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There is still a lack of sufficient evidence-based basis for the treatment of simple gaming disorder. The purpose of this paper is to review the research progress of gaming disorder intervention， in order to provide references for the treatment of patients with gaming disorder. With the development and popularization of the Internet， the adverse events caused by the pathological use of online games have attracted wide attention. At present， gaming disorder has been listed in the International Classification of Diseases， eleventh edition （ICD-11） by WHO. This paper reviewed the latest interventions measures about gaming disorder at home and abroad in the past decade， including psychological， pharmacological and physical intervention methods， and analyzed and summarized these intervention measures， so as to provide references for patients with gaming disorder to formulate a reasonable intervention plan.
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By comparing the training status of clinical research methods between United States and China, this article introduces comprehensive training system in the United States in and after the university, and discusses the problems in clinical research methodology training in China. These issues include that when medical students at school do not receive the training of professional clinical research courses, and after they go to the work, they also lack professional and accurate clinical research methodology training, which make it difficult for doctors to independently conduct clinical research. Therefore, it is recommended that Chinese medical schools should systematically establish clinical research methodology courses for undergraduates and graduate students to cultivate the clinical research capabilities of medical students. Secondly, according to the clinical research levels of doctors, different training models are proposed in the study. The existing social resources should be scientifically guided. We hope our work would provide some references for the improvement of clinical research methodology in China, to promote clinicians to be independently responsible for conducting clinical research, and improve the national medical level.
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Objective:To investigate the clinical value of computer tomography (CT)-based three-section formula in identification of Siewert types of adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 62 AEG patients who were admitted to two medical centers, including 33 patients from Peking University Cancer Hospital and 29 patients from the First Affiliated Hospital of Amy Medical University, between January 2019 and January 2021 were collected. There were 53 males and 9 females, aged (66±9)years. All patients underwent CT examination to obtain the coronal and axial images and determine the upper and lower edges of the tumor and the esophagogastric junction, which were imported into the formula for Siewert classification. Observation indicators: (1) results of CT examination and pathological examination; (2) consistence of judgements for CT examination between doctors; (3) consistence of judgements between CT examination and patholo-gical examination. Results of pathological examination came from intraoperative surgical observa-tion and postoperative histopathological examination. Measurement data with normal distribution were represented as Mean± SD, and count data were described as absolute numbers or percentages. The consistency coefficient Kappa ( κ) was used to evaluate the consistency of diagnosis between resear-chers. The κ≥0.75 was regarded as excellent consistency, 0.40< κ<0.75 as good consistency, κ ≤0.40 as poor consistency. Wilcoxon rank sum test was used to evaluate the statistical difference between results of the CT-based three-section formula method and the pathological examination. Taking the results of histopathological examination as standard, the sensitivity, specifi-city, accuracy and 95% confidence interval of the CT-based three-section formula method were calculated. Results:(1) Results of CT examination and pathological examination: all the 62 patients underwent CT examination successfully to obtain the coronal and axial images and determine the upper and lower edges of the tumor and the esophagogastric junction, which were used for Siewert classifica-tion. There were 3 cases with AEG of Siewert type Ⅰ, 47 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ according to doctor's judgement from the Peking University Cancer Hospital, and there were 3 cases with AEG of Siewert type Ⅰ, 49 cases with AEG of Siewert type Ⅱ and 10 cases with AEG of Siewert type Ⅲ according to doctor's judgement from the First Affiliated Hospital of Amy Medical University, respectively. After arbitration, there were 2 cases with AEG of Siewert type Ⅰ, 48 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ determined by the CT based three-section formula. There were 7 cases of stage T1, 10 cases of stage T2, 24 cases of stage T3, 14 of stage T4a and 7 cases of stage T4b of pathological T staging. There were 2 cases with AEG of Siewert type Ⅰ, 48 cases with AEG of Siewert type Ⅱ and 12 cases with AEG of Siewert type Ⅲ determined by pathological examination. (2) Consistence of judgements for CT examination between doctors: the consistency of Siewert classification determined by CT-based three-section formula between 2 doctors was good ( κ=0.74, P<0.001). (3) Consistence of judgements between pathological examination and CT examination: with Siewert classification determined by pathological examination as reference, the accuracy of Siewert classification determined by CT based three-section formula was 90.3%( κ=0.73, P<0.001). The sensitivity and specificity of CT-based three-section formula were 66.7%(95% confidence interval as 20.8%-93.9%) and 100.0%(95% confidence interval as 93.9%-100.0%) for AEG of Siewert type Ⅰ, 97.7%(95% confidence interval as 88.2%-99.6%) and 72.2%(95% confidence interval as 49.1%-87.5%) for AEG of Siewert type Ⅱ, 73.3%(95% confidence interval as 48.0%-89.1%) and 97.9%(95% confidence interval as 88.9%-99.9%) for AEG of Siewert type Ⅲ, respectively. Conclusion:The CT-based three-section formula can be used for identification of Siewert types of AEG, with a high accuracy.
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Objective:To study the efficacy and safety of EndoClot polysaccharide hemostatic system (EndoClot PHS) for heparinized arterial hemorrhage of upper digestive tract (Forrest Ⅰa) in animal model.Methods:Twelve experimental pigs were randomly divided into the test group ( n=6) and the control group ( n=6) by simple random grouping method. Gastric arterial hemorrhage models were established. Endoclot PHS and Hemospray were used to spray on the wound to stop bleeding in the test group and the control group respectively. The time of effective hemostasis, the amount of hemostatic particles used, and the blockage of the powder feeding tube and its replacement were compared between the two groups. The survival and complications of experimental pigs were observed after the operation. In 10 days after the operation, the experimental pigs were euthanized for pathological dissection. Results:Spurting or pulsatile bleeding was achieved in all experimental pigs. There were significant differences in the time of effective hemostasis (8.75±0.84 min VS 9.83±0.62 min, t=-2.53, P=0.030) and the amount of hemostatic particles used to achieve effective hemostasis (6.71±0.39 g VS 14.10±1.62 g, t=-10.86, P<0.001) between the test group and the control group. There was no significant difference in the occurence of clogging or the replacement of powder feeding pipes between the two groups (0.64±0.02 times VS 0.67±0.04 times, t=-1.64, P=0.131). In addition, the gas source of the test group was stable, and the visual field under the endoscope was clear. Neither the test group nor the control group had gastric lesions, perforation, or embolism. The blood glucose, blood routine, and liver and kidney functions were normal, and no thrombosis or embolism of the main organs occurred in either group. Conclusion:EndoClot PHS is safe and effective for heparinized upper gastrointestinal arterial hemorrhage (Forrest Ⅰa) in animal models.
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Objective:To investigate the efficacy of CT imaging features in evaluating occult peritoneal metastasis (OPM) of diffuse infiltrating gastric cancer (Borrmann Type Ⅳ).Methods:Totally 101 patients with locally advanced Borrmann type Ⅳ gastric cancer were retrospectively collected who were admitted to Peking University Cancer Hospital from March 2014 to March 2021. The patients were divided into OPM group (53 cases) and the non-OPM group (48 cases) according to the results of preoperative CT and laparoscopic exploration/peritoneal cytology examination. The pathological examination results were recorded, including the degree of histological differentiation and Lauren classification. The evaluation indicators included the tumor center position, the number of tumor-occupied portions, involved orientation, mucosal broadband sign, stratified enhancement, serosa invasion, increased density of peripheral fat tissue, and enlarged lymph nodes. The maximum thickness of the primary tumor, average CT value of the primary tumor (arterial phase, venous phase, and delayed phase), difference between venous phase and arterial phase, difference between delayed phase and venous phase, and pattern of the enhanced curve were recorded. The Mann-Whitney U or Chi-square test was used to compare the differences of pathological and CT features between two groups. The multivariate logistic regression was used to screen independent predictors and establish a nomogram. The receiver operating characteristic curve was used to evaluate the performance of the nomogram in predicting OPM, and the Hosmer-Lemeshow test was used to test the model′s goodness of fit. Results:There was statistical significance in the seven indicators between the OPM and non-OPM groups, including tumor-occupied portions of stomach, mucosal broadband sign, stratified enhancement, serosa invasion, increased density of peripheral fat tissue, the enhanced curve pattern and the degree of histological differentiation ( P<0.05). Among them, the degree of histological differentiation (OR=0.19, P=0.033), stratified enhancement (OR=7.02, P=0.005) and serosa invasion (OR=14.27, P<0.001) were independent predictors of OPM. The nomogram was established based on the three significant features. The area under the curve for predicting OPM was 0.826 (95%CI 0.745-0.908), the sensitivity was 0.566 and the specificity was 0.938. The Hosmer-Lemeshow test showed a good agreement between the OPM risk predicted by the nomogram and the actual risk ( P=0.525). Conclusions:The CT features of Borrmann type Ⅳgastric cancer complicated with OPM have specific characteristics. The diagnosis model based on the degree of histological differentiation, stratified enhancement, and serosa invasion had high efficacy in evaluating OPM.
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Objective:To investigate the application value of ambulatory surgery mode for small and medium abdominal wall hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 33 patients with small and medium abdominal wall hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2019 to January 2021 were collected. There were 19 males and 14 females, aged 54(range, 26?85)years. Patients individually underwent Onlay repair, Sublay repair, intraperitoneal onlay mesh repair (IPOM)according to the diagnosis and treatment mode of ambulatory surgery. Observation indicators: catogaries of small and medium abdominal wall hernia, surgical methods, intraoperative measured diameter of hernia ring defect, operation time, volume of intraoperative blood loss, duration of hospital stay, delayed discharge of patients, hospitalization expenses, postoperative follow-up, complications, postoperative visual analogue scale of pain, chronic pain, postoperative satisfaction. Follow-up using telephone interview or outpatient examinations was conducted to detect hernia recurrence, surgical-related complications (wound infection, pain, hematoma or seroma, intestinal leakage, intestinal obstruction) and postoperative satisfaction at postoperative 3 days, 7 days, 1 month, 3 months, 6 months and 12 months. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and count data were represented as absolute numbers. Results:Of the 33 patients, 16 cases had umbilical hernia, 14 cases had incisional hernia, 3 cases had lumbar hernia. There were 7 patients treated with Onlay repair, 16 with Sublay repair, and 10 cases with IPOM. The intraoperative measured diameter of hernia ring defect, operation time and volume of intraoperative blood loss of 33 patients were 2.8(range, 1.0?6.0)cm, 51(range, 20?85)minutes, 4.3(range, 1.0?10.0)mL. The duration of hospital stay of 33 patients was 24?48 hours, including 25 cases with duration of hospital stay ≤24 hours, 8 cases with duration of hospital stay >24 hours and ≤48 hours. Of the 8 patients undergoing IPOM with delayed discharge, 5 cases had postoperative pain and 3 cases had dizziness, nausea and vomiting after general anesthesia. They were recovered and discharged from hospital after observation and symptomatic support until the next morning. The hospitalization expenses were 17 139(range, 6404?34 124)yuan. All the 33 patients were followed up regularly after operation. No hernia recur-rence, wound infection, hematoma and seroma, intestinal fistula or intestinal obstruction was observed during the follow-up period. From postoperative 3 days to 12 months, the visual analogue scale of pain was from 2.90±0.10 to 0 for patients with Onlay repair, from 3.10 ±0.10 to 0 for patients with Sublay repair, from 3.50 ±0.20 to 0 for patients with IPOM. No patient suffered from chronic pain after the operation and postoperative satisfaction of patients was 100%. Conclusion:The ambulatory surgery mode has safety and feasibility in small and medium abdominal wall hernia repair.
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Objective:To study the clinical characteristics and classification of gastric neuroendocrine neoplasm(NEN) and prognostic factors of mixed adenoneuroendocrine carcinoma (MANEC) and gastric neuroendocrine carcinoma(NEC).Methods:A total of 148 gastric NENs were divided into type Ⅰ, type Ⅱ and type Ⅲ based on the classification of European Neuroendocrine Tumor Society (ENETS). Kaplan-Meier test and Cox regression model were used in univariate and multivariate survival analysis in 108 cases with pathological G3 gastric NEN.Results:In this study, the percentages of type Ⅰ, type Ⅱ and type Ⅲ were 25.0%(37), 3.4%(5) and 71.6%(106) respectively. Among type Ⅰ patients, 28(75.7%) lesions were located in gastric fundus or body, 29(78.4%) had bumps. Lymph node involvement was found in 4 (10.8%) patients. Twenty-six (70.3%) patients received endoscopic treatment and 11 (29.7%) with surgery. All 5 type Ⅱ patients presented lesions in gastric fundus or body, including 4 with ulcers, who were all treated by endoscope. Three type Ⅱ patients had gastrinoma, and 2 combined with multiple endocrine neoplasmⅠ. In type Ⅲ patients, 56(52.8%) showed ulcerative lesions. The majority of patients (102, 96.2%) had a single lesion, 94(88.7%) with lymph node or other organ metastasis. In this study, no deaths were reported in gastric NEN with a pathological grade of G1 or G2. The mortality rate was 38.9%(42/108) in patients with G3 NEN. Survival analysis suggested that age, metastasis of tumor were associated with poor prognosis ( P=0.041, 0.025). Conclusions:Patients with gastric NEN have heterogenous clinical presentations according to gender, age, endoscopic features, infiltration and metastasis, and pathological grade. Aging and metastasis are negative prognostic factors of G3 gastric NEN.
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Objective:To investigate the computed tomography (CT) features of adenocarcinoma of esophagogastric junction (AEG) after neoadjuvant chemotherapy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 59 patients with AEG who underwent neoadjuvant chemotherapy in Peking University Cancer Hospital from February 2010 to November 2014 were collected. There were 51 males and 8 females, aged from 46 to 82 years, with a median age of 63 years. All the 59 patients underwent enhanced CT examination before and after neoadjuvant chemotherapy. Observation indicators: (1) pathological examination and neoadjuvant chemotherapy of patients with AEG; (2) results of CT examination in patients with AEG, including ① qualitative indicators of CT and ② quantitative indicators of CT. Measurement data with skewed distribution were represented as M( P25, P75) or M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed by the chi-square test. Results:(1) Pathological examination and neoadjuvant chemotherapy of patients with AEG: of the 59 patients with AEG, high-differentiated adenocarcinoma was observed in 1 patient, moderate-differentiated adenocarcinoma in 40 patients, and low-differentiated adenocarcinoma in 18 patients. Effective response to neoadjuvant chemotherapy was observed in 13 patients, including 6 patients of pathological tumor regression grading (pTRG) 0 and 7 of pTRG 1; poor response was observed in 46 patients, including 12 patients of pTRG 2 and 34 patients of pTRG 3. (2) Results of CT examination in patients with AEG. ① Qualitative indicators of CT: for the 13 patients with effective response to neoadjuvant chemotherapy, 13 had the presence of ulcers, 5 had layered enhancement, 10 had infiltration of adventitia surface, and 2 had positive extramural venous invasion (EMVI) before neoadjuvant chemotherapy; after neoadjuvant chemotherapy, 13 had shallowed or disappeared ulcers, 7 patients had changed enhancement pattern, 3 had infiltration of adventitia surface, and 1 had positive EMVI. For the 46 patients with poor response to neoadjuvant chemotherapy, 28 had the presence of ulcers, 18 had layered enhancement, 37 had infiltration of adventitia surface, and 22 had positive EMVI before neoadjuvant chemotherapy; after neoadjuvant chemotherapy, 23 had shallowed or disappeared ulcers, 7 patients had changed layered enhancement pattern, 33 had infiltration of adventitia surface and 21 had positive EMVI, respectively. There was no significant difference in the layered enhancement or infiltration of adventitia surface before neoadjuvant chemotherapy between patients with different treatment response ( χ2=0.002, 0.000, P>0.05). There were significant differences in the presence of ulcers and positive EMVI before neoadjuvant chemotherapy between patients with different treatment response ( χ2=5.591, 4.421, P<0.05). After neoadjuvant chemotherapy, there were significant differences in the changes of layered enhancement pattern, infiltration of adventitia surface and positive EMVI between patients with different treatment response ( χ2=6.359, 10.090, 4.728, P<0.05); while there was no significant difference in the shallowed or disappeared ulcers between patients with different treatment response ( χ2=1.239, P>0.05). ② Quantitative indicators of CT: for the 13 patients with good response to neoadjuvant chemotherapy, the maximum tumor height, the maximum tumor area, enhanced CT value of the lesion before neoadjuvant chemotherapy were 1.37 cm(0.94 cm, 1.88 cm), 8.9 cm 2 (4.7 cm 2, 9.9 cm 2), 53 HU(47 HU, 63 HU), respectively. After neoadjuvant chemotherapy, the above indicators were 1.17 cm(0.79 cm, 1.29 cm), 4.4 cm 2(2.5 cm 2, 6.1 cm 2), 30 HU(25 HU, 53 HU), respectively. The change rates of the maximum tumor height, the maximum tumor area, and enhanced CT value of the lesion were -23%(-42%, 9%), -51%(-60 %, -21%), -44%(-51%, 19%), respectively. For the 46 patients with poor response to neoadjuvant chemotherapy, the maximum tumor height, the maximum tumor area, enhanced CT value of the lesion were 1.57 cm(1.21 cm, 1.96 cm), 9.4 cm 2(6.6 cm 2, 13.1 cm 2), 60 HU(53 HU, 66 HU) before neoadjuvant chemotherapy, respectively. After neoadjuvant chemotherapy, the above indicators were 1.16 cm(0.94 cm, 1.37 cm), 6.2 cm 2(4.8 cm 2, 8.1 cm 2), 55 HU(47 HU, 65 HU), respectively. The change rates of the maximum tumor height, the maximum tumor area, and enhanced CT value of the lesion were -27%(-38%, -9%), -33%(-47%, -12%), -9%(-22%, 9%), respectively. There was no significant difference in the maximum tumor height, the maximum tumor area, enhanced CT value of the lesion before neoadjuvant chemotherapy between patients with different treatment response ( Z=-1.372, -1.372, -1.331, P>0.05). There was no significant difference in the maximum tumor height after neoadjuvant chemotherapy between patients with different treatment response ( Z=-0.503, P>0.05), while there were significant differences in the maximum tumor area and CT value of the lesion ( Z=-2.743, -3.049, P<0.05). There was no significant difference in the change rate of the maximum tumor height or the maximum tumor area between patients with different treatment response ( Z=0.000, -1.481, P>0.05), while there was a significant difference in the change rate of CT value of the lesion ( Z=-3.231, P<0.05). Conclusion:Effective response of AEG to neoadjuvant chemotherapy was characterized by the changes in tumor layered enhancement pattern, reduction in the maximum tumor area, reduced CT value of the lesion, negative infiltration of adventitia surface, and negative EMVI.
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Objective To design a simple screening tool for non-alcoholic fatty liver disease based on Chinese healthy physical examination population. Methods Subjects were selected from the health management center of China Medical University since January 2017 to December 2017. A total of 32,578 subjects were included. 80% subjects were randomly selected as the training set for modeling and internal assessment, and the remaining 20% subjects were used as the verification set for external assessment. Stepwise logistic regression analysis was used to construct the NAFLD screening index. Results Multivariate regression analysis showed that body mass index (BMI), fasting glucose (FPG), serum triglyceride (TG), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) were included in the NAFLD screening model. The constructed NAFLD screening index was 2×BMI+FPG+3×TG-7×(AST/ALT). The AUC of the index was 0.883 [95%CI (0.879, 0.887)] in the training set and was 0.888 [95%CI (0.880, 0.896)] in the verification set. Conclusion The NAFLD screening index, as a simple and effective screening tool, can be used to screen large-scale population at high risk, which has certain epidemiological and health economic significance.
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Objective@#To investigate the clinical value of biological mesh in repairing abdominal wall defect after tumor resection.@*Methods@#15 patients with abdominal wall defect left over by radial resection of abdominal wall tumor were treated with primary biological mesh herniorrhaphy from Sep 2015 to Sep 2017 at the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital.@*Results@#The operation was successful in all 15 patients. The operation time was 95(65-145)min. The hospital stay was 17(9-22)d. The patients were followed up for 18(17-32) months. postoperative seroma occurred in 8 cases, postoperative fever occurred in 1 case. One case died of multiple systemic metastases of advanced gastric cancer. All the other patients were followed up without complaining about local pain, foreign body sensation, intestinal obstruction, intestinal fistula.@*Conclusions@#Biological mesh is safe and feasible for the treatment of abdominal wall defect after tumor resection.
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Objective To investigate the clinical value of biological mesh in repairing abdominal wall defect after tumor resection.Methods 15 patients with abdominal wall defect left over by radial resection of abdominal wall tumor were treated with primary biological mesh herniorrhaphy from Sep 2015 to Sep 2017 at the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital.Results The operation was successful in all 15 patients.The operation time was 95 (65-145)main.The hospital stay was 17 (9-22) d.The patients were followed up for 18 (17-32) months.postoperative seroma occurred in 8 cases,postoperative fever occurred in 1 case.One case died of multiple systemic metastases of advanced gastric cancer.All the other patients were followed up without complaining about local pain,foreign body sensation,intestinal obstruction,intestinal fistula.Conclusions Biological mesh is safe and feasible for the treatment of abdominal wall defect after tumor resection.
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Objective To evaluate treatment experience for mesh infection after inguinal hernia repair.Methods 392 cases underwent surgery for mesh infection after inguinal hernia repair in Beijing Chaoyang Hospital from Jan 2007 to Jun 2018.For mesh infection after open inguinal hernia repair,infected mesh and tissue were removed by open operation,while laparoscopic operation was adopted for mesh infection after laparoscopic inguinal hernia repair.Time of infection,type of bacteria,and hernia recurrence were evaluated.Results 369 cases suffered mesh infection after open inguinal hernia repair and 23 cases were after laparoscopic inguinal hernia repair.61 cases suffered mesh infection within 3 months,258 cases were from 3 months to 1 year and 73 cases were after one year.During follow up of 6 to 36 months after operation,29 cases suffered hernia recurrence in 24 to 34 months after removal of mesh.Bacterial culture were positive in 193 cases,including 126 cases of staphylococcus aureus,18 cases of escherichia coli and 15 cases of pseudomonas aeruginosa.Conclusion Individualized treatment policy based on original mesh placement is safe and effective for mesh infection after inguinal hemiorrhaphy.
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Objective@#To explore the relationship between psychological resilience and cognitive bias towards school violence in grade 3-5 primary school students in Luzhou city, so as to provide scientific basis for prevention and control of school violence in primary school students.@*Methods@#Students from grade 3-5 in primary schools in Luzhou were selected through stratified cluster random sampling method and were investigated with questionnaire survey.@*Results@#A total of 5 976 valid questionnaires were included, with an average score of psychological resilience (40.08±8.05) and an average score of school violence cognition (62.55±6.38). Multivariate results showed that psychological resilience was an independently associated with school violence perception (OR=1.04, P<0.01). The awareness of campus violence increased with resilience score. In addition, public school (OR=0.45) was associated with low awareness of school violence; senior grades (OR=1.77), girls (OR=1.20), and a greater number of friends(OR=1.37), student cadre(OR=1.37), middle/upper score in class(OR=2.13), no game playing(OR=1.33), no off-campus wandering(OR=1.78), timely parenting (OR=1.45) was associated with high awareness of school violence(P<0.05).@*Conclusion@#Psychological resilience positively correlates with cognition bias towards school violence. The higher the psychological resilience, the more positive perception of campus violence. Family, school and community-based interventions to enhance the resilience of students, increasing awareness towards school violence and ultimately reducing potential adverse impacts of school violence.
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Objective@#To evaluate treatment experience for mesh infection after inguinal hernia repair.@*Methods@#392 cases underwent surgery for mesh infection after inguinal hernia repair in Beijing Chaoyang Hospital from Jan 2007 to Jun 2018. For mesh infection after open inguinal hernia repair, infected mesh and tissue were removed by open operation, while laparoscopic operation was adopted for mesh infection after laparoscopic inguinal hernia repair. Time of infection, type of bacteria, and hernia recurrence were evaluated.@*Results@#369 cases suffered mesh infection after open inguinal hernia repair and 23 cases were after laparoscopic inguinal hernia repair. 61 cases suffered mesh infection within 3 months, 258 cases were from 3 months to 1 year and 73 cases were after one year. During follow up of 6 to 36 months after operation, 29 cases suffered hernia recurrence in 24 to 34 months after removal of mesh. Bacterial culture were positive in 193 cases, including 126 cases of staphylococcus aureus, 18 cases of escherichia coli and 15 cases of pseudomonas aeruginosa.@*Conclusion@#Individualized treatment policy based on original mesh placement is safe and effective for mesh infection after inguinal hemiorrhaphy.
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Objective To investigate the clinical efficacy of laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett's esophagus.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 12 patients with gastroesophageal reflux disease complicated with Barrett's esophagus who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between July 2012 to July 2016 were collected.Preoperative tests of patients included distal esophageal manometry and 24-hour pH monitoring,gastroscopy and upper gastroenterography.According to preoperative evaluation of patients,laparoscopic Nissen fundoplication was preferred,and laparoscopic Dor fundoplication was used for patients with discordant esophageal peristalsis function.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up:① subjective changes of reflux symptoms;② distal esophageal manometry and 24-hour pH monitoring after operation;③ progression of esophageal mucosal lesions.Patients were followed up using outpatient examination and telephone interview with questionnaire at one month after operation and gastroscopy every 6 months up to June 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (range).Results (1) Surgical and postoperative recovery situations:of 12 patients,7 underwent laparoscopic Nissen fundoplication and 5 underwent laparoscopic Dor fundoplication.Seven patients complicated with esophageal hiatal hernia underwent laparoscopic repair of esophageal hiatal hernia,without conversion to open surgery.Operation time,volume of intraoperative blood loss and duration of hospital stay were (98±21) minutes,(27± 13) mL,(2.3± 1.2) days.There were no intraoperative and postoperative severe complications in the 12 patients.(2) Follow-up:12 patients were followed up for 20-42 months with a average time of 32 months.① Subjective changes of reflux symptoms:12 patients completed questionnaires at one month after operation.Scores of heartburn in the 12 patients were 0.Acid regurgitation in the 12 patients was relieved,requiring no acid-inhibitory drugs.Upper abdominal dull pain in 3/4 of the patients and retrosternal pain in 2 patients were relieved.Patients had mild dysphagia or abdominal distention at 2 weeks after operation and recovered to normal diet by dietary instruction within 4 weeks.Score of dysphagia was 2 (range,0-4) and no patient need hospitalization or surgical treatment.Score of surgery satisfaction was 9 (range,7-10) in the patients.② Distal esophageal manometry and 24-hour pH monitoring after operation:lower esophageal sphincter pressure and DeMeester score were (12.8 ± 2.8) mmHg (1 mmHg =0.133 kPa) and 11±3 respectively.③ Progression of esophageal mucosal lesions:2 of 9 patients with short Barrett's esophagus were detected complete regression of esophageal mucosal lesions at postoperative one year,1 was detected partial regression of esophageal mucosal lesions at postoperative one year and 6 were detected no change at postoperative 2 years.One of 3 patients with long Barrett's esophagus was detected partial regression of esophageal mucosal lesions at postoperative one year and 2 complicated with mild poor differentiation were detected no change at postoperative 2 years.Conclusion Laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett's esophagus can improve subjective symptom and objective markers of patients and provide satisfactory efficacy.
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Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.