Purpose Amyand’s hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand’s hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand’s hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia. Methods Six patients diagnosed with Amyand’s hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes. Results The diagnosis of six cases with Amyand’s hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had appendicitis. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8 ± 6.1 days. One patient suffered from a wound infection. No additional postoperative complications were detected. Conclusions Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand’s hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.

Purpose: Amyand’s hernia is a rare hernia defined as an inguinal hernia that contains the appendix within the hernia sac. Current treatment of Amyand’s hernia remains controversial. Our study retrospectively reviewed 6 cases of Amyand’s hernia, aiming to provide a reference for the surgical treatment of Amyand's hernia.Methods: Six patients diagnosed with Amyand’s hernia from September 2010 to May 2020 were retrospectively enrolled in our study. We summarized clinical data of six patients including the chief complaint, physical examinations, laboratory examinations, imaging examinations, surgical methods, and postoperative treatments and outcomes.Results: The diagnosis of six cases with Amyand’s hernia was made during surgery. Two patients had normal appendixes whereas the remaining four patients had inflamed appendixes. Two patients with normal appendix received tension-free mesh repair through the inguinal incision. Among those with inflamed or perforated appendixes, two received mesh repair and the other two did not. The discharge time after surgery of six patients was 9.8±6.1 days. One patient suffered from an incision infection. No additional postoperative complications were detected. Conclusions: Computed tomography and ultrasonography are helpful but limited in the definite diagnosis of Amyand’s hernia. The presence of a normal appendix does not require to be resected, but appendicectomy is necessary if the appendix is inflamed. The treatment of Amyand's hernia should be tailored based on the patient's condition and the type of Amyand's hernia.

Background: The efficacy and safety of anti–nerve growth factor (NGF) antibody therapy used for osteoarthritis (OA) pain are controversial. Purpose: To evaluate the efficacy and safety of anti-NGF antibody therapy via a meta-analysis of randomized controlled trials (RCTs). Study Design: Systematic review; Level of evidence, 1. Methods: PubMed, the Cochrane Central Register of Controlled Trials, Embase, and the Web of Science databases were searched for RCTs assessing anti-NGF antibody treatments for hip and knee OA. A total of 623 records were retrieved from the databases. A random-effects model was used to assess primary and secondary outcomes. Bias was assessed using the Cochrane Collaboration tool, funnel plots, and the Egger test. Subgroup analyses were used to assess the efficacy and safety of the independent variables. Sensitivity analysis was conducted to evaluate the effectiveness of tanezumab and the effectiveness of anti-NGF antibodies compared to active comparator drugs. We present the effects of dose, administration mode, and treatment duration on the efficacy and safety of anti-NGF antibody therapy. Results: There were 19 RCTs included in our meta-analysis. Anti-NGF antibody treatment showed significant improvements on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, physical function, and stiffness as well as on a patient global assessment (PGA). The overall standardized mean differences were as follows: WOMAC pain (–0.31 [95% CI, –0.36 to –0.26]; Z = 11.75; P < .001; I 2 = 38%), WOMAC physical function (−0.36 [95% CI, –0.41 to –0.30]; Z = 12.67; P < .001; I 2 = 44%), WOMAC stiffness (–3.59 [95% CI, –4.87 to –2.30]; Z = 5.47; P < .001; I 2 = 98%), and PGA (−0.28 [95% CI, –0.34 to –0.22]; Z = 9.39; P < .001; I 2 = 50%). Anti-NGF antibody treatment resulted in a greater incidence of adverse events (risk ratio, 1.09 [95% CI, 1.06 to 1.12]; Z = 5.60; P < .001; I 2 = 0%). The incidence of serious adverse events was similar between the treatment and control groups (risk ratio, 1.15 [95% CI, 0.98 to 1.34]; Z = 1.71; P = .09; I 2 = 0%). Conclusion: Anti-NGF antibody treatment significantly relieved pain and improved function in patients with hip and knee OA. However, no conclusion could be drawn regarding the optimal treatment plan for anti-NGF antibodies when all 3 variables (dose, administration mode, and treatment duration) were combined in the analyses.

Abstract. The development and widespread use of real-time constrained multi-media application in MANET has resulted in the need to optimize or update current routing mechanisms. This paper proposed a QoS routing mechanism for multi-media transmission under real-time constraint in MANET, named ad-hoc on-demand distance vector routing based on location information and linkstability evaluation (LL-AODV). The mechanism abstracts the routing problems into the shortest path problem of an undirected weighted graph in which the weights of the paths are determined by the duration time of links, the residual battery and energy consumption of nodes, and utilizes the shortest path algorithm to determine a feasible transport path. We use a prediction model of the duration time of links to predict the probable time the link may maintain, and that improves the deficiency of the AODV routing mechanism, which only uses hop counts as the transport path metric. Furthermore, it adopts periodical maintenance and rescue maintenance to ensure an alternative path can be found in time to transmit data, and thus improves the reliability of multimedia data transmission under real-time constraint. Simulation and the experimental results showed that the mechanism could provide a better QoS route for the multi-media transmission under realtime constraint in MANET. Ⅰ. IntroductionMobile ad hoc network (MANET) [1][2] is a subset of wireless and mobile network. It is a multihop temporary autonomous system without fixed infrastructures, and it employs distributed protocols to maintain the network connection. All nodes in MANET are equal and mobile, and there is no central control node. Each node can communicate with an access point with its wireless transmitters and receivers. MANET has the properties of high networking speed and high survivability [3], which make it widely used in military, civil and other fields.In recent years, with the development of multimedia and MANET technology, there is a great require of the real-time communication of multimedia data in MANET, such as real-time audio and video communication, etc. However, because of the characteristics in the MANETs, such as limited channel bandwidth, highly dynamic network topology, imprecise link state information, limited power at the nodes, etc.[4], the paths connection between source nodes and destination nodes may be very unstable and will go down at any time. It makes communication over MANET difficult and is hardly to assure the reliability of data transmission, much less could the protocol provide a better quality of service (QoS). To overcome these issues, appropriate cross-layer cooperation is required. QoS schemes provide QoS information by factoring the impacts of node mobility and lower-layer link parameters into QoS performance. But in the real-time multimedia transmission scenarios where the high rate and severe delay constraints are required, the above issues become more severe. Therefore, a new QoS routing mechanism performed well at the end-to-end real-time communica...