years group and 2.3 ± 1.0,(1.5 ± 1.3) days in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =1.419,-0.126,P ＞0.05).(4) Follow-up:all the patients were followed up for 23-60 months,with a median time of 43 months.Cases with non-restricted activity recovery at postoperative week 2 and 4 were 973,978 in the under 60 years group and 2 208,2 222 in the 60 years or older group,respectively,showing no statistically significant difference between the 2 groups (X2=0.113,P ＞0.05).The recurrence of hernia,severe complications,serum tumescence,paresthesia and enteroparalysis were detected in 1,0,49,5,1 sides in the under 60 years group and 11,3,132,16,2 sides in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (x2=1.556,0.269,0.254,P ＞ 0.05).The urinary retention in the under 60 years group and 60 years or older group was respectively detected in 6 and 44 sides,showing a statistically significant difference between 2 groups (x2=6.956,P ＜ 0.05).Conclusion LIHR is safe and effective in elderly patients,and it can achieve good clinical efficacy under selecting reasonable operation procedures and patches.
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Methods The clinical data of 4445 cases (5 530 hernias) who underwent LIHR at Ruijin Hospital from Jan 2001 to Dec 2015 were analyzed retrospectively.2 125 cases underwent 2 402 trans-abdominal preperitoneal procedure(TAPP),2 306 cases did 2 907 totally extraperitoneal (TEP),and 21 IPOMs in 20 cases.There were 3 216 indirect hernias (60.3％),1 164 direct hernias (21.8％),399 recurrent hernias (7.5％),479 complex hernias (9.0％),and 72 femoral hernias (1.4％).The median time of follow-up is 51 months with a range between 7 and 187 months.Results The average operation time was 27.1 ± 8.7 min for unilateral hernia repair,and 43.0 ± 11.0 min for bilateral hernia repair.The average hospital stay was 1.4 ± 1.1 d.There were 250 seroma (4.7％),68 urinary retention (1.3％),23 transient neuropraxia (0.4％) and 3 paralytic obstruction of intestines (0.1％).Severe complications included 1 port site hernia,1 intestinal injury,and 1 mechanical intestinal obstruction.After a medium follow-up of 51 months,there were 13 recurrent cases (0.24％),including 5 cases after TAPP,7 after TEP,1 after IPOM.Conclusion LIHR is a safe and efficient technique for hernia repair.
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Objective To evaluate the safety and efifcacy of Laparoscopic partial nephrectomy (LPN) versus 1aparoscopic cryoablation (LCA) for the small renal tumors (SRMs).Methods The databases of PubMed, SCI, Ovid, the Cochrane Library, CNKI, CBM, VIP and Wangfang Data were searched to controlled clinical trial about LPN versus LCA for the treatment of small renal tumor. The retrieval time span was from inception to Apr 2016. The studies were screened according to the inclusion and exclusion criteria, the date were extracted and the quality was evaluated by 2 reviewers independently. And then the Meta-analysis was conducted using RevMan 5.3 software.Results 9 studies were included, and 748 cases were involved. The meta-analysis showed that comparing with LPN, the operation time of LCA was shorter [MD = 42.75, 95 % CI (12.19~73.31),P = 0.006], less intraoperative blood loss [MD = 190.73, 95 % CI (126.67~254.78),P = 0.000], shortening hospital stay [MD = 2.23, 95 % CI (0.17~4.28),P = 0.030], lower transfusion rate [OR
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Objective To investigate the clinical efficacy of unilateral small incision Quadrant channel assisted MIS?TLIF unilateral pedicle screw fixation system in the treatment of degenerative lumbar disease. Methods From January 2011 to December 2013,a total of 56 cases with low back and leg pain were selected in the People′s Hospital of Dongguan,including 25 cases with lumbar disc herniation,18 cases with lumbar tube stenosis,10 cases with discogenic low back pain,2 cases of recurrence after posterior lumbar spine surgery,1 case of recurrence after transforaminal endoscopic surgery. Unilateral pedicle screw fixation was performed in the treatment of MIS?TLIF with expandable pipeline system. VAS and Oswestry dysfunction index scoring system( ODI) were used to evaluate of pain and functional recovery in patients with preoperative and postoperative pain and functional recovery,the Suk method was used to observe the bone graft fusion. Results There were 5 cases of non operative side waist back pain after operation,and the waist circumference and anti?inflammatory pain relief were improved after treatment. One case of postoperative subcutaneous fat liquefaction, was cured by dressing change. One patient with recurrence of MED intraoperatie cerebrospinal fluid leakage,was cured after treatment by the bed,dehydration and others. Other complications such as infection,screw loosening, nerve root injury and other complications had no found. After 1 month,the VAS score from preoperative ( 6. 82 ±0. 92) points fell to (1. 95±0. 55) points,ODI score from preoperative (35. 21±2. 73) points fell to (10. 05 ±1. 72) points, significantly improved compared with the preoperative, the differences were statistically significant( t=36. 775,65. 858,P<0. 05) ,based on the fusion of Suk judgment method,2 cases of patients with possible fusion,the rest were fusion. Conclusion Unilateral small incision under the quadrant assisted MIS?TILF unilateral pedicle nail stick system has obvious advantages in treatment of degenerative lumbar spine disease,as long as we choose to suitable cases and most patients can obtain satisfactory results.
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Objective To evaluate whether three chronic kidney disease epidemiology collaboration (CKD-EPI) equations (CKD-EPI2009Scr,CKD-EPI2012SCysC and CKD-EPI2012Scr-SCysC) are applicable in the prediction of glomerular filtration rate (GFR) in Chinese patients with diabetic nephropathy (DN).Methods One hundred and eight patients with DN who were hospitalized in the First Affiliated Hospital of Guangzhou Medical University with GFR being measured by dynamic renal imaging with 99mTc-DTPA from June 2012 to April 2014 were enrolled in this study.GFR measured by dynamic renal imaging with 99mTe-DTPA was used as the reference value (rGFR).GFR was estimated by the CKD-EPI2009Scr equation,the CKD-EPI2012SCySC equation,and the CKD-EPI2012Scr-SCysC equation (labeled as eGFR1,eGFR2,eGFR3).The correlation,30％ accuracy,staging consistency,deviation and diagnostic accuracy were compared among the three CKD-EPI equations.Results The rGFR in 108 DN patients was (61.78±26.51) ml· min-1· (1.73 m2)-1.The correlation between three eGFRs and rGFR was significant (all P ＜ 0.01),the correlation coefficients were 0.738,0.708,0.782.The 30％ accuracy were 74.07％,52.78％,67.59％,The 30％ accuracy of eGFR1 and eGFR3 were higher than eGFR2 (all P ＜ 0.05),but there was no significant difference between eGFR3 and eGFR1 (x2=0.874,P=0.436).The staging consistency was not ideal,Kappa values were 0.391,0.180 and 0.422.For the deviations between three eGFRs and rGFR,there was no significant difference between eGFR3 and rGFR (P ＞ 0.05),eGFR1 underestimated rGFR,eGFR2 overestimated rGFR (all P ＜ 0.01).The results of the Bland-Altman chart showed that consistencies between three eGFRs and rGFR were poor,the degree of deviation of eGFR3 was the smallest.The area under the ROC curve (AUC) of three eGFRs was 0.878,0.883 and 0.915.The AUC,sensitivity,specificity,overall compliance rate and Youden index of eGFR3 were the highest.Conclusions The eGFRs predicted by the three CKD-EPI equations showed good relevance,accuracy and diagnostic accuracy with the rGFR,but poor in consistencies.Comparatively,CKD-EPI2012Scr-SCysC may be better than others,but its consistency limits exceeds the acceptable limits.Therefore,the applicability of using the three CKD-EPI equations to predict the GFR in Chinese DN patients requires a larger sample and multiple verifications as well as further improvement.
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Objective To study the expression and clinical significance of matrix metalloproteinase 2 (MMP-2) in chinese patients with bladder cancer. Methods The relevant original articles published in journals from 1998 to 2014 were selected. The ratio of the case group and the control group (OR value) regarded as an effect index. Then the original data were analyzed using Meta analysis software RevMan 5.0, the combined OR values and 95%confidence interval were calculated, and the forest map was draw. Results 13 studies involving 692 patients that met the inclusion criteria were included in the Meta analysis. The OR values of bladder cancer tissue group and normal bladder tissue group, superficial bladder cancer group and invasive bladder cancer group, and low grade bladder cancer group and senior bladder cancer group were 45.83, 0.22 and 0.31, respectively. The positive rates of MMP-2 in bladder cancer tissue group, invasive bladder cancer group and advanced bladder cancer group were significantly higher than those in normal bladder tissue group, superficial bladder cancer group and low grade bladder cancer group (all P< 0.05). Conclusions The high expression of MMP-2 has a certain effect in bladder cancer. The detection of MMP-2 contributes to the understanding of the biology of bladder cancer, and provides information for clinical treatment and prognosis.