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Some patients after mild traumatic brain injury (mTBI) experience microstructural damages in the long-distance white matter (WM) connections, which disrupts the functional connectome of large-scale brain networks that support cognitive function. Patterns of WM structural damage following mTBI were well documented using diffusion tensor imaging (DTI). However, the functional organization of WM and its association with gray matter functional networks (GM-FNs) and its DTI metrics remain unknown. The present study adopted resting-state functional magnetic resonance imaging to explore WM functional properties in mTBI patients (108 acute patients, 48 chronic patients, 46 healthy controls [HCs]). Eleven large-scale WM functional networks (WM-FNs) were constructed by the k-means clustering algorithm of voxel-wise WM functional connectivity (FC). Compared with HCs, acute mTBI patients observed enhanced FC between inferior fronto-occipital fasciculus (IFOF) WM-FN and primary sensorimotor WM-FNs, and cortical primary sensorimotor GM-FNs. Further, acute mTBI patients showed increased DTI metrics (mean diffusivity, axial diffusivity, and radial diffusivity) in deep WM-FNs and higher-order cognitive WM-FNs. Moreover, mTBI patients demonstrated full recovery of FC and partial recovery of DTI metrics in the chronic stage. Additionally, enhanced FC between IFOF WM-FN and anterior cerebellar GM-FN was correlated with impaired information processing speed. Our findings provide novel evidence for functional and structural alteration of WM-FNs in mTBI patients. Importantly, the convergent damage of the IFOF network might imply its crucial role in our understanding of the pathophysiology mechanism of mTBI patients.

Mild traumatic brain injury (mTBI) is the most prevalent neurological insult and leads to long-lasting cognitive impairment. Neuroimaging studies have discovered abnormalities in brain network connectivity following mTBI as the underlying neural basis of cognitive deficits. However, the pathophysiologic mechanisms involved in imaging alterations remain elusive. Proteins neuron-specific enolase (NSE) and ubiquitin C terminal hydrolase 1 are reliable markers for neuronal cell-body damage, both of which have been demonstrated to be increased in serum following mTBI. Therefore, we conducted a longitudinal study to examine relationships between abnormal brain network connectivity and serum neuronal biomarkers and their associations with cognitive recovery following mTBI. Sixty patients were followed-up at 1 week and 3 months post-injury and 41 controls were recruited. Resting-state functional magnetic resonance imaging was used to build a functional connectivity matrix within large-scale intrinsic networks, and their topological properties were analyzed using graph theory measures. We found that, compared with controls, mTBI patients showed significant decreases in a number of nodal characteristics in default mode network (DMN), salience network, and executive network (

The bark of Cinnamomum bejolghota (Buch.-Ham.) Sweet (C. bejolghota) is widely used as medicine to treat bacterial diarrhea in Myanmar. We previously reported that the bark extract of C. bejolghota significantly inhibited secretion effector proteins of the type three secretion system (T3SS) in Salmonella. This study is designed to investigate the anti-virulence potential of the C. bejolghota bark extract against Salmonella Typhimuriumin in in vivo and in vitro experiments. The results suggested that the polar fraction Fr.M1 inhibited the secretion of effector proteins SipA, SipB, SipC and SipD without affecting bacteria growth and the translocation of SipC into MDA-MB-231 cells. In addition, Fr.M1 alleviated inflammatory symptoms of mice in Salmonella-infected mouse model. Overall, the results provide evidence for medicinal usage of C. bejolghota bark to treat diarrhea in Myanmar.

Deficits in information processing speed (IPS) are among the earliest and most prominent cognitive manifestations in mild traumatic brain injury (mTBI). We investigated the impact of white matter fiber location on IPS outcome in an individual basis assessment. A total of 112 acute mild TBI with all CT negative underwent brain DTI and blood sampling for inflammation cytokines within 7 days postinjury and 72 age‐ and sex matched healthy controls with same assessments were enrolled. IPS outcome was assessed by the trail making test at 6–12 month postinjury in mild TBI. Fractional anisotropy (FA) features were extracted using a novel lesion‐load analytical strategy to capture spatially heterogeneous white matter injuries and minimize implicit assumptions of uniform injury across diverse clinical presentations. Acute mild TBI exhibited a general pattern of increased and decreased FA in specific white matter tracts. The power of acute FA measures to identify patients developing IPS deficits with 92% accuracy and further improved to 96% accuracy by adding inflammation cytokines. The classifiers predicted individual's IPS and working memory ratings (r = .74 and .80, respectively, p, Combination of inflammation cytokine and fibers projecting to frontal cortex as predictors can identify long‐term information processing speed deficits in mild TBI patients with negative CT.

Background:The abuse of methamphetamine (MA) worldwide has gained international attention as the most rapidly growing illicit drug problem. The classification and treatment response prediction of MA addicts are thereby paramount, in order for effective treatments to be more targeted to individuals. However, there has been limited progress.Methods:In the present study, 43 MA-dependent participants and 38 age- and gender-matched healthy controls were enrolled, and their resting-state functional magnetic resonance imaging data were collected. MA-dependent participants who showed 50% reduction in craving were defined as responders to treatment. The present study used the machine learning method, which is a support vector machine (SVM), to detect the most relevant features for discriminating and predicting the treatment response for MA-dependent participants based on the features extracted from the functional graph metrics.Results:A classifier was able to differentiate MA-dependent subjects from normal controls, with a cross-validated prediction accuracy, sensitivity, and specificity of 73.2% [95% confidence interval (CI) = 71.23–74.17%), 66.05% (95% CI = 63.06–69.04%), and 80.35% (95% CI = 77.77–82.93%), respectively, at the individual level. The most accurate combination of classifier features included the nodal efficiency in the right middle temporal gyrus and the community index in the left precentral gyrus and cuneus. Between these two, the community index in the left precentral gyrus had the highest importance. In addition, the classification performance of the other classifier used to predict the treatment response of MA-dependent subjects had an accuracy, sensitivity, and specificity of 71.2% (95% CI = 69.28–73.12%), 86.75% (95% CI = 84.48–88.92%), and 55.65% (95% CI = 52.61–58.79%), respectively, at the individual level. Furthermore, the most accurate combination of classifier features included the nodal clustering coefficient in the right orbital part of the superior frontal gyrus, the nodal local efficiency in the right orbital part of the superior frontal gyrus, and the right triangular part of the inferior frontal gyrus and right temporal pole of middle temporal gyrus. Among these, the nodal local efficiency in the right temporal pole of the middle temporal gyrus had the highest feature importance.Conclusion:The present study identified the most relevant features of MA addiction and treatment based on SVMs and the features extracted from the graph metrics and provided possible biomarkers to differentiate and predict the treatment response for MA-dependent patients. The brain regions involved in the best combinations should be given close attention during the treatment of MA.

INTRODUCTION The objective of this study was to evaluate the impact of operative timing on outcomes of acute appendicitis. METHODS This study examined adult patients who had presented to the hospital with acute appendicitis and had undergone appendectomy from December 2017 to February 2019. Time delay and outcomes of perforated and non-perforated appendicitis were compared. Patients were classified into five groups based on the period from symptom onset to operation: group 1

Ethnopharmacological relevance Myanmar's Mon people largely depend on a traditional medical system for health care, however, information about their medical plants is rare in the current literature. In this first ethnobotanical study of Mon traditional medicinal plants (MTMs), we attempt to answer three research questions: 1) What species are used as MTMs by the Mon people and what diseases can be treated with these MTMs? 2) What are the general characteristics of these MTMs? 3) Which species and their usages have high consensus of knowledge? Aim of the study We aimed (1) to document both the diversity of medicinal plants used by the Mon people and their knowledge of the therapeutic usages of these plants; and (2) to quantitatively identify the most well-known medicinal plant species and prevalent diseases treated by these species, and to evaluate the status of scientific research and application for each of these species. Materials and methods Ethnobotanical surveys and interviews were carried out in 10 villages in four townships of Mon State, Myanmar in 2018. Data were collected from interviews with 131 informants, chosen via the snowball sampling method. Therapeutic uses of medicinal plants were categorized according to the ICPC-2 standard. Voucher specimens of plant species were collected and identified by experts. To evaluate the consensus of knowledge, we applied use reports (URs) using the R package of ethnobotanyR. Results In total, we recorded 158 medicinal plant species belonging to 64 families as being used by the Mon people, with 13 species being newly recorded as medicinal plants in Myanmar. The people listed 78 therapeutic uses for these plants, which could be classified into 16 ICPC-2 disease categories. Digestive, urological and respiratory diseases ranked as the most prevalent diseases based on use reports. Fabaceae was the most represented family and the leaf was the most commonly used plant part. Decoction and oral administration ranked top in preparation and administration methods, respectively. Tinospora sinensis (Lour.) Merr, the introduced species Chromolaena odorata (L.) R. M. King & H. Rob., Mimosa pudica L., Tadehagi triquetrum (L.) H. Ohashi, and Alysicarpus vaginalis (L.) DC were the five most cited medicinal plant species, and were used to treat dysuria, cuts and wounds, cough, diabetes and gall stones respectively, with high consensus. Conclusion The Mon people of Myanmar have a rich and diverse knowledge of traditional medicinal plants. The list of medicinal plants in Myanmar can be renewed, with the addition of 13 species. MTMs still function as an important component of the health care of the Mon people in Myanmar, and a systematic documentation of the local knowledge of MTMs would be of great value in the future. Resource monitoring, phytochemical and pharmacological research and evidence-based drug development are suggested to promote the use of MTMs and aid drug discovery.

Ethnopharmacological relevance People in Southern Xinjiang, China have been consuming medicinal teas for healthcare since before the ancient Silk Road markets began. Several pharmaceutical studies have illustrated the potential healthcare benefits of medicinal teas used in Southern Xinjiang, China. However, little information is available from the literature about the diversity of the species used and related traditional knowledge of these medicinal teas. Aims of the study (i) create a comprehensive record of medicinal tea plant species (MTPS) and combinations used with related traditional knowledge for healthcare in Southern Xinjiang, China; (ii) assess safety of MTPS, and (iii) address conservation status for sustainable use of MTPS. Materials and methods We employed both field and market surveys from 2014 to 2019 in 10 counties/cities and four main medicinal tea markets by using semi-structured interviews. We interviewed 236 informants and 70 medicinal tea shop vendors. The commonly used MTPS were ranked by Frequency of Citation. Safety issues were assessed based on expert knowledge and with reference to the official list of Medicinal Plants Used as Food. Conservation implications of plant use were assessed as part of the interviews and this was cross referenced with official records. Results The surveys revealed 145 different plants from 65 families used for making medicinal teas, expanding the list of known Chinese herbal tea species from 782 to 884. Leguminosae, Rosaceae, Lamiaceae and Apiaceae were dominant families. Herbs (60.7%, 88 species) were the most commonly used plant types; fruits (23.1%, 50 species) and seeds (22.2%, 48 species) were commonly used parts. Nearly half (42.1%) of the plant species were introduced from abroad. Respondents reported more than 50 types of healthcare uses of medicinal teas. Tonic (13.7%, 71 species) and promoting digestion (9.6%, 50 species) were the most frequently mentioned healthcare uses. The majority of commonly used plant species were spices (20 species, 50%) and aromatic plants (10 species, 25%). Cinnamomum cassia (L.) J.Presl, Piper longum L. Syzygium aromaticum (L.) Merr. & L. M. Perry and Gardenia jasminoides J. Ellis were the most cited species. High doses of Piper longum L., Crocus sativus L., Curcuma longa L, and Senna alexandrina Mill. May have negative health implications. Assessments of conservation status and sustainable use of tea species indicate that wild harvesting of Nardostachys jatamansi (D. Don) DC. and Pterocarpus indicus Willd. Should be controlled and cultivation technologies should be improved. Conclusions We found high plant species diversity and rich traditional knowledge of medicinal teas used in Southern Xinjiang, China. The traditional healthcare uses of some of the medicinal teas are also supported by pharmaceutical evidence. Others should be investigated further. Conservation pressures exist for commonly used wild species. China's ‘Healthy China 2030’ policy should do more to take traditional cultural practices into account. In doing so, both local and national government agendas may seek to promote sustainable harvest and to protect traditional knowledge so that this cultural heritage continues to serve human well-being into the future.

Seroma is a virtually unavoidable early sequela after TEP hernioplasty. This randomised controlled trial evaluated the outcomes of preperitoneal closed-system suction drainage in laparoscopic totally extraperitoneal (TEP) hernioplasty for inguinal hernia. Ninety patients aged 18–80 years who presented to our hospital between May 2016 and February 2017 with primary unilateral inguinal hernia were randomised into the preperitoneal drain and no-drain groups. The primary outcome was seroma size on postoperative day 6. Secondary outcomes included clinical seroma formation and seroma size on day 1, day 6, 1 and 7 months postoperatively, length of postoperative stay, pain score, and recurrence. There was no significant difference in age, sex, co-morbidities, hernia side, mean hernia size, operating time, fixation adjuncts, or postoperative stay. The overall incidence of clinical seroma formation was 25.6% on postoperative day 1, 60.3% on postoperative day 6, 13.2% 1 month and 0% 7 months postoperatively. The mean drain output was 57.9 ml. The drain group had significantly fewer patients with seroma on day 1 (6 vs 14, p = 0.022) and day 6 (17 vs 30, p = 0.000), and a smaller mean seroma size on days 1 and 6 (p = 0.000). Subgroup analysis showed that sac ligation versus reduction, peritoneal perforation, and fixation adjuncts had no significant effects on seroma formation or size. There is a trend of lower early post-operation VAS score and more urinary retention in drain group was observed but not reaching statistical significance. No differences in postoperative pain score or complications were observed at 1 and 7 months’ post operation. Preperitoneal drainage for 23 h after laparoscopic TEP hernioplasty for inguinal hernia can effectively decrease seroma formation in the early postoperative period, and potentially improving postoperative pain. The benefit is short-term and no significant difference was demonstrated after 1-month post operations. This tradition technique applied to novel operative repair of inguinal hernia is safe and feasible with no significant morbidity demonstrated. Preperitoneal drainage after TEP can be considered as an option to improve patient satisfactions and recovery in selected patient group for maximal benefit, especially for those with prolonged operation which may associate with higher chance of seroma formation.

Mesh infection after large incisional ventral hernia repair is a clinical dilemma in abdominal wall hernia surgery. It is believed foreign material should be removed but it causes secondary trauma to the abdominal wall tissue and might be associated with a higher risk of complications. Currently, there is no consensus on mesh-preservation treatment in cases of mesh infection after hernia repair in general. Herein we present the case of a 27-year-old male who recovered well from mesh infection after large incisional ventral hernia repair by mesh-preservation approach. The path to success is choice of material of prosthetic mesh; surgical approach of hernia repair, sufficient wound irrigation and drainage, and acquiring sterility of the mesh surface by wound care techniques such as local iodophor packing and vacuum sealing drainage. Clinical cohorts are needed to verify the feasibility of mesh-preservation treatment of mesh infection after large incisional hernia repair.

Coumestrol (CMS), a coumestan isoflavone, plays key roles in nodulation through communication with rhizobia, and has been used as phytoestrogens for hormone replacement therapy in humans. Because CMS content is controlled by multiple genetic factors, the genetic basis of CMS biosynthesis has remained unclear. We identified soybean genotypes with consistently high (Daewonkong) or low (SS0903-2B-21-1-2) CMS content over 2 years. We performed RNA sequencing of leaf samples from both genotypes at developmental stage R7, when CMS levels are highest. Within the phenylpropanoid biosynthetic pathway, 41 genes were tightly connected in a functional co-expression gene network; seven of these genes were differentially expressed between two genotypes. We identified 14 candidate genes involved in CMS biosynthesis. Among them, seven were annotated as encoding oxidoreductases that may catalyze the transfer of electrons from daidzein, a precursor of CMS. Two of the other genes, annotated as encoding a MYB domain protein and a MLP–like protein, may increase CMS accumulation in response to stress conditions. Our results will help to complete our understanding of the CMS biosynthetic pathway, and should facilitate development of soybean cultivars with high CMS content that could be used to promote the fitness of plants and human beings.

Coronary microembolization (CME) occurs when atherosclerotic plaque debris is detached during the treatment of acute coronary syndrome with Percutaneous Coronary Intervention (PCI). The complications of distal microvascular embolism, including local myocardial inflammation, are the main causes of myocardial damage and are a strong predictor of poor long-term prognosis and major cardiac adverse events. microRNAs (miRNAs) are involved in the pathophysiological processes of cardiovascular inflammatory diseases. Dysregulation of microRNA (miR)-26a-5p, in particular, is associated with a variety of cardiovascular diseases. However, the role of miR-26a-5p in CME-induced myocardial injury is unclear. In this study, we developed an animal model of CME by injecting microembolic balls into the left ventricle of rats and found that miR-26a-5p expression decreased in myocardial tissue in response. Using a miR-26a-5p mimic, echocardiography, hematoxylin-eosin staining, and Western blot analysis we found that the diminished cardiac function and myocardial inflammation induced by CME is alleviated by miR-26a-5p overexpression. Furthermore, our results show that inhibitors of miR-26a-5p have the opposite effect. In addition, in vitro experiments using real-time PCR, Western blot analysis, and a dual luciferase reporter gene show that HMGA1 is a target gene of miR-26a-5p. Thus, overexpression of miR-26a-5p could be a novel therapy to improve CME-induced myocardial damage.

To explore the correlation of MIR17HG polymorphism with susceptibility and prognosis of multiple myeloma (MM).A total of 217 MM patients treated with high-dose melphalan combined with autologous peripheral blood stem-cell transplantation at our hospital were enrolled as the case group, and 220 healthy people were included as the control group. Sequenom MassARRAY iPLEX Gold single nucleotide polymorphism genotyping was used to detect polymorphisms of MIR17HG, including rs7336610, rs17735387, rs4284505, and rs1428.An increased risk of MM was found in patients who carried the rs7336610 T allele and rs4284505 G allele, and the higher the Durie-Salmon and International Staging System stages were, the more MM patients carrying rs7336610 CT + TT genotype and rs4284505 AG + GG genotype (all P .05). Haplotype AC (rs4284505-rs1428) and CA (rs7336610-rs4284505) evidently reduce MM risk, whereas haplotype GC (rs4284505-rs1428) significantly elevated MM risk (all P .05). Kaplan-Meier curve analysis demonstrated that rs7336610 CC genotype carriers had higher 5-year survival rate than CT + TT genotype carriers (P = .034), and the AA genotype carriers of rs4284505 had higher 5-year survival rate than AG + GG genotype carriers (P .001).Polymorphisms of MIR17HG rs7336610 and rs1428 were correlated with MM risk and prognosis.

Laparoscopic low anterior resection (LAR) with sphincter preservation for ultra-low rectal cancer is always a challenging operation in colorectal surgery. To achieve negative margins, reducing the difficulty and risks of the procedure are major goals for us. The marker meeting approach we reported can help to accomplish this goal. The key technique for the marker meeting approach is to ensure a clear distal margin in a low resection of the rectum by transanal dissection. This procedure allows access to the space around the distal rectum and mesorectum and to pack the gauzes in the distal part of the space as a landmark. Routine laparoscopic LAR was performed to dissect the space until reaching the gauzes packed above and achieve complete mobilization of the rectum and mesorectum. This surgical procedure is simpler and reduces the difficulty of the operation. Therefore, it is expected to reduce the risk of surgery-related complications and positive margins and is suitable to be widely applied and extended in clinical practice. The short-term and long-term clinical outcomes of the marker meeting approach need more research in large samples.

Ethnopharmacological relevance Herbal teas have long been consumed by Chinese people for preventive and/or therapeutic healthcare. Although herbal teas are widely consumed by many cultural groups in different regions of China, no thorough review has been undertaken to assess the diversity of the country's herbal tea usage. This literature review, complemented by a quantitative survey in an important tea market in Kunming, begins to fill this knowledge gap. Aims of the study The study aims to summarize the current knowledge of plant species used as herbal teas by different cultural groups in different regions of China, with a focus on the teas’ perceived traditional healthcare functions, related phytochemical/pharmaceutical research, and safety issues. Materials and methods The study involved a comprehensive literature review and a market survey. The literature review was based on published ethnobotanical studies of herbal teas in China. We searched the Web of Science™, ELSEVIER, the China National Knowledge Infrastructure (CNKI) and the China Science and Technology Journal Database to locate relevant studies (including journal articles, Masters/PhD dissertations and books) that were published before March 2017. A species list was compiled based on the review and supplemented with information retrieved from the Scifinder database ( https://scifinder.cas.org ) and the Chinese Pharmacopoeia (2010). A Use Value Index was employed for ranking the most cited species. Based on the 29 most cited species, we discussed the current research status in relation to healthcare benefits and safety concerns of herbal teas in China. To better understand the current status of the herbal tea market in China, we also surveyed 136 tea vendors at the Xiongda Tea Market in Kunming. Information gathered from the survey included the species sold, the sale prices and the form of the herbal tea product. Results The literature identified 759 plant species used as herbal tea in China and the market survey identified an additional 23 species. Most of the species used were from the Leguminosae, Compositae and Lamiaceae families. Twenty two provinces and fourteen ethnic minority groups have records on the consumption of herbal teas. Southern China uses up to 82% of the total species, and 211 out of 759 species are used by minority groups. Thirty categories of traditional healthcare functions are linked with herbal teas, with clearing away heat, relieving toxicity and suppressing cough being the most important functions. There is phytochemical/pharmaceutical evidence to support the claimed healthcare benefits of some Chinese herbal teas. Although Chinese herbal teas are generally safe to consume, overdoses of some herbal teas and some unapproved mixtures of species may cause health risks. Based on our market survey, the prices of most herbal teas range between 100 and 200 RMB (US$15–30) per kg. Conclusions A rich array of herbal tea species with various traditional healthcare functions have long been used in China, and as such there is a huge market potential for Chinese herbal teas. More pharmaceutical/phytochemical research is needed to assess a wide range of perceived healthcare benefits of Chinese herbal teas. Our research highlights the need to study herbal teas through an ethnopharmacological perspective and by employing a holistic approach, which requires greater consideration of traditional knowledge in the pharmacological research design. Product safety and sustainability issues should also be considered, so the traditional applications of herbal teas can be transformed to efficient health boosting functional products.

Parastomal hernia is one of the most common long-term complications after abdominal ostomy. Surgical treatment for parastomal hernia is the only cure but a fairly difficult field because of the problems of infection, effects, complications and recurrence. Laparoscopic repair operations are good choices for Parastomal hernia because of their mini-invasive nature and confirmed effects. There are several major laparoscopic procedures for parastomal hernioplasty. The indications, technical details and complications of them will be introduced and discussed in this article.

Paris Linnaeus (1753: 367) comprises 30 species of perennial herbs, distributed in Eurasia, and the center of distribution is the Himalayan-Hengduan Mountion area (Li et al. 1998, Osaloo & Kawano 1999, Liang & Soukup 2000, Li et al. 2017, Ji et al. 2017, Wang et al. 2017, Yang et al. 2018, Liu et al. 2018). Many are medicinal plants. Paris birmanica, described in Daiswa by Takhtajan (1983), was transferred to Paris by Li & Noltie (1997). It was also noted (Li et al. 1997, Li et al. 1998) that P. birmanica is endemic to Myanmar. However, since the type specimens were collected in the 1920s, P. birmanica had not been sighted by botanists, which left the morphological characteristics of this species without detailed description of its rhizome, ovary and ovules.

Background Angioleiomyoma is an uncommon benign soft tissue tumor and originates from the vascular smooth muscle. It often causes pain and is rarely found in inguinal region. We present a rare case of inguinal canal angioleiomyoma of a female patient who suffered from right groin pain for 4 years and mimicking inguinal hernia clinically. Presentation of case A 53-year-old Chinese female patient presented with 4-year history of right groin pain which was exacerbated by movement. Magnetic resonance imaging was performed in view of atypical presentation and absence of cough impulse. Inguinal canal was subsequently explored by open approach and the mass was found arising from the posterior wall of the inguinal canal and measured 5.2 cm × 3.8 cm. The posterior wall was repaired by Bassini approach after the mass was resected en-bloc. Inguinal pain was resolved and no hernia was found during follow-up. Pathology of the resected specimen confirmed angioleiomyoma with clear resection margins. Conclusion This is the first report of a case of angioleiomyoma of the inguinal canal, which presents as a painful mass. Magnetic resonance imaging should be considered when presenting history and physical examination does not confirm with the diagnosis of inguinal hernia. After inguinal canal exploration, suture or mesh repair should be performed to prevent weakening of posterior wall leading to inguinal hernia.

Laparoscopic resection of gastric wall tumor is commonly performed nowadays. The exact surgical procedure was decided according to the location, size and morphology of the tumor. In this video, we performed a laparoscopic resection of a 5cm tumor located at distal posterior gastric wall near the greater curvature. Technical consideration was discussed.

Laparoscopic repair of ventral incisional hernia with intraperitoneal onlay mesh (IPOM) technique by anti-adhesion mesh has been widely adopted. Due to clinical heterogenicity in location, quantity and size of abdominal incisional hernia, strategy of such repair can be challenging. We hereby present the video of a patient with multiple swiss-cheese hernias in a single long midline incision repaired with double anti-adhesion mesh by IPOM technique. Patient demographics, technical details and clinical tips & tricks are discussed.

Background: With advances in oesophagogastroduodenoscopy (OGD), incidental finding of submucosal tumor (SMT) in upper gastrointestinal tract is increasingly reported. These lesions are usually small and the patients are generally asymptomatic, conservative management is commonly practiced before the era of endoscopic surgery. Nonetheless, with the rapid development in endoscopic instruments and techniques, endoscopic resection of SMT is frequently performed worldwide. We herein present a patient with endoscopic resection of an antral SMT. Method: A 68-year-old woman presented with upper abdominal pain for 3 months. Upper endoscopy showed a 3 cm SMT at the antero-superior part of the antrum. Endoscopic ultrasound and CT scan were performed and the preliminary diagnosis was gastric wall lipoma. Endoscopic resection of the SMT was performed and the procedure was described. Results: The operation was performed under general anesthesia uneventfully. The patient resumed fluid diet on the first post-operative day and was discharged on the fourth day after the procedure. Conclusions: Endoscopic resection of gastric SMT can be performed safely. This is as-sociated with quick recovery and definitive histopathological diagnosis can be obtained.

Laparoscopic inguinal hernia repair is performed more and more nowadays. The anatomy of these procedures is totally different from traditional open procedures because they are performed from different direction and in different space. The important anatomy essentials for laparoscopic inguinal hernia repair will be discussed in this article.

Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, especially the differences to laparoscopic repair of inguinal hernia are discussed in this article.

Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. The procedures include intraperitoneal onlay mesh (IPOM) repair, transabdominal preperitoneal (TAPP) repair and total extraperitoneal (TEP) repair. These procedures have totally different anatomic point of view, process and technical key points from open operations. The technical details of these operations are discussed in this article, also the strategies of treatment for some special conditions.