Objective To compare the clinical efficacy of 3% hypertonic saline with 20% mannitol in the treatment of acute brain edema in children.Methods Twenty children with acute brain edema were randomly divided into hypertonic saline(HS) group and mannitol group.HS group and mannitol group were given 3% HS solution or 20% mannitol respectively.Main outcome measurements included intracranial pressure(ICP),mean arterial pressure(MAP),central venous pressure(CVP),cerebral perfusion pressure (CPP),serum electrolytes,plasma osmolality,renal function and urine volume.Results Both 3% HS and 20% mannitol were effective in reducing ICP(P ＜0.05).Therapeutic effect lasted(4.5±1.2) h in HS group and(3.2±1.5) h in mannitoi group.3% HS had a longer duration of action than marmitol(P＜0.05).At the time point of 2 hours after treatment,MAP and CPP of HS group increased more than those of mannitol group(P＜0.05).Conclusion Both 3% HS and 20% mannitol could rapidly decrease ICP.3% HS has a longer duration of action in reducing ICP than 20% mannitol.3% HS is more effective in stabilizing circulation and improving CPP than 20% mannitol.

Objective To compare the safety and feasibility of laparoscopic splenectomy and esophagogastric devascularization (LS + ED) versus open splenectomy and esophagogastric devascularization (OS + ED) in treating portal hypertension using Meta-analysis.Methods Controlled trials comparing LS + ED and OS + ED in treating portal hypertension were electronically searched from Wan Fang Data Knowledge Service Platform,Medalink,CNKI,PubMed,Elsevier,SpringerLink and CBM disc.The most recent search was conducted in April 2015.All the relevant data and references were retrieved and screened.RevMan 5.2 was used for data analysis.Results Eventually,7 randomized controlled trials (RCTs) or high-quality case-controlled studies involving 468 patients were included into this study.Meta-analysis showed LS reduced blood loss [WMD =214.67,95％ CI 198.74-230.60,P ＜ 0.01],shortened flatus time [WMD =17.72,95％ CI 12.39-23.04,P ＜ 0.01] and postoperative hospital stay [WMD =3.75,95％ CI 3.28-4.23,P ＜ 0.01],while the duration of surgery was shorter in OS (P ＞ 0.05).However,OS was comparable with LS in complication rates.Conclusions Comparing with OS,LS had the advantages of reducing intraoperative blood loss and shortening recovery time after operation.In patients with cirrhosis,portal hypertension and esophageal varices,laparoscopic splenectomy was safe and effective.

Objective To evaluate laparoscopic radical resection of liver hydatid cyst as compared with conventional open surgery.Methods From May 2006 to January 2013 clinical data of 41 patients undergoing laparoscopic radical resection of hepatic hydatid cyst were compared with those 112 cases treated by open surgery.Operation time,blood loss,conversion rate,length of hospitalization and recurrence rate were compared and analyzed.Results There was not statistical significant difference in operative time and blood loss between the two groups (t =1.97,P ＞ 0.05) (t =2.00,P ＞ 0.05).Five laparoscopic patients were converted to open surgery,conversion rate was 12.2 ％ (5/41),three due to inadequate exposure,and two for intraoperative bleeding.Postoperative hospital stay was significantly shorter in laparoscopic group than that in conventional group.The overall morbidity was 4.9％ (2/41) in laparoscopic and 16.0％ (18/112) in conventional group with statistical significance(x2 =3.92,P ＜ 0.05).Recurrence rate and mortality was 0 in both groups.Conclusions Laparoscopic radical resection of hydatid cyst is safe and effective in carefully selected patients and provides short hospital stay,good cosmetic result,fast recovery and fewer complications.

Objective To systematically evaluate the storage effect and transplant outcomes of University of Wisconsin (UW) preservation solution and histidine-tryptophan-ketoglutarate (HTK) preservation solution on liver allografts.Methods Literatures were researched using PubMed,Embase (1980-),Ovid Medline (1948-),The Cochrane Library,Wanfang database,VIP database from the database establishement to October 2015 with the key words including organ preservation,storage solutions,Histidine-tryptophan-ketoglutarate or HTK,custodial,bretschneider,University of Wisconsin,UW solution,viaspan,cardiosol,belzer solution,hepatic transplantation,liver transplantation,viscera transplantation,liver grafts,hepatic grafts,liver allografts,hepatic allografts,器官移植,器官保存液,UW,HTK,肝移植and比较.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients using UW and HTK preservation solutions were respectively allocated into the UW group and HTK group.Count data were represented as the odds ratio (OR) and measurement data were represented as the standardized mean difference (SMD) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven literatures were retrieved,and the total sample size were 34 475 patients including 25 248 in the UW group and 9 227 in the HTK group.The results of Meta analysis showed that there were no statistically significant differences in the primary transplants nonfunction,retransplant rate and 1-year grafts overall survival rate between the 2 groups (OR =1.18,0.84,0.97,1.02,95％ CI:0.55-2.57,0.47-1.50,0.66-1.42,0.66-1.58,P ＞0.05).There were also no statistically significant differences in the levels of alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil) at postoperative day 1 between the 2 groups (SMD =-0.19,-O.30,0.30,95％ CI:-0.62-0.23,-0.70-0.10,-0.01-0.61,P ＞0.05).There were no statistically significant differences in the postoperative prothrombin time(PT) and alkaline phosphatase(ALP) between the 2 groups (P ＞0.05) and in the incidence of postoperative biliary complications between the 2 groups (OR =1.49,95％ CI:0.97-2.30,P ＞ 0.05).Conclusion There is similar storage effect between UW and HTK preservation solutions on liver allografts,and no difference in the transplant outcomes.

The occurrence and development of hepatic ischemia-reperfusion injury (HIR) has important clinical significance,while interleukin-6 (IL-6) is closely related to HIR and it plays an important role in the signaling pathway between downstream signal transducer and activator of transcription 3 (STAT3).IL-6 has been considered to be a typical proinflammatory cytokine.Activation of the gpl30 homodimer by IL-6 leads to the initiation of Janus kinase (JAK)-STAT path-way that is often constitutively switched on in inflammatory diseases.However,a plethora of studies in the last decade showed that only signaling via the soluble IL-6R (trans-signaling) accounts for the deleterious effects of IL-6,whereas the signaling via the membrane-bound receptor (classic signaling) is essential for the regenerative and anti-inflammatory effects of IL-6.In this paper,the latest progresses in the research field of the IL-6/STAT3 signaling pathway in HIR is discussed.

BACKGROUNDHepatic alveolar echinococcosis (AE) is a parasitic disease in humans and caused by the Echinococcus multilocularis (Em). Orthotopic liver transplantation (OLT) may be the only effective treatment for end-stage hepatic AE. However, in some AE patients, extrahepatic Em can not be completely eliminated after OLT. We aimed to study whether the immunological changes caused by Em evasion may influence the rejective response.

METHODSRat modles of AE were established by injecting the Em suspension into abdomen of Brown Norway (BN) rats. Three months later, in the experimental group, the liver was transplanted from Lewis (LEW) rats to Em-infected BN rats. In the control group, transplantation was from LEW rats to healthy BN rats. Liver tissue and peripheral blood (PB) samples were collected on days 1, 3, 5, and 7 after OLT. Liver tissue was analyzed after hematoxylin and eosin (H&E) staining; numbers of CD4, CD8, and CD28 on peripheral blood cells were detected by flow cytometry; and expression of the chemokine fractalkine (Fkn) was detected by reverse transcription PCR (RT-PCR). Interleukin-10 (IL-10) was measured in the serum by enzyme-linked immunosorbent assay (ELISA). In every group, eight BN rats were retained for observing survival time.

RESULTSThe survival times of recipients in the experimental group were prolonged compared with those in the control group. The rejective response occurred later and was milder in the experimental group. percentage of CD4, CD8, CD28 T-cells and Fkn mRNA expression were lower in the experimental group. While the serum IL-10 levels were higher in the experimental group than those in the control group.

CONCLUSIONSAcute rejective response after OLT was attenuated in the rats with Em infection, and the recipients` survival time was prolonged. Em may play a role in this process by elevating IL-10 secretion, decreasing the effector T cells, inhibiting the expression of Fkn, which lead to reduce the inflammatory cells infiltration into the liver.

Animals ; CD28 Antigens ; metabolism ; CD4-Positive T-Lymphocytes ; metabolism ; CD8-Positive T-Lymphocytes ; metabolism ; Echinococcosis, Hepatic ; mortality ; surgery ; therapy ; Echinococcus multilocularis ; pathogenicity ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Graft Rejection ; immunology ; Interleukin-10 ; blood ; Liver Transplantation ; adverse effects ; Rats ; Reverse Transcriptase Polymerase Chain Reaction

Objective:To explore the application value of digital technology in free transfer of ALTPF to repair large-area soft tissue defect of limbs.Methods:A total of 13 patients with large-area soft tissue defects of limbs treated from April 2017 to April 2020 were selected in the study, including 9 males and 4 females, aged 39-58 years old. The average age was (42.75±1.94) years old. The area of flap was 16 cm×10 cm-27 cm×18 cm. Before operation, CTA was performed on the donor and recipient areas, and the 3-dimensional image of arterial blood supply in the donor area was obtained by 3-dimensional digital reconstruction technology of CT angiography, so as to clarify the origin, course, classification, length vascular pedicle, of diameter and location of perforating fulcrum of the blood supply of ALTPF. According to the image parameters 3-dimensional, of the defect of the recipient area was reconstructed and designed with Mimics software, and the 3-dimensional digital designed flap was used accurately and standardized during the operation.Results:All the 13 flaps survived without a vascular crisis. The patients entered the follow-up for 6 to 24(mean 16) months by outpatient clinic visits combined with WeChat reviews. At the last follow-up, the surviving flaps had soft texture and good blood supply, the shape and colour of the flap were basically the same as those of normal skin. The limb function recovered well. According to Chinese Medical Association Upper Limb Function Evaluation (TAM) method and Maryland ankle function evaluation method: 8 cases were in excellent, 3 cases were in good and 2 cases were in fair.Conclusion:The preoperative application of digital technology to assist the reconstruction of large-area soft tissue defects of limbs with free ALTPF has high accuracy and standardisation. It improves the quality and success rate of free flap repair. This method is reliable, practical and with clinical value.

Objective:To compare internal fixation with 3 cannulated screws versus with an anteromedial support plate plus 3 cannulated screws using finite element analysis for unstable femoral neck fractures (Pauwels type Ⅲ).Methods:Recruited for this study was a 34-year-old male volunteer with a height of 173 cm and a weight of 75 kg. Continuous thin-layer helical CT was conducted to scan the segment from his hip joint to the middle shaft of his tibia. Digital medical software was used to establish three-dimensional models of the femur based on his femoral CT data. The digital femoral necks were dissected as necessary to simulate femoral neck fractures of Pauwels type Ⅲ. The fractures were fixated with 3 ordinary cannulated screws in a mode of inverted triangle (screw group) and with 3 ordinary cannulated screws in a mode of inverted triangle plus an anteromedial steel plate (screw-plate group). After the 2 groups of models were subjected to identical constraints and 3 kinds of load (slow walking, twisting and standing on one leg), they were compared in terms of distribution of Von Mises stress and deformation.Results:Under various loads in both groups, the maximum deformation occurred in the femoral head. In the condition of slow walking, the deformation in the screw-plate group was 1.97 mm, which was smaller than that in the screw group (2.26 mm). In the conditions of twisting and standing on one leg, similar deformations were observed in both groups. Under all kinds of load, the maximum stress occurred in the middle part of the bottom screw and the fracture line in all the models. In the screw group, the peak stresses were 318.09 MPa, 92.11 MPa and 147.21 MPa for conditions of slow walking, twisting and standing on one leg, greater than those in the screw-plate group (229.86 MPa, 86.94 MPa and 124.48 MPa).Conclusions:The cannulated screws plus an anteromedial support plate are a recommendable fixation method for young adults with unstable femoral neck fracture, because they can effectively share the stress on the cannulated screws, lead to better mechanical stability of the fracture ends than the fixation with merely 3 cannulated screws and effectively prevent shortening of the femoral neck.